Country Spotlight: Malawi
Our Work in Malawi
Building on 10 years of technical support to the MOH, EGPAF’s Malawi program fills a critical technical assistance role, providing training, mentoring, and supportive supervision to health workers and coordinators at the site and district levels. In partnership with the Malawi MOH, the United States Agency for International Development (USAID), the President's Emergency Plan for AIDS Relief (PEPFAR), ViiV Healthcare, Partnerships in Hope and Lilongwe Medical Relief Fund Trust the program now focuses its efforts on:
- Health systems strengthening through building facility and staff capacity for health service planning and provision
- Promotion of integrated service approaches to improve service efficiency and patient outcomes
- Quality improvement through comprehensive data use
- Training to ensure use of state-of-the-art technical knowledge and practices
- Improving access to comprehensive PMTCT and pediatric care services
- Capacity building of local Community Based Organizations (CBOs) to ensure local ownership in addressing the HIV/AIDS epidemic in Malawi
- Reducing HIV-related stigma and increasing community involvement
EGPAF is dedicated to advancing research that leads to improvements in HIV/AIDS prevention, care, and treatment service delivery. EGPAF's Malawi program works toward achieving this goal through engaging in research activities aimed at:
- Increasing program efficacy and efficiency
- Improving service uptake and integration of health services
EGPAF is a global advocate for policies that address the needs of women, children, and families living with and affected by HIV and AIDS. Working in close collaboration with the MOH and other partners, EGPAF is:
- Supporting MOH in national HIV policies and programmatic scale-up
- Ensuring a sustainable approach to service delivery support
As of March 31, 2013, EGPAF-supported programs in Malawi have:
- Tested more than 544,000 pregnant women for HIV.
- Provided more than 753,000 women with PMTCT services.
- Provided more than 39,000 HIV-positive pregnant women and more than 30,000 HIV-exposed infants with lifesaving antiretroviral drugs to prevent transmission of HIV from mother to child.
Key Projects in Malawi
District Service Delivery, Quality Improvement, and Health Systems Program (CDC/PEPFAR: 2012-2017)
Funded by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), this five-year project seeks to strengthen district-level capacity and systems to ensure the provision of high quality service delivery through the following objectives:
- Improved district level planning financial management, implementation, and monitoring;
- Improved review, analysis, and use of data;
- Strengthened human resources for health;
- Strengthened health systems activities infrastructure at district and facility levels;
- Improved quality of Service Delivery;
- Scale-up of comprehensive services through direct support HIV prevention, care and treatment will be the focus, but the program also will strengthen services for sexually transmitted infections (STI), tuberculosis, malaria, and select elements of reproductive health/maternal and child health as part of the Malawian essential health package. The project will be implemented in seven districts in the central and northern zones of the country.
Expediting Access to Antiretroviral Treatment for More Infants and Young Children in Malawi (ViiV Healthcare: 2010-2013)
With funding from ViiV Healthcare, this project is focused on improving and expediting access to testing, care, and antiretroviral treatment (ART) for infants and young children in Malawi. The project has the following two objectives:
• Objective 1: Improve access in five existing pilot sites in Dedza, Ntcheu, and Lilongwe districts with a focus on better understanding of key gaps and testing of potential solutions.
• Objective 2: Increase access to early infant diagnosis and treatment services through scale-up of pilot program in additional high volume sites in two new districts (Salima and Nkhotakota Districts).
The project has been critically important to EGPAF’s efforts to pilot, monitor, and evaluate innovative approaches to improving access to early infant diagnosis and treatment (EIDT). These include initiating interventions to fill key gaps in testing, care, and treatment for infants and young children (IYC), as well as the identification and monitoring of key indicators at ViiV-supported pilot sites in order to ascertain improvements in HIV testing and treatment initiation among exposed IYC in light of our ViiV-supported activities.
In addition, the project has resulted in significant rate increases for patients testing for HIV and receiving their results, both key early infant diagnosis indicators for Malawi. A total of 32% of infants who tested HIV-positive using DNA-PCR received their results within eight weeks of testing (an important increase from our baseline of 8%). Facilities also saw a five-fold increase in HIV-positive infants under a year old who were initiated on ART (10% at baseline compared to 53% at the end of year one).
Community-Based Organization Technical Assistance Approach (ViiV Healthcare: 2011-2012)
Through funding provided by ViiV’s Positive Action for Children Fund (PACF), this project seeks to provide technical assistance capacity building to six community-based organizations in Malawi. Guided by the self-identified needs included in the small grant proposals provided by the community-based organizations (CBOs), EGPAF has developed a blended, pragmatic, and participatory approach that seeks to provide these CBOs with the tools and skills to better plan, manage, and implement their PACF-funded projects. This approach includes conducting baseline assessments to identify technical support needs, as well as group workshops to cover organizational development topics including workplan development, financial management, and monitoring and evaluation. The workshops will be followed by technical assistance outreach to the CBOs to enhance their ability to identify and address various implementation challenges, and to monitor progress using the developed work plans. Outreach visits include the completion of progress reports to monitor progress, identify continued challenges, and take corrective action. In 2013 EGPAF also will facilitate exchanges across the CBOs. This project is implemented in coordination and with input from EGPAF/Kenya, which has extensive experience working with CBOs. Of note, the CBOs are selected and funded directly by ViiV, with EGPAF in a support and advisory role.
Extending Quality Improvement for HIV/AIDS in Malawi (USAID/Partners In Hope: 2010-2013)
EQUIP-Malawi is a PEPFAR-funded project with a goal of strengthening the capacity of health care systems in central Malawi to deliver HIV/AIDS care by improving the continuum of HIV care, the quality and efficiency of care, and workforce training and development, and to evaluate the delivery of this care system to serve as a model for scale-up across Malawi. In partnership with Partners in Hope, the EQUIP-Malawi project capitalizes on the partners' existing networks, infrastructure, and acquired expertise, and has three complementary objectives:
- Strengthening the continuum of HIV care among various health services, facilities, and communities;
- Developing training and mentoring programs to improve workforce capacity and quality of care;
- Creating a consortium of sites for operational research to improve the quality of HIV care and training The EQUIP project began as a support to Christian Health Association of Malawi (CHAM) facilities, and now includes public sector facilities in the central and northern regions of the country.
Safeguard the Family Project (Lilongwe Medical Fund Trust Relief) (USAID/LMRFT: 2011-2014)
The USAID/PEPFAR-funded Lilongwe Relief Fund Trust of Malawi (LMRFT), in collaboration with several other partners including EGPAF, is implementing the Safeguard the Family Project, which is aimed at decreasing mother-to-child transmission of HIV and reducing maternal and infant mortality. Situated in the central region of Malawi, which currently includes 99 clinics and about one-quarter of the country’s population, or 3.8 million people, the project incorporates testing for HIV and syphilis, a prevention, treatment and referral program for mothers who test HIV-positive, partner involvement and support group programs, recruitment of traditional birth attendants, and distribution of water purification packets, insecticide-treated bed nets, and infant food supplements. The objectives of the project include:
- Building the capacity of district health offices and service providers in PMTCT/ART and early infant diagnosis (EID) service delivery;
- Increase uptake and quality of integrated prevention of mother-to-child transmission of HIV (PMTCT) and EID service delivery in supported sites;
- Strengthen monitoring and evaluation system in supported sites
During the project, EGPAF is providing training, mentorship, and supportive supervision at government health facilities to support the scale-up of PMTCT services. We also are providing technical assistance to LMRFT, helping to build their capacity to manage U.S. Government funding and to increase their accountability for program activities and targets.
A Secondary Analysis of Retention Across the PMTCT Cascade in Selected Countries Implementing the Various Guidelines. Kenya: Option A; Swaziland: Option A; Rwanda: Option B; Malawi: Option B+ (USAID/Population Council: 2011-2014)
This PEPFAR-funded HIVCORE study is a retrospective cohort analysis of mother-infant pair retention in prevention of mother-to-child transmission of HIV (PMTCT) services from antenatal clinic through 18 months postpartum in four selected EGPAF-supported country programs that are implementing Option A, Option B, or Option B+ for PMTCT. The study is being conducted in selected urban, semi-urban, and rural facilities in Malawi, Rwanda, Kenya, and Swaziland. The primary objectives of the study are to determine:
- What are the levels of retention 30 days after entry into the PMTCT program, at delivery, six weeks, two months (60 days), three months (90 days), six months, and 12 months post-delivery among women and infants on Option A and on Option B/B+?
- How do the levels of retention vary by facility characteristics such as type of facility, higher versus lower volume PMTCT facility, rural/urban facility, and presence and type of follow-up (active/passive) among women and infants on Option A and on Option B/B+?
- How do the levels of retention vary by demographic and clinical characteristics among women and infants on Option A and on Option B/B+?
- What are the most modifiable characteristics associated with retention in Option A and in Option B/B+ sites?
In Malawi, the study will include 500 mother-infant pairs from 10 sites in Lilongwe, Dedza, and Ntcheu districts.
Call to Action (USAID/PEPFAR: 2002-2010)
Call to Action (USAID/PEPFAR: 2002–2010) EGPAF has been working in Malawi under the USAID/PEPFAR-funded Call to Action Project since 2002. EGPAF, in collaboration with local partners, initiated one of Malawi’s first programs to provide prevention of mother-to-child transmission (PMTCT) services. By 2010, EGPAF had assisted the Malawi Ministry of Health (MOH) in establishing PMTCT service provision at 42 antenatal care (ANC) sites and expand to provide direct technical support to 91 PMTCT sites in three districts, providing more than 203,000 pregnant women with counseling and testing services and approaching 100% antiretroviral (ARV) uptake among HIV-positive pregnant women. Efforts to scale up infant ARV provision have reached 71% of HIV-exposed infants at supported sites over the life of the project. The project also supported a number of innovative programs to reduce stigma and provide psychosocial support to people living with HIV. These include:
- Training mother mentors and peer educators to encourage women to deliver at facilities and to bring their infants to health facilities to receive ARV prophylaxis;
- Establishing peer-led support groups for HIV-positive mothers for lactation and psychosocial support;
- Facilitating a pilot program to provide clean water kits and supplemental food to weaned HIV-exposed infants attending well-child clinics;
- Targeting male partners of pregnant women for counseling and testing through the “Male Championship” program at ANC sites; the “Male Championship” model resulted in improved rates of male partner testing by almost 10 times, from 1,284 men in 2008 to 11,106 men in 2009
A hallmark of EGPAF/Malawi’s program has been in building MOH capacity to deliver PMTCT services in several maternal and neonatal child health (MNCH) sectors. EGPAF and its partners have made a significant impact in this area, having trained over 2,100 nurses, coordinators, midwives, and Health Surveillance Assistants in PMTCT service delivery since the program’s inception.
Reaching More in Need: PMTCT Enhancement through Expanded Implementation and Operations Research (Bill and Melinda Gates Foundation: 2006-2011)
The Bill and Melinda Gates Foundation funded this project that was designed to expand access to prevention of mother-to-child transmission of HIV (PMTCT) services in 10 countries, including Malawi, allowing EGPAF to fill critical gaps, ensuring continued service delivery in resource-limited countries, and leveraging other donor resources to increase access to PMTCT services. Notably, EGPAF reached 1,008,268 pregnant women with HIV testing during the original grant period – far exceeding the goal of 300,000 pregnant women. Under this project, EGPAF:
- Provided support and technical assistance to host country governments to strengthen commitment to scale up PMTCT service;
- Trained thousands of government personnel at the site, district, and provincial levels to build health care worker capacity to provide HIV services;
- Strengthened integration with other essential services;
- Improved linkages to care and treatment. In Malawi, the project:
- Developed, pre-tested and revised a PMTCT capacity assessment tool, collecting data from 50 PMTCT sites in Dedza and Ntcheu districts in close collaboration with the Ministry of Health (MOH), district health officers and coordinators;
- Increased uptake of PMTCT in EGPAF-supported sites;
- Increased women receiving combination ARV regimens;
- Supported the efforts of the Lilongwe District Health Office to provide quality PMTCT services at all 42 antenatal care (ANC) facilities;
- Built the capacity of district and zonal level PMTCT coordinators to plan, monitor, and manage PMTCT quality improvement and scale-up through coordination and implementation of the zonal mentorship program;
- Conducted refresher training for PMTCT providers on combination regimens, early infant diagnosis (EID), adherence support, and monitoring and evaluation (M&E);
- Worked in collaboration with the MOH to develop national PMTCT M&E tools such as the mother’s health passport and ANC and Maternity registers
The Prevention of Mother-to-Child Transmission of HIV (PMTCT) Partnership (Johnson & Johnson: 2009-2012)
EGPAF, in partnership with Johnson and Johnson (J&J), worked in Malawi, Cameroon, and India to improve coverage and quality of prevention of mother-to-child transmission of HIV (PMTCT) services. The partnership also supported global health leadership in the PMTCT field by replicating and documenting best practices, and by supporting national governments to adapt and implement the revised World Health Organization (WHO) recommendations for PMTCT and infant feeding, which will optimize PMTCT programming. In 2009, EGPAF/Malawi began providing district-level technical support to the neighboring Dedza and Ntcheu districts in close collaboration with District Health Officers, while continuing to support Lilongwe district through the EGPAF-LMRFT partnership. Over the course of the project, EGPAF has worked to:
- Expand support to 95 sites in three districts, assess those districts’ overall PMTCT delivery capacity, and work with district MOH leadership to address key issues identified in the assessments;
- Strengthen capacity, as well as directly advise the Ministry of Health on PMTCT policy;
- Share expertise as a member of the National PMTCT Working Group;
- Provide supportive supervision and technical support to partners and service providing sites;
- Support an innovative zonal mentorship program
Country adaptation of the 2010 World Health Organization recommendations for the prevention of mother-to-child transmission of HIV: Download PDF
Using Data to Understand and Address Gaps in the Treatment Cascade for HIV-Positive Infants and Young Children: Experiences from Lesotho, Malawi, and Swaziland: Download PDF