A “how-to” guide on an innovative, community-driven advocacy approach that can be used to facilitate local-level implementation of national policies and strategies has been published by HP+. HP+ used this multisectoral approach to strengthen implementation of Malawi’s national youth-friendly health services strategy, developing and piloting the approach in Mangochi District. The guide is intended to enable policymakers, government institutions, implementing partners, and others to replicate, refine, and tailor the approach used by HP+ to strengthen community-level implementation of national policies and strategies. While the HP+ pilot focused on youth-friendly health services and the guide’s contents are presented in those terms, the approach can easily be applied to support local-level implementation of other national strategies.
In Malawi, HP+ launched an intergenerational mentoring activity to support emerging young leaders to engage village, district, and national stakeholders to deliver on the sexual and reproductive health and rights promises laid out in national policies. Connecting emerging young leaders with more experienced mentors in a structured advocacy mentoring program provides a unique opportunity to support young people to affect the institutions with which they work. In line with positive youth development methodologies, the purpose of such a mentoring program is to (1) provide one-on-one support to build the agency of young people to participate in decision-making processes and (2) cultivate their knowledge, leadership skills, and abilities to meaningfully participate and advocate for their priorities. This guide provides best practices in mentoring learned from the experience in Malawi.
Representatives from four district hospitals in Malawi where new nursing standards are being piloted came together this month to share experiences, challenges, and lessons learned. HP+ and the Nurses and Midwifery Council of Malawi (NMCM) developed new technical standards for nursing and midwifery practices for child and adult health, oncology care, and breastfeeding. The lack of specific standards for these key areas of practice has been an obstacle for nurses and midwives in delivering high-quality care and has prevented professional councils such as NMCM from assessing and assuring quality of care in service delivery. HP+ trained staff from NMCM and the Ministry of Health’s Quality Management Directorate as quality improvement coaches in rolling out the adult health standards in the four pilot sites. HP+ coached this team as members implemented the standards using a QI approach and facilitated the learning and review meeting. All four sites improved their compliance with the standards against the baseline assessment, despite having had only five months to adopt the concept, implement the standards, and undergo assessment. The pilot helped to identify gaps in the draft standards, which will now be revised, finalized, validated by the professional committee, and scaled up.
Guatemala and Malawi recently launched two university courses on policy modeling, data utilization, and demography and development created with HP+ support. Public Health and Demography, Reproductive Health and Nutrition at the School of Medicine of the Universidad San Carlos de Guatemala is an initiative of the Technical and Academic Commission led by USAC faculty in the School of Medicine, of which HEP+ has been a part since February 2021. HEP+ led the course's development by coordinating workshops and course approval and developed the course documentation and modules. Classes include Introduction to Public Health, Public Policy Framework, Demography and Development, and Reproductive Health and Development. In Malawi, HP+ developed the Policy Modeling curriculum at the University of Malawi’s Chancellor College alongside professors in the college’s Department of Population Studies, contributing models for policy planning such as Spectrum, DemDiv, and ImpactNow. The course, which was developed in 2019 and approved in 2021, will be mandatory for fourth-year demography students. In both courses, students will gain knowledge and skills in analyzing and communicating complex data for decision making, set policy goals, and use model results for policy analysis, implementation, and planning. These activities will prepare students to be effective public health policy influencers and practitioners.
Eight facilities that HP+ trained on the Baby Friendly Hospital Initiative (BFHI) from 2019-20 received accreditation as baby-friendly during the national launch of World Breastfeeding Week on July 30 in Lilongwe. Malawi Minister of Health and Population Khumbize Kandodo Chiponda recognized the facilities and encouraged health workers and service providers to continue to support women to breastfeed exclusively from birth until at least six months. In each facility, HP+ trained 80 percent of the clinical and support staff on the World Health Organization’s Baby-Friendly Hospital Initiative course. Community promoters are also trained to provide ongoing support to women to continue breastfeeding after they return home with their babies. HP+ provided ongoing coaching and mentorship as the facility staff prepared to undergo their external accreditation assessments by the Ministry of Health. HP+ has trained 12 facilities in Malawi on the BFHI program since 2018; all have now received accreditation.
Success stories are emerging from efforts to train Malawi youth in business management and entrepreneurship through HP+ and Palladium’s Feed the Future Agricultural Diversification project. The project is focused in Mangochi District, where several youth clubs have dramatically increased their profits. The Wake UP youth club doubled its revenue after the training, from MWK 400,000 ($ 497), at which level it had stagnated for the past four years, to MWK 800,000 ($994) in 2020. Mlambe Youth Club increased its investment in land for its green maize production from 2019 to 2020 and grew its revenue. The club now makes an average annual gross profit of more than MWK 1 million ($1,242). Through the youth clubs’ Village Savings and Loan programs, individuals have been borrowing start-up funds and launching their own successful businesses, such as selling tomatoes or fish. In addition to investing in expanding their businesses, the clubs also are putting their profits toward constructing youth corners, physical structures where youth can access family planning services and commodities. Other clubs are supporting needy students with school fees and bicycles and motorbikes to help youth from remote areas access youth friendly health services.
Sessions on presenting evidence and ideas on public financial management, the health impacts of COVID-19, and health insurance financing were among those delivered by HP+ researchers at this year’s International Health Economics Association (iHEA) online congress. Representatives from HP+ Kenya, Malawi, and Nigeria hosted an organized session on the need for a strong public financial management system and the challenges faced by many countries in delivering better spending in their journeys toward universal health coverage. HP+’s Rebecca Ross collaborated with the London School of Hygiene and Tropical Medicine to convene an organized session, presenting results from a mixed method study on the impact of Indonesia’s national health insurance scheme on the competitive landscape of public and private healthcare providers. View HP+’s sessions.
HIV services for men and boys are getting a boost in Malawi through the efforts of teen clubs and a church-based support group. With the support of HP+, the Evangelical Association of Malawi is reaching out to teens in Phalombe and Nkhotakota districts with psychosocial counseling, nutritional support, assistance with treatment adherence, and viral load monitoring. Since July 2020, the Faith and Communities Initiative effort has reached 662 men and boys and 82 teen members with nutritional support. The teen clubs have promoted access to early viral load testing among boys living with HIV at Kapiri Health Centre, where 148 members have accessed viral load monitoring services.
Malawi religious leaders are using dance to reach men and boys with messages of hope on HIV testing, treatment, and adherence. In May, the Quadria Muslim Association of Malawi (QMAM), with support from the U.S. President’s Emergency Plan for AIDS Relief and HP+, organized a dance event at Traditional Authority Chamba that attracted 2,500 people and distributed 197 HIV self-test kits. The traditional dances, called Zikiri dances, are performed as a competition by young men in praise of Allah. As part of their grant activities, QMAM integrated HIV messages of hope into their praise songs to help create demand for HIV services.
In a historic accomplishment, Malawi youth clubs supported by HP+ have banded together to form the first youth-led and youth-centered cooperative in Mangochi District. The cooperative will continue the individual businesses established by the clubs—beekeeping and the sale of honey—and the businesses’ support of local family planning initiatives. Such initiatives include revamping youth corners, buying bicycles and motorbikes to ferry youth to and from facilities, and supporting youth-friendly health services/family planning coordinators to conduct limited outreach. Members also hope to establish a facility separate from the hospital space where they now hold their regular meetings. The Thema Honey Youth Producers and Marketing Cooperative Society is one of only 12 in the district. To establish the cooperative, the individual clubs completed a required training facilitated by a multisectoral government team from central, district, and community levels and with financial and technical assistance provided by HP+. After the training, members applied to the Ministry of Trade and Industry for certification. Once certified, the cooperative will be eligible to access better markets for their honey as well as other government initiatives and opportunities.
After receiving an entrepreneurial training delivered jointly by HP+ and Feed the Future’s Agriculture Diversification Activity, participants from Nankumba Traditional Authority in the Mangochi district of Malawi used the curriculum and their own resources to orient other youth clubs on the topic. This raises the total number of youth clubs conducting social enterprises (such as bee keeping, maize farming, and goat farming) from the initial 15 clubs, two years ago when the training was first provided, to 29. Since a proportion of the profits from these businesses are invested in youth-friendly health services (YFHS), an increase in the number of clubs translates to an increase in YFHS investments. The vision of these clubs is to construct a youth resource center in their community through collective contributions, beyond the other investments currently being made. The youth resource center will serve as a separate space where FP information and some services can be provided, as the YFHS facility where youth currently access services is located within the local hospital and is quite small.
The Malawi Ministry of Health recently completed a detailed review of health programs and data in all five health zones. District health management teams and national and departmental representatives used these data to discuss progress on implementing the Health Sector Strategic Plan II. MoH Chief of Health Services Dr. Queen Dube praised the quality of the review: “We have noted major improvements in the quality of the analysis in the presentations; we now need to focus on the implementation of the action plans that have been developed.” The U.S. President’s Malaria Initiative and HP+ have been providing central-level health information systems support as well as ongoing training, tools and templates, and mentorship on routine data analysis to district data management focal persons and program coordinators. For additional background, view our brief.
Malawi is developing guidelines on how to sustain youth-friendly health services (YFHS) as evidence shows that the COVID-19 pandemic has drastically decreased the use of such care. The use of YFHS declined by approximately one-third in April/May of 2020 compared to the same period in 2019, according to two 2020 assessments on COVID-19 and YFHS. In response, HP+ Malawi is working with government and other stakeholders to develop National Guidelines for Sustaining Provision of Youth-Friendly Health Services amidst the COVID-19 Pandemic. The guidelines, which are being developed by a multisectoral group of stakeholders, are intended for both governmental and nongovernmental entities that offer health information and services to young people. They are a framework to hold implementers accountable for offering services during the pandemic as well as a way to empower communities and youth themselves to better understand their right to access health services despite COVID-19-related restrictions or access barriers. The government of Malawi is further discussing how to expand the scope of the guidelines to address public health emergencies beyond COVID-19.
Several local media outlets in Malawi have reported on evidence-based HIV programming implemented by faith-based organizations. HP+ is providing these organizations funding from the U.S. President’s Emergency Plan on AIDS Relief as well as technical and organizational development assistance. The project conducts outreach, provides counseling, and carries out advocacy around HIV, with a focus on reaching men and boys with messages of hope and information about HIV. The religious organizations are shifting social norms by reducing stigma and increasing acceptance of discussing HIV in faith settings. They are providing HIV self-test kits and linking individuals to health facilities to support them to know their status and, if positive, to start and stay on treatment. Media coverage of the role of faith communities in HIV programming in Malawi will increase awareness of the important role the faith community plays in the HIV response. This coverage is expected to increase local confidence in the ability of faith leaders to contribute to the HIV response, bolstering strong collaboration between faith communities and the health system.
HP+ and Feed the Future conducted a gender-focused leadership training for 15 youth leaders under age 30 from youth-led organizations in Malawi. The training used the Gender Action Learning System methodology, which empowers communities to articulate needs, envision change, and identify gender-equitable initiatives. Suited to communities with limited literacy and numeracy skills, it communicates abstract concepts such as gender sensitivity and isolates the roots of social norms. HP+ adapted the methodology to include positive youth development domains and policy. Participants demonstrate leadership growth by replicating the training and spearheading the development agenda of their organizations, communities, and districts. Participants are expected to implement what they learned in their communities. There are already results from the training. One youth leader secured an internship with the training partner and another facilitated a similar training in her community less than two weeks later. HP+, Feed the Future, and MERAMO Consulting will continue to monitor and offer technical support to the youth leaders as they cascade the methodology within their communities.
In March, HP+ convened and led a workshop that kicks off a six-month leadership development process in Malawi using the new model for building the capacity of health stewardship. The 23 participants are drawn from four districts and comprise district youth officers, family planning coordinators, youth development officers, youth-friendly health services coordinators, district nursing and midwifery officers. The curriculum combines in-person and virtual learning events with a virtual peer support group, a leadership assessment, one-on-one coaching and mentoring, and individual stewardship development plans that link leadership development daily professional responsibilities. Participants will be undergoing a leadership assessment in the coming weeks and begin preparing for a second learning event in June. This activity’s anticipated impact is a cohort of key actors in each of the select four districts with strengthened leadership and stewardship capacities to better address key challenges within the health system, with particular emphasis on family planning and youth-friendly health services.
HP+ has developed a guide on how to incorporate the priorities of Malawi’s national costed implementation plan for family planning into local district-level plans. The guide calls for a three-step approach to helping councils increase their awareness of national objectives and develop district-level plans based on the Costed Implementation Plan (CIP) for Family Planning (2016–2020). HP+ collaborated with the Ministry of Health’s Reproductive Health Directorate to facilitate implementation in several districts by establishing multisectoral task forces to facilitate the integration of priority plan activities into district implementation plans. One district, Machinga, allocated its own resources to implement family planning activities for two years in a row, while other district task forces directed available donor resources to family planning activities. The guide is intended to enable others to replicate and refine this approach beyond the life of the project. While the guide was developed for Malawi's health context, it could be adapted and used in other decentralized settings.
A Malawi youth is using skills acquired at a recent USAID-funded training to advocate for youth-friendly health services (YFHS) in his home district of Mwanza. He is one of 15 Malawi youth leaders HP+ trained in health budget advocacy with the goal of increasing young people’s engagement in health budget processes. After the training in November, the youth developed an advocacy action plan focused on increased budget allocations for YFHS and presented it to representatives of the Mwanza CSO Network in December. The CSO Network pledged its support, committing to engage a member of Parliament as a strategic partner to strengthen the advocacy community in Mwanza. HP+ will be monitoring the implementation of this action plan for the next nine months.
HP+ has helped the Malawi Ministry of Health relieve an acute and long-standing shortage of data management personnel. Health and local government ministries recently absorbed 327 facility data management staff, strengthening data management and improving the quality and use of data to develop health service delivery across all levels of care. The shortage stemmed from a recruitment freeze arising from expenditure restrictions and resulted in limited use of data to inform health sector decision making and data quality concerns. HP+ is helping the government hire and recruit an additional 397 data staff by 2022, a move that will increase data management staff levels to more than 100 percent from the 2016 level of around 25 percent, before HP+ helped develop and operationalize a plan to address the shortage.
Using skills gained in HP+-led training sessions, a Malawi sheik is among the 30 religious leaders active in their communities promoting HIV treatment and prevention. The two-day sessions in Dwangwa and Nkhotakota.in August 2020 focused on the promotion of HIV testing and counselling, HIV treatment services, and treatment adherence. Sheiks have been promoting these messages among their faith community, with a particular emphasis on reaching men and boys. Sheik Muhamad Abdul from Dwangwa’s main mosque has referred 30 men and boys for HIV testing and supported three people in restarting antiretroviral therapy (ART) after one year of discontinuing. The messages promote HIV testing, ART initiation and ART adherence. This work is being supported by PEPFAR’s Faith and Communities Initiative (FCI) and implemented by HP+ with six local faith organizations in Malawi.
The Malawian Ministry of Health in January officially endorsed and adopted the updated Respectful Maternity Care (RMC) Charter: The Universal Rights of Women and Newborns, which sets an international standard for the rights and services women and newborns should receive when seeking care. The charter was updated in 2019 by USAID, HP+ partner White Ribbon Alliance, and other partners to ground the charter in widely accepted international and regional human rights instruments. To advocate for adoption of the charter, WRA Malawi coordinated with key nursing and midwifery institutions including, the Directorate of Nursing and Midwifery Services and the Kamuzu College of Nursing to present, provide feedback on, and approve the updated charter. The effort was buoyed by the What Women Want campaign, whose survey had found the top priority among women and girls was respectful and dignified care. WRA Malawi also introduced and advocated for adoption of the charter with key decisionmakers, such as the Safe Motherhood Technical Working Group and the Reproductive Health Directorate and hosted the official launch event where the MOH officially endorsed and adopted the charter. The MOH and nursing and midwifery training institutions will translate the document into Chichewa and update their curricula to be in alignment with it. WRA will support the Reproductive Health Directorate in distributing the charter to all health facilities in Malawi and will begin introducing the charter to women and health workers.
HP+ partner the White Ribbon Alliance launched a documentary highlighting women’s and girls’ challenges in accessing reproductive and maternal health services through the lens of the What Women Want campaign, which mobilized over 84,000 women and girls in Malawi to voice their requests for high-quality reproductive and maternal health services and outcomes. The documentary has had a wide reach thus far, including a snippet being viewed as part of the September 2020 Partnership for Maternal, Newborn, and Child Health Accountability Breakfast opening video during the UN General Assembly. The documentary will continue to serve as an advocacy tool to advance efforts to meet women’s and girls’ health needs in Malawi.
In Malawi, youth clubs are thriving, enabling young people to continue to access youth-friendly health services (YFHS) during the COVID-19 pandemic. The 45 youth clubs in Mangochi, trained by HP+ and the USAID AgDiv Project in June 2019 on enterprise and entrepreneurship, have been mentored by an HP+-trained multisectoral ministry team and youth champion during the pandemic. They have invested approximately MWK 459,000 (US$611) in their respective centers, supporting the provision of YFHS and information on COVID-19 to youth throughout the region.
In Malawi’s Mangochi district, youth clubs are supporting the construction of a standalone building to house youth-friendly health services at Nankumba Health Center. Following a training on small-scale businesses conducted by HP+ and Ag Div in June 2019 and subsequent months of advocacy efforts, the youth clubs secured financial support from the community amounting to MWK 400,000 (approximately US$540) as well as commitments from local leaders to support the initiative. By building this separate facility—expected to serve up to 50 individuals by the end of 2021—the youth aim to provide a safe, private space for their local peers to access health services.
Health Policy Plus (HP+) marked World Contraception Day this year with a focus on the positive, a welcome distraction from the COVID-19 pandemic, by asking our colleagues and partners, “what about contraception puts a smile on your face?” With a reflection by family planning and reproductive health lead, Jay Gribble, and a photo collage featuring messages from around the world, HP+ demonstrates many reasons to smile as voluntary contraception and method choice continue to improves the lives of women and men, their families, and communities.
HP+ explores links between food insecurity, poverty, and poor health outcomes and the need to address underlying causes such as malnutrition with a multisectoral approach. In a new blog in its series, A Multisectoral Endeavor Called Health, co-authors Jay Gribble and Joni Waldron of USAID’s Feed the Future Ag Diversification Activity showcase efforts in Malawi where project design and implementation are linking agriculture to food security, economic growth, and health for long-term, sustainable change. Read the blog, “Reducing Malnutrition: A Multisectoral Approach to Addressing Underlying Causes.
In Malawi’s Chikwawa district, faith healers have been discouraging community members living with HIV from taking antiretroviral therapy (ART). Concerned that this may lead to ART defaults and increased death, religious mother body PECHANOMA facilitated a dialogue with other leaders in July, with HP+ support, to reinforce their role in emphasizing accurate messaging around HIV and COVID-19 and the importance of continuity in ART for people living with HIV. The leaders committed to continue disseminating accurate HIV messaging in their communities by holding meetings with religious and local leaders, disseminating radio and TV messages, and using mobile vans with loudspeaker systems.
With HP+ support, youth journalists in several districts in Malawi air weekly programs on community radio about topical health issues. Recently, Nkhotakota Radio youth reporters noticed that the number of pregnant adolescent girls getting HIV tests at the local district hospital had dropped significantly. In early June, the station aired a radio program urging pregnant teens to get tested for HIV. The District Health Office reported that in the two weeks following the broadcast, testing was higher than ever—about 40 pregnant girls had visited the facility to be tested. Said Nkhotakota District Hospital Nurse Chimwemwe Nyasulu, “This is what community radio is supposed to do.”
HP+ is supporting district-level youth-friendly health services (YFHS) reporting performance in Malawi by analyzing monthly District Health Information System 2 reports and providing technical support to health management information system officers and YFHS coordinators to improve timely and complete reporting. The district with the highest performance each quarter receives recognition; districts share best practices and lessons learned via a WhatsApp group. As a result of this emphasis on data quality and reporting, performance has steadily improved over time. Accurate and timely information about service utilization allows decision-makers at various levels to tailor programs and allocate resources to more effectively serve youth beneficiaries across Malawi.
In Malawi, district youth-friendly health services (YFHS) coordinators are using performance data to analyze YFHS uptake nationwide, sharing best practices and challenges encountered to improve program decision-making across all levels of the health system. Since 2018, HP+ has supported the Ministry of Health’s Central Monitoring and Evaluation Directorate to analyze district performance in reporting YFHS uptake and share these results with district-level coordinators via WhatsApp. As a result, the overall national reporting performance of the YFHS program has improved from 13 percent in 2018 to 72 percent as of March 2020, demonstrating strengthened capacity to submit complete, timely data critical to supporting informed decision-making.
A new blog by HP+’s Laura Brazee—Opening Doors: Mentoring for Effective Advocacy—was published by Knowledge SUCCESS. The blog shares insights from an intergenerational mentoring program for youth in Malawi. It demonstrates how engagement with mentors supports emerging young leaders to engage village, district, and national stakeholders to deliver on promises related to youth-friendly health services (YFHS) and strengthens advocacy for policies to end early marriage. Mentees were supported to build partnerships with youth networks and organizations to advance their advocacy work and connect to new stakeholders. View more Malawi-specific materials.
HP+ is strengthening relationships between communities of faith, health facilities, and district governments in Malawi to support the country’s HIV response. The project is supporting six Religious Mother Bodies (RMBs) to implement PEPFAR’s Faith and Community Initiative, which aims to rapidly increase the proportion of men and boys living with HIV to access testing and treatment. The RMBs and PEPFAR clinical partners are working together to establish how faith leaders and health facilities can coordinate to increase male access to services, including coordinating with eight district governments to establish working relationships and obtain buy-in and guidance on geographic targeting for their activities.
In March, following an HP+ policy advocacy training and ongoing mentorship, two student youth advocates at Malawi’s University of Livingstonia established a Sexual and Reproductive Health and Rights (SRHR) club on campus to provide information and referrals for students seeking to access contraceptives, counseling, HIV testing, and information on SRHR. The advocates are now seeking to establish a youth-friendly health services space at the university where students can access information, services, and referrals to the closest hospital and mobile clinic. There are currently 700 students attending Livingstonia University and 64 have expressed interest in joining the SRHR network.
In Malawi, youth trained in policy communication have successfully advocated for policy changes at the district level. The training, facilitated by HP+ in coordination with partner Population Reference Bureau (PRB) in July 2019, resulted in the creation of policy advocacy plans by youth advocates. Recent follow-up by PRB revealed multiple successes in the implementation of these plans, including implementation of a differentiated care model for antiretroviral therapy service delivery, expanded clinic hours to target youth, and inclusion of youth leaders in local decision-making committees and district structures. These policy changes improve youth access to health services and family planning information, contributing to improved health outcomes across Malawi.
In Malawi, cervical cancer data management and program monitoring systems are generating crucial data to be used in decision making at national and district levels. With technical support from HP+, the Ministry of Health and Population’s Cervical Cancer Task Force developed quality assurance standard operating procedures, guidelines, and data tools, and trained health workers on how to screen for and treat cervical cancer. The tools have been integrated into the country’s health information system to support evidence-based decision making. Over 180 health facilities have received screening and treatment equipment, and linkages and referrals for specialized treatment and care have been strengthened as a result.
Early results from districts in Malawi where hospitals have been accredited as baby-friendly (BFHI) have revealed great success: on average, in the nine hospitals HP+ has trained, early initiation of breastfeeding increased from 43 to 75 percent. In Dedza, exclusive breastfeeding contributed to a reduction in neonatal deaths from 24 to 13 percent over six months. Learning from prior experience, HP+ adapted the BFHI program to train hospitals sequentially. The revised approach provides immediate feedback and ongoing mentorship and ensures that at least 80 percent of clinical staff are trained in each facility, as well as support staff and community mentors.
FDH Bank of Malawi was awarded the first-ever Positive Youth Development Award at the annual Marketing Excellence Awards by Malawi’s only association of professional marketers. The award, recognizing the bank for excellence in developmental and social services targeting young people ages 10-35, was recently introduced as a new award by Chartered Institute of Marketing (CIM Malawi). The award aims at mobilizing the private sector to support implementation of the country’s National Youth Friendly Health Services Strategy in order to improve youth empowerment and access to health services through strengthened public-private partnerships. At the awarding ceremony, private sector attendees expressed enthusiasm about the introduction of the youth award category, which is expected to stimulate the private sector to invest more in youth related interventions as the companies compete to win in coming years. This all comes as a result of HP+ support to the Ministry of Health to prioritize and promote youth friendly health services.
Malawi reached a key milestone in decentralization of the health sector at the end of 2019 with the establishment of district-level condom coordination committees to enhance distribution and access in all 28 districts. The District Condom Coordination Committees (DCCCs), oversight groups with clearly defined roles and responsibilities for accountability, were outlined as a priority in Malawi’s National Condom Strategy (2015-2020), which was developed with USAID support. Initially, HP+ helped to establish the coordinating committees in five priority districts and shared the approach with PSI to reach an additional three districts. HP+ scaled it up further in two more districts and then leveraged funding from UNFPA through the Family Planning Association of Malawi to set up committees in the remaining 18 districts to establish a Comprehensive Condom Program in every district. During the set-up process, HP+ oriented district staff and community partners on reporting tools for the community and facilities to improve distribution and prevent stockouts. Malawi’s National Condom Strategy was launched in 2017 by the Ministry of Health and Population’s Department of HIV/AIDS to improve availability of and access to male and female condoms and condom compatible commodities, for the purpose of preventing unintended pregnancies, HIV, and other sexually transmitted infections. Read local coverage
HP+ recently launched Growing Together: Multisectoral Investments in Malawi’s Youth, an ENGAGE multimedia presentation that describes how investments in young people’s health, education, employment opportunities, and participation in governance can create a window of opportunity for accelerated economic development. The presentation was developed with the guidance of a multidisciplinary taskforce chaired by Malawi’s Ministry of Health and included youth leaders and representatives from government and civil society. The presentation was utilized by UNFPA to launch their event “Road to Nairobi for the ICPD” on World Population Day 2019, and stakeholders across sectors will continue to use the resource in their call for increased cross-sectoral investments in Malawi’s young people.
The Economic Association of Malawi (ECAMA), an independent association of economists, committed in early November 2019, to the management of population growth and investments in youth and articulated the importance of policies that support job creation as key in harnessing Malawi’s demographic dividend. At their annual meeting, ECAMA members published a resolution detailing 10 steps that will improve human development. Health Policy Plus provided evidence from RAPID to support the Ministry of Health and Population’s planning team make a case for the integration of population in planning. HP+ technical advisor of family planning, Julius Chingwalu participated as a discussant on the population and development panel.
Since 2011, Malawi’s HIV clinical guidelines have recommended that providers proactively offer family planning to all clients at each ART visit to ensure no missed opportunity to support PLHIV’s reproductive intentions. This approach, called Provider-Initiated Family Planning (PFIP), calls for condoms and injectables to be available at the ART clinic, and referrals for other methods as needed. In 2015, the USAID-funded Health Policy Project assessed the extent of PFIP implementation in Malawi by collecting data at 41 health facilities (both public and NGO) through facility audits, provider interviews, client exit interviews, and mystery client visits. This study – discussed in a new article in Global Health Science and Practice Provider-Initiated Family Planning within HIV Services in Malawi: Did Policy Make It into Practice? – found that contrary to clinical protocols, only 14% of clients at the ART clinic reported being offered family planning during their visit that day. Furthermore, only 24% of providers had received training in FP-HIV integration, 21% had no family planning training at all, and only half of providers had information on where to refer clients for family planning. Only 24% of sites had both condoms and injectables on hand, and only 15% of ART clinics had a full range of FP available. Overwhelmingly most ART clients relied on condoms for FP, yet there was significant demand for family planning among the female ART clients, with about half wanting no more children. These findings suggest that although Malawi has been an early adopter of PFIP, this innovative policy is not being implemented in practice. The authors, Erin K. McGinn (Palladium) and Laili Irani (Population Council), conclude that the demand for integrated services and high unmet need for FP among PLHIV underscores the need for more focused efforts to fully implement PIFP in Malawi’s HIV services.
Malawi's population is one of the fastest-growing in Africa, placing great strain on its health system, environment, and economy—hindering the country's ability to meet its development goals. To address unmet need for family planning services and the needs of adolescent girls and young women at all levels, HP+ is coordinating across multiple sectors including engaging traditional and religious leaders and communities. Christian Connections for International Health (CCIH) published a story this week about a family in Malawi helped by the Evangelical Association of Malawi, under an HP+ supported activity. The account of a family receiving marriage and birth-spacing counseling after a family tragedy, demonstrates how engagement with community leaders on family planning messaging helped on family mend and achieve financial security.
Developing Radio Partners (DRP), has leveraged its HP+ work with PRB in Malawi to garner more funding that is significantly expanding the listening audience for a community radio project broadcasting messages about youth-friendly health services. With HP+ support, DRP has trained and mentored teams of teenagers over the past two years to produce weekly programs that are aired by community radio stations in three districts in Central and Southern Malawi. Last year, it added two more stations, raising the project’s audience to more than 3 million. Building on the success, DRP has received $30,000 from the Conservation, Food & Health Foundation, based in Boston, to fund similar activities at two more stations through September 2019. Mzati Radio in Mulanje in southern Malawi and the Voice of Livingstonia in Mzuzu in the north were chosen in part because their listening areas have high rates of HIV, and early marriage is prevalent in Mzuzu. DRP is working with teams at the two new stations to produce weekly programs. This includes instruction on technical production as well as information about the National Youth-Friendly Health Services Strategy so the young journalists can accurately spread word via their radio programs to their peers about the services they are entitled to receive.
On January 25, at a meeting of parliamentarians convened by HP+ partner the White Ribbon Alliance for Safe Motherhood (WRA) Malawi, a representative from the Department of Human Resources Management and Development reported that 925 midwives were recruited and 303 midwives were promoted during fiscal year 2018/2019. This success—which goes even further than the government’s initial commitment to hiring 800 midwives—is in large part due to WRA Malawi’s Bedside Midwives report that highlighted a shortage of 20,000 midwives and has been a key advocacy tool since the campaign began in 2017. At the meeting, WRA Malawi praised the government’s progress to date and asked for continued support through approval of an increased budget to recruit, train, and retain more midwives, and the creation of a district-level nursing and midwifery pathway.
Two district hospitals in Malawi were recently certified as “baby-friendly,” meaning that they meet World Health Organization standards under the Baby-Friendly Hospital Initiative, bringing the total number of baby-friendly district hospitals in the country to seven. This achievement comes as Malawi is witnessing stagnating improvements in child survival rates. A baby-friendly hospital encourages and assists mothers to exclusively breastfeed until six months of age, which contributes to improving these survival rates. Since 2018, HP+ has been training, mentoring, and coaching district hospitals on exclusive breastfeeding. The Malawian Ministry of Health intends to achieve baby-friendly certification for all hospitals that provide maternity and antenatal care services; HP+ will continue to support these critical efforts to improve child survival rates in Malawi. Read more about recent progress.
A national youth conference on HIV/AIDS and sexual reproductive health and rights, organized by the National Youth Council of Malawi (NYCOM) and supported by the Global Fund, was held June 28, 2018, in Lilongwe. The conference provided a venue for youth, government, and civil society leaders to exchange best practices and recommendations in sexual and reproductive health, HIV, and other issues that impact youth under the theme is “Reflect and Act for Improved Youth Participation and Leadership.” USAID through the Health Policy Plus (HP+), supported the participation of five youth champions and five district Youth Friendly Health Services coordinators and held capacity building and leadership strengthening sessions for the youth leaders. As a result of advocacy led by youth at the conference, the U.S. Embassy revised its criteria for youth organization eligibility for PEPFAR’s Small Grants Program and NYCOM announced on July 1, 2018, its new board of directors, which until then had several vacancies in critical leadership positions.
On June 25, 2018, Malawi’s Ministry of Health approved the Monitoring and Evaluation Health Information Systems (MEHIS) Strategy 2018-2022. The purpose of the strategy is to provide a blueprint for the Ministry of Health to strengthen Malawi’s health information system, and to ensure that the system can generate and use high-quality data to monitor and evaluate the success of its Health Sector Strategic Plan II. USAID, through the Health Policy Plus (HP+) project, coordinated the development of the strategy, analyzing the implementation of Malawi’s previous health information systems strategy for key achievements, gaps, and lessons learned; facilitating workshops; and contributing to the writing and costing of the strategy. HP+ provided both technical inputs and financial support to the strategy development process, in collaboration with the Bloomberg Data for Health Initiative, the World Health Organization, U.S. Centers for Disease Control and Prevention, the Bill & Melinda Gates Foundation, the Kuunika Project, and Germany’s development agency GIZ. A monitoring and evaluation expert seconded by HP+ to the Ministry of Health’s Central Monitoring and Evaluation Division facilitated the efforts.
An article describing a University of North Carolina (UNC) study and co-authored by Health Policy Plus Malawi country director, Olive Mtema, was published this month in the International Journal of Gynecology & Obstetrics. The article, “Effect of family planning interventions on couple years of protection in Malawi,” features USAID-funded work by the Health Policy Project (HPP) to sensitize religious leaders and their congregations on the benefits of family planning, and address barriers to family planning related to religious beliefs. This work was part of the community mobilization and demand generation aspect of a package of services delivered to two intervention sites as part of a quasi-experimental study conducted by the University of North Carolina (UNC) Project-Malawi. The full package of interventions delivered to study sites included community mobilization and demand generation for family planning, and training and mentoring of health providers in LARC insertion. The study found that uptake of family planning methods, particularly long-acting reversible contraceptives (LARC), increased following implementation of the package of family planning interventions.
Two participants in the USAID-funded HP+ women leadership workshops held in Malawi — Nissily Mushani and Elizabeth Nailantei Kileku — are winners of the 120 under 40 award celebrating the next generation of family planning champions. In support of their nominations, HP+ shared voting information widely through an outreach campaign. Nissaly is a knowledge translation officer at the African Institute for Development and Policy and Elizabeth Nailantie Kileku is a nurse based in Kisumu, Kenya, working for the ministry of health. Winners will each receive $1,000 grant to continue their work in family planning or to jump start new initiatives. The award is organized by the Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, with sponsorship from Bayer.
Based on advocacy by HP+ partner White Ribbon Alliance Malawi, the Government of Malawi committed to train Health Advisory Committee members throughout the country on Respectful Maternity Care. The training aims to sensitize communities about the right to respectful maternity care and open an avenue for women to report issues of disrespect and abuse. The government has also committed to hiring 800 midwives, an important step in addressing the country’s critical shortage of midwives. Similarly, White Ribbon Alliance Zimbabwe conducted three Respectful Maternity Care trainings for all provincial and district nursing officers in Zimbabwe, including midwifery tutors and senior managers from the private sector. Among other materials, each participant was given a locally produced video showing women's experiences of maternity care that the nursing officers can use as an advocacy and education tool at their institutions. This advocacy led to Respectful Maternity Care being incorporated into the monitoring and evaluation criteria used to monitor maternity care in all of Zimbabwe’s health facilities.
This World Population Day, the USAID-funded Health Policy Plus project produced an online slideshow featuring responses to the question, "How can family planning investments help your country achieve the Sustainable Development Goals?" Olive Mtema, HP+ Malawi, responds: “Results from HP+’s DemDiv model estimate that Malawi’s per capita gross domestic product could increase from US$397 (2014) to US$2,148 by 2054 when family planning is included, turning Malawi into a middle-income country around the year 2040.” Responses from Ms. Olive and others are captured in a photo show, and in a blog by HP+ country directors from Malawi, Nigeria, and Pakistan.
The USAID-funded Health Policy Project (HP+) supported the “Midwives’ Voices, Midwives’ Realities” policy dialogue at the Wilson Center, in Washington, DC, on February 27th. The event featured Midwives Voices, Midwives Realities, a global survey conducted by the World Health Organization, International Confederation of Midwives, and White Ribbon Alliance. HP+’s work supporting comprehensive midwifery policy reforms was featured at the event, by Nancy Kamwendo, National Coordinator for HP+/White Ribbon Alliance, Malawi, who provided a country perspective on the broader global survey findings. HP+/White Ribbon Alliance Malawi recently conducted a “headcount” survey of Malawian midwives that found that only one-third the number of midwives previously thought to be in service are actively providing direct midwifery services. This headcount, highlighting the shortage of midwives needed to provide adequate pre and postnatal care, will inform policy-making decisions on midwifery. WRA Malawi and HP+ have shared the findings with the Ministry of Health, Parliament, citizens, and journalists. This advocacy campaign is paying off. Ministry officials have recently agreed to use the country-level survey data generated by the HP+/White Ribbon Alliance Malawi team to inform their health sector strategic planning process.
The Malawi Network of AIDS Service Organisations (MANASO) supported several of its member organizations and associate members in writing successful grant proposals, which will advance health budget advocacy work and training funded through the Tiltonse Fund (which receives funds from DIFD, the Royal Norwegian Embassy, and Irish Aid). The success of these proposals flows from a USAID-supported training conducted by HPP in 2015 for local civil society organizations; and through the use of Health Budget Advocacy: A Guide for Civil Society in Malawi, also created under HPP. Activities funded under these grants will help to further disseminate HPP’s guide, training, and knowledge to the local level.
USAID’s HP+ AOR team visited Malawi in August, meeting with Youth Net and Counseling (YONECO), a local NGO providing a range of HIV-related services for children, youth, and women. While at the YONECO Chinamwali drop-in center, HP+ and USAID staff members were able to see how the 2015–2010 Youth Friendly Health Services (YFHS) Strategy has been implemented since its development and launch in 2015. The National YFHS Strategy was developed with USAID support under the Health Policy Project, and advocates for investments in youth-friendly health services that will ultimately allow Malawi realize a demographic transition for accelerated economic growth. The strategy will ensure that young people complete their education, delay their sexual debut, make informed choices on their sexuality, and transition into healthy young adults as represented in the matrix; and it will reduce the number of children born and minimize HIV transmission.
An article published in the Pacific Standard (Malawi’s Secret Weapon Against HIV: Male Circumcision, September 8, 2016) highlights the impact of USAID's Voluntary Male Medical Circumcision modeling study conducted by the Health Policy Project. The study recommends that Malawi focus on recruiting men and boys between the ages of 10 and 34 and to prioritize urban areas. The recommendation led the government of Malawi to shift its VMMC focus with an aim to have 60 percent of males between the ages of 10 and 34 in 14 of Malawi’s 28 districts circumcised by 2025. If Malawi reaches this goal the study calculates a potential total savings of $344 million.
A recent survey conducted in Malawi by the USAID Health Policy Plus project’s partner, the White Ribbon Alliance, found a total of 3,420 bedside midwives serving an estimated population of 17.3 million people; it estimates the need for an additional 20,217 midwives. It is anticipated that increasing the number of midwives in Malawi will positively impact the country’s frequency of safe births. Safe motherhood coordinators from all districts used the survey findings to develop a factsheet on the current status of midwifery positions, which was presented as a guide for the director of nursing and midwifery services at the Ministry of Health.
The Government of Malawi adjusted its VMMC programming based on recommendations presented in a study authored by the USAID-supported Health Policy Plus project. The study models the impact and cost of focusing Malawi’s VMMC program by client age and geography. It recommends that Malawi focus on recruiting men and boys between the ages of 10 and 34 and to prioritize urban areas. In response to recommendations, the Government of Malawi is shifting its VMMC focus to aim to have 60 percent of males between the ages of 10 and 34 in 14 of Malawi’s 28 districts circumcised by 2025. If Malawi reaches this goal the study calculates a potential total savings of $344 million. The Health Policy Project’s study and its influence on programming in Malawi was featured in a Pacific Standard article on September 8, 2016 (Malawi’s Secret Weapon Against HIV: Male Circumcision).