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Malawi

HP+ More recent Malawi publications are available.

  • The demographic dividend is an important opportunity for economic development that arises through population change. As fertility rates fall and the share of working-age adults rises, the dividend can boost economic growth and productivity, raising incomes and allowing families and governments to invest more in the health, education, and well-being of future generations. There is the potential for a dividend in Malawi based on demographic trends such as its age structure and dependency ratio. To open the window of opportunity and achieve a demographic dividend, sustained and integrated investments in demographic, economic, and social policies and programs are required beginning today.

  • This USAID-funded Health Policy Project analysis summarizes how one strategy— reducing the unmet need for family planning in line with Malawi’s FP2020 goals—can make achieving and sustaining the MDGs more affordable in Malawi, in addition to directly contributing to the goals of reducing child mortality and improving maternal health. Calculations show that for every dollar invested in family planning between 2013 and 2025, the government of Malawi could save five dollars in other social services such as education, immunization, malaria, maternal health, and water and sanitation.

  • In 2007, WHO recommended that voluntary medical male circumcision (VMMC) should be scaled up in priority countries with high HIV prevalence and low male circumcision (MC) prevalence. UNAIDS estimated that 3.2 million males had undergone VMMC by the end of 2012. Implementation experience has raised questions about the need to refocus VMMC programs on specific subpopulations for the greatest epidemiological impact and programmatic effectiveness. As Malawi prepared its National Operational Plan for VMMC, it sought to examine impacts of targeting subpopulations by age and subnational region. The Health Policy Project, with funding from PEPFAR through USAID, applied the new DMPPT 2.0 model (see this poster  for model description) to study the impact of scaling up VMMC to different target populations disaggregated by age group and geographical subregions of Malawi. This poster was presented at the 20th International AIDS Conference in Melbourne, Australia, in July 2014.

  • Based on the UTETEZI Project curriculum, Advocacy for Improved Access to Services for MSM: A Workshop Curriculum for a Multi-Stakeholder Policy Advocacy Project, this advocacy for policy change guide is designed for use by MSM (men who have sex with men) groups, community-based organizations (CBOs), civil society organizations (CSOs), and individuals working in HIV and MSM health to help them advocate regionally, nationally, and locally for improved HIV and health-related MSM policies. In particular, this guide can serve as an important tool for CSOs working on MSM issues in hostile legal environments.

  • The Health Policy Project (HPP) helped countries achieve their health goals by building capacity for policy, advocacy, governance, and finance at multiple levels. The project developed global tools and best practices for policy work, promoted South-South sharing and collaboration, and carried out regional and country-specific policy initiatives. The files included in this zip document provide brief program overviews for each country highlighting key accomplishments. Individual briefs are available from the country pages.

  • Poster for the 2015 Population Association of America Conference summarizing results of the USAID-funded Health Policy Project paper, "Inconsistencies in the Total Fertility Rate and Contraceptive Prevalence Rate in Malawi."

  • HPP undertook a policy analysis to determine the level of FP-HIV integration that appears in national government policy documents and explored the extent to which the policies outline and address the integration of services. For the purpose of this review, we defined policies to include policies, strategies, guidelines, action plans, implementation plans, clinical and service delivery standards, and other similar documents.

    We retrieved 30 Government of Malawi policies, strategies, and guidelines on family planning, HIV and AIDS, and general health, of which 19 addressed the provision of FP and/or HIV/AIDS services or discussed integration. There was significant mention on the need to integrate FP services into HIV services, for example through ART clinics. The policy documents are well aligned, providing supplementary guidance and information, but the fact that various elements of integration of FP-HIV services are spread out across a dozen health documents likely results in a disjointed vision for FP-HIV integration in Malawi, as well as inconsistent implementation. Furthermore, although these documents mention multisectoral collaboration, either in the development of policies or the implementation of programs, specific details on how to increase and strengthen multisectoral collaboration efforts are unclear. Since the different policies use a variety of approaches to FP-HIV integration, the MOH may want to consider developing an implementation and monitoring plan that will outline the various elements of integration noted across all the policy documents and identify how they should be measured.

  • Family planning (FP) advocacy plays a key role in policy development. Despite a significant body of evidence-based advocacy promoting family planning, there are few systematic studies on decisionmakers’ opinions of such advocacy; how advocacy and evidence are used by decisionmakers; what types of evidence and advocacy are persuasive from the perspective of decisionmakers themselves; and how and why decisionmakers support FP policies. This USAID-funded Health Policy Project study was designed to address these issues. The findings draw from structured interviews in three countries: Ethiopia, Kenya, and Malawi.

  • Malawi is one of the fastest-growing countries in sub-Saharan Africa. The country’s population has more than tripled over the past 40 years, and is expected to triple again by 2040. This growth is undermining Malawi’s economic development, destroying its natural resources, and placing immense strain on social services such as health and education. Malawi’s population growth is fueled by high fertility, in combination with a lack of access to family planning services. Religious leaders in Malawi have a key role to play in addressing population and family planning issues.  The Health Policy Project worked in partnership with the Government of Malawi to engage religious leaders to become active partners in addressing these issues. With the project’s support, representatives from Malawi’s religious “mother bodies”—the Evangelical Association of Malawi (EAM), the Episcopal Conference of Malawi (ECM), the Malawi Council of Churches (MCC), the Muslim Association of Malawi (MAM), the Seventh Day Adventists (SDA), and the Qadria Muslim Association of Malawi (QMAM)—came together in an interfaith effort to draft this advocacy guide. Two versions of the guide were created, one for Muslim leaders and one for Christian leaders. These guides are intended to serve as tools to support religious leaders’ advocacy efforts on population and family planning. The guides were translated into the local Chichewa language to reach a wider audience of religious leaders.

  • Malawi is one of the fastest-growing countries in sub-Saharan Africa. The country’s population has more than tripled over the past 40 years, and is expected to triple again by 2040. This growth is undermining Malawi’s economic development, destroying its natural resources, and placing immense strain on social services such as health and education. Malawi’s population growth is fueled by high fertility, in combination with a lack of access to family planning services. Religious leaders in Malawi have a key role to play in addressing population and family planning issues.  The Health Policy Project worked in partnership with the Government of Malawi to engage religious leaders to become active partners in addressing these issues. With the project’s support, representatives from Malawi’s religious “mother bodies”—the Evangelical Association of Malawi (EAM), the Episcopal Conference of Malawi (ECM), the Malawi Council of Churches (MCC), the Muslim Association of Malawi (MAM), the Seventh Day Adventists (SDA), and the Qadria Muslim Association of Malawi (QMAM)—came together in an interfaith effort to draft this advocacy guide. Two versions of the guide were created, one for Muslim leaders and one for Christian leaders. These guides are intended to serve as tools to support religious leaders’ advocacy efforts on population and family planning. The guides were translated into the local Chichewa language to reach a wider audience of religious leaders.

  • In 2014, USAID requested the Health Policy Project (HPP) to undertake an assessment of the status and extent of FP-HIV integration in Malawi. Since integration at the policy level is important and the first step to a well-guided implementation of health service delivery (EngenderHealth, 2014), HPP undertook a policy analysis to determine the level of FP-HIV integration that appears in government policy documents and explored the extent to which the policies outline and address the integration of services. For the purpose of this review, we defined policies to include policies, strategies, guidelines, action plans, implementation plans, clinical and service delivery standards, and other similar documents. Other research components on the status of FP-HIV integration, including stakeholder interviews and a facility-level assessment, are documented in separate reports (forthcoming).

  • In order to better understand how FP-HIV integration is being implemented, HPP conducted a situational analysis of the policy and program environment by speaking to 48 national- and district-level stakeholders. The purpose of the interviews was to understand stakeholders’ perspectives on how integration of FP and HIV services as mentioned in the policies was being implemented and how integration of services could further be improved. The semistructured interviews covered various topics including institutional arrangements; processes for addressing integration within health systems such as human resources, commodities, infrastructure, and monitoring and reporting; financing mechanisms; integration within health facilities; the role of the private sector; and behavior change communication (BCC).

    Our findings cover stakeholder perspectives on the institutional arrangements at the national and district levels through which health services and programs are being implemented within the public sector. We further assessed opinions on the progress made in integrating FP and HIV services across the components of the health systems, such as trained healthcare workers, availability of commodities, facility structures to ensure integration, and joint monitoring and reporting. Stakeholders also described how FP and HIV services are currently being implemented in the majority of the facilities and shared some successful pilot programs of integration. This report also describes how information on FP and HIV is currently being addressed in BCC and mass media campaigns, highlights the role of the private sector in assisting to provide FP and HIV services, and also pays special attention to the progress made in reaching youth. 

  • The Health Policy Project (HPP), with support from USAID and in cooperation with national policymakers and advocates, undertook a systematic assessment to better understand and document the current policy environment, along with the challenges and opportunities Malawi faces in implementing more gender-responsive population and family planning policies. The assessment included both a desk review of current policies, and a series of key informant interviews that sought also to assess the role and impact of gender stewardship mechanisms on sexual and reproductive health-related policies and programs, and to document first-hand perspectives on policy implementation.

  • Among the many efforts of the Government of Malawi to prevent and respond to GBV, the Department of Gender Affairs from the Ministry of Gender, Children, Disability and Social Welfare currently is working to improve GBV data systems and data use. As a part of this effort, the USAID-funded Health Policy Project has conducted a literature review to help to contribute to a better-informed national GBV response through identification and synthesis of existing studies and key government documents on gender-based violence in Malawi.

    The literature review was conducted primarily using online search methods and then followed-up with collection of documents not available online by country partners as needed. The literature was conducted to help answer how, in Malawi: GBV is defined and measured and see whether or not definitions are comparable throughout the literature; look at the prevalence rates of the various forms of GBV and how they compare across data sources; find out what information is available on GBV among specific populations or in specific settings; what factors are associated with GBV; what the impact of GBV is; what information is available on interventions and effectiveness; and what the key government documents on GBV are and how they address the issue.

  • The Sub-Saharan Africa MSM Engagement (SAME) Tool was developed based on literature reviews and expert/technical inputs from the USAID- and PEPFAR-funded Health Policy Project (HPP), the Johns Hopkins School of Public Health, amfAR, African Men for Sexual Health and Rights (AMSHeR), and USAID. In collaboration with eight leading MSM organizations—one each from Rwanda, Malawi, Togo, Mozambique, Zambia, Tanzania, Ghana, and Cameroon—HPP and AMSHeR piloted the tool from April to June 2013, in both English and French. This poster summarizes the pilot study, and was presented at the 20th International AIDS Conference in July 2014.

  • This guide is intended to inform civil society organisations (CSOs) in Malawi on health budget advocacy, serving as an introduction and easy reference guide. The guide describes how health budgets are developed in Malawi at both the national and district levels, and suggests entry points through which advocates can seek to influence government health budgets.

    Content in this guide was adapted from the budget advocacy guide for civil society organisations in Tanzania, developed under the Health Policy Project’s predecessor project, the Health Policy Initiative.

  • Two commonly used measures of population policy effectiveness and family planning programs are the total fertility rate (TFR) and the contraceptive prevalence rate (CPR). Over the past 18 years in Malawi, CPR increased dramatically from 13 percent in 1992 to 46.1 percent in 2010 among reproductive-age women in union. Surprisingly, this dramatic increase in CPR resulted in only a modest decline in TFR from 6.7 to 5.7 births per woman in the same period. According to international correlations, the increase of 33 points in CPR would have lowered TFR by 2 births.

    This study, conducted by the USAID-funded Health Policy Project (HPP), uses available data from the Demographic and Health Surveys (DHS) to explore why the rise in CPR has not translated into significant reductions in TFR in Malawi. It employs the Proximate Determinants of Fertility Model developed by Bongaarts to estimate TFR at the national level, and urban and rural levels in 2000, 2004 and 2010. The observed (as calculated from DHS data) and estimated (as calculated by HPP) TFR values are compared and explanations of any differences are explored.

  • Over the past two years, the Health Policy Project (HPP) has been working with religious organizations (mother bodies) in Malawi to organize districtwide “Population Weekends.” The purpose of these weekends is for communities to hear about population and development issues, including family planning (FP), in their places of worship. In March and April 2015, HPP worked with the Institute of Public Opinion and Research (IPOR) to conduct public polling in two districts (Salima and Thyolo) to see if any insights could be gleaned to inform future design and implementation of FP programs. The findings in this brief are drawn from a survey of 754 respondents that took place in March 2015 (before implementation of population weekend activities).

  • At the request of the USAID Mission in Malawi, the USAID-funded Health Policy Project (HPP) undertook a comprehensive facility-based assessment to ascertain the extent to which FP services have been integrated into HIV services in Malawi through different integration models and across various types of facilities (public and non-profit private). The study was also designed to examine how the reproductive rights of people living with HIV (PLHIV) are being respected and addressed through approaches such as PIFP and access to method choice. Finally, the study aimed to identify any systems-level barriers to integration and provide practical recommendations for the Ministry of Health (MOH) and other stakeholders to improve FP-HIV integrated services in Malawi.

  • This presentation aims to raise awareness about the impact of rapid population growth on Malawi’s development. It includes projections of population growth from 2008 to 2040 based on two hypothetical population scenarios. One scenario assumes that women in Malawi will continue to have 5.7 children on average during their lifetime, while the other scenario assumes a gradual decline in fertility to three children per woman. The first scenario with continued high fertility shows the population growing from about 13 million people in 2008 to 38 million people in 2040. By contrast, the second scenario with lower fertility shows an increase from about 13 million people to 30 million. By 2040, Malawi would have over 8 million fewer people if women were to have three children instead of nearly six.

    These projections demonstrate the impact that rapid population growth can have on various sectors, such as education, health, agriculture and food security, environment and land use, and the labour force and employment.

  • This briefing book aims to raise awareness about the impact of population growth on Malawi's development. It includes projections of population growth from 2008 to 2040 based on two hypothetical population scenarios. One scenario assumes that women in Malawi will continue to have 5.7 children on average during their lifetime, while the other scenario assumes a gradual decline in fertility to 3 children per women. The first scenario with continued high fertility shows the population growing from about 13 million in 2008 to 38 million in 2040. By contrast, the second scenario with lower fertility shows an increase from about 13 million in 2008 to 30 million in 2040. By 2040, Malawi would have more than 8 million fewer people if women were to have three children instead of nearly six. 

    These projections demonstrate the impact that rapid population growth can have on various sectors, such as education, health, agriculture and food security, environment and land use, and the labor force and employment. In the case of education and health, a slower population growth rate results in less pressure on the government budget to provide free primary education and public health services. 

  • This 2-page briefer aims to raise awareness about the impact of rapid population growth on Malawi's development. 

  • The Government of Malawi recognizes that the health of young people is a component of public health, which is of concern in this country. However, lives of most young people continue to be threatened by a number of factors such as sexually transmitted infections including HIV and AIDS, teenage pregnancies, unsafe abortion complications, nutrition inadequacies, alcohol and drug abuse and mental health problems. This contributes significantly to the high mortality and morbidity rates in Malawi. The Ministry of Health through the Directorate of Reproductive Health and partners initiated the program evaluation of youth-friendly health services to assess the extent to which young people access the health services they need at various levels of care. The findings and recommendations from the evaluation stressed the need to have a robust adolescent and youth sexual and reproductive health strategy.

    This strategy, therefore, aims at giving direction and guidance to the implementation of SRH services for all young people countrywide, so as to achieve the highest possible level of quality integrated services.

  • Malawi's Ministry of Gender, Children, Disability and Social Welfare recognizes the breadth and seriousness of intimate partner violence and coordinates the national response to end this violence and strengthen support for survivors. To aid the ministry’s efforts, the Health Policy Project (funded by USAID and PEPFAR) reviewed research, program reports, and government documents to produce a profile of what is documented about intimate partner violence (and gender-based violence, more generally) in Malawi, how the problem has been handled to date, and where action is needed most urgently. The findings are the basis for this brief.

  • International health programs and donors throughout the world increasingly recognize the importance of promoting gender equality to improve health and development outcomes. International initiatives such as the Sustainable Development Goals include specific gender equality goals and targets. Yet, translating gender equality goals into action is challenging. Practical tools for integrating gender into health policies and programs are needed. The USAID-funded Health Policy Project (HPP) prepared this brief to provide policymakers, donors, and program managers with real examples of methods for promoting gender equality in family planning, maternal and child health, and gender-based violence policies and programs.

  • In sub-Saharan Africa (SSA), expected national fertility levels and country-level observations demonstrate repeated mismatches in magnitude and/or direction.Thus there is an unfulfilled demand for better explaining, understanding, and communicating how fertility changes. Accurately predicting fertility is critical for understanding how populations may be expected to change, and for managing expectations about the possible impacts of TFR-affecting policy levers. The USAID-funded Health Policy Project produced this poster for the 2015 Population Association of America conference to determine to what extent can the accuracy of predicting fertility in SSA using the proximate determinants framework be improved by implementing revisions, with emphasis on the contraception index.

  • This document is a report on the District Orientation meetings led by the Malawi Ministry of Gender, Children, Disability and Social Welfare (MoGCDSW) with support from the USAID-supported Health Policy Project. The orientation meetings were held to kick-start the implementation of the national Institutional Framework and the MoGCDSW Strategic Plan, in order to achieve the objectives of the Joint Sector Strategic Plan.

  • This report documents the process undertaken for the review and update of guidelines and standards for gender mainstreaming in Malawi, which was undertaken jointly by HPP and the Ministry of Gender, Children, Disability and Social Welfare. The report also documents the outcomes of this process.

  • About one-in-four Malawian women of reproductive age have an unmet need for family planning. The 2010 Demographic and Health Survey found that 26 percent of all births in the preceding five years had been unwanted and that an additional 19 percent were mistimed, indicating that nearly half of all women in Malawi are not adequately meeting their reproductive intentions. Unwanted and mistimed pregnancies contribute substantially to high maternal mortality and increase the strain on already limited resources for health, education, natural resources, and food security.

    With over 97 percent of Malawians belonging to an organized religion, faith leaders could be an important conduit of social change. In 2013, to support the Ministry of Economic Planning and Development’s strategy to raise awareness about population and development issues, HPP engaged  Malawi’s six major religious institutions (known locally as “mother bodies”)—the Episcopal Conference of Malawi, Evangelical Association of Malawi, Malawi Council of Churches, Muslim Association of Malawi, Seventh Day Adventists, and Quadria Muslim Association of Malawi—and their local faith leaders. HPP organized training and sensitization meetings with over 1000 faith leaders, to help them speak openly about population and family planning issues. After one year, Episcopal Conference of Malawi (ECM), the governing body of the Catholic Church in Malawi, decided they wanted to further institutionalize these activities and messages. They requested HPP’s assistance with drafting a booklet on family planning for use by Catholic marriage counselors. The booklet, which is available in both English and Chichewa, provides counselors with an introduction to population and development issues, as well as basic information on medical and natural family planning methods. 

  • Ministries of health (MOHs) are largely responsible for achieving the commitments that their national governments have made as part of the FP2020 initiative, which aims to enable 120 million more women and girls to use contraceptives by 2020. However, MOHs’ ability to meet FP2020 goals depends on the strength of their stewardship functions, including the support they generate from and collaboration with other actors and sectors.This brief describes four skills that parliamentarians can develop and strengthen to become more effective at lobbying for, demanding, and securing additional funding for FP. It is part of a series of three briefs produced by the USAID-funded Health Policy Project to provide guidance to MOH officials and members of parliament (MPs) on three different approaches to strengthen MOHs’ stewardship functions for FP2020. The other briefs in the series are Stewardship for FP2020 Goals: Working with the Private Sector, and Stewardship for FP2020 Goals: MOH Role in Improving FP Policy Implementation.

  • The  Malawi government  introduced  the  Youth  Friendly  Health  Services (YFHS) program in  2000 and  in  2007  the  Ministry of Health-Reproductive Health Directorate (MOH-RHD)  developed  Youth  Friendly  Health  Services Standards  with  the aim of providing  quality services  to young  people. In 2014, the MOH-RHD and the Centre for Social Research, University of Malawi, with assistance from the USAID-supported Evidence to Action project, conducted its first comprehensive evaluation of the YFHS program. The evaluation assessed the quality of YFHS compared to the existing national standards, in the context of the current sexual and reproductive health (SRH) needs of Malawian youth.  

    This brief summarizes the implementation of YFHS standards in Malawi and suggests key questions for policy makers and program managers to consider in order to improve YFHS in Malawi.

  • The  Malawi government  introduced  the  Youth  Friendly  Health  Services (YFHS) program in  2000 and  in  2007  the  Ministry of Health-Reproductive Health Directorate (MOH-RHD)  developed  Youth  Friendly  Health  Services Standards  with  the aim of providing  quality services  to young  people. In 2014, the MOH-RHD and the Centre for Social Research, University of Malawi, with assistance from the USAID-supported Evidence to Action project, conducted its first comprehensive evaluation of the YFHS program. The evaluation assessed the quality of YFHS compared to the existing national standards, in the context of the current sexual and reproductive health (SRH) needs of Malawian youth.  

    This brief summarizes data collected in 2013 by the E2A project, and lays out key questions for policy consideration.

  • The  Malawi government  introduced  the  Youth  Friendly  Health  Services (YFHS) program in  2000 and  in  2007  the  Ministry of Health-Reproductive Health Directorate (MOH-RHD)  developed  Youth  Friendly  Health  Services Standards  with  the aim of providing  quality services  to young  people. In 2014, the MOH-RHD and the Centre for Social Research, University of Malawi, with assistance from the USAID-supported Evidence to Action project, conducted its first comprehensive evaluation of the YFHS program. The evaluation assessed the quality of YFHS compared to the existing national standards, in the context of the current sexual and reproductive health (SRH) needs of Malawian youth.  

    This brief summarizes the sexual knowledge and behaviour of youth in Malawi and suggests key questions for policy makers and program managers to consider in order to improve YFHS in Malawi.