Background: Community health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of a CHW programme. In this study, we evaluated expan...ding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC).
Methods: We conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20–40 households for monthly (or more frequent) visits.
Findings: The intervention resulted in a decrease of approximately 20% in the rate of patients defaulting from chronic NCD care each month (−0.8 percentage points (pp) (95% credible interval: −2.5 to 0.5)) while maintaining the already low default rates for HIV patients (0.0 pp, 95% CI: −0.6 to 0.5). First trimester ANC attendance increased by approximately 30% (6.5pp (−0.3, 15.8)) and paediatric malnutrition case finding declined by 10% (−0.6 per 1000 (95% CI −2.5 to 0.8)). There were no changes in TB programme outcomes, potentially due to data challenges.
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This curriculum was designed to train newly recruited health care workers (HCW) in the basic knowledge and skills needed to improve different HIV services within the health facility including identification, linkage, retention and support. In addition to HIV basics, the training has supplementary un...its focused on PMTCT, psychosocial support, opportunistic infections, tuberculosis and HIV, nutrition and family planning in order to give a more well-rounded and comprehensive training of related topics.
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The third Malawi Growth and Development Strategy (MGDS III) has been formulated following the expiry of its predecessor strategy, MGDS II, in June 2016. The strategy has been prepared at a time when Malawi has been experiencing multiple shocks including floods, drought and financial crises. While fo...od production improved in 2017, the cycle of food deficit and surplus has kept the country preoccupied with fighting disasters instead of pursuing its development agenda. It is for this reason that the theme of the MGDS III is "Building a Productive, Competitive and Resilient Nation". With this theme, the Government of Malawi undertakes to support Malawi's development into a productive nation competing on the global stage while ensuring that the nation builds systems that deal with natural shocks and disasters.
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Evidence shows that oral pre-exposure prophylaxis (PrEP) reduces the risk of contracting HIV during sexual intercourse by more than 90% when taken daily. It is for this reason the National HIV Prevention Strategy 2015-2020 (2018 Revision) emphasises the role of preexposure prophylaxis (PrEP) in ...reducing new HIV infections in Malawi.
The Ministry of Health has prioritised PrEP use among the populations most at-risk of HIV infection in Malawi: young women ages 10 to 24 years, sero-discordant couples, female sex workers, men who have sex with men, and other priority populations (such as members of the uniformed services, prisoners, and mobile populations).
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This new Policy aims at ensuring that evidence-based, highimpact nutrition interventions are developed and implemented at scale. The Policy will be implemented in line with the overarching National Development Strategy, which considers nutrition as one of the priority area under the social developme...nt thematic area.
The Policy is aligned with the Scaling Up Nutrition movement, global declarations and commitments, which Malawi is signatory such as the Sustainable Development Goals and the World Health Assembly targets. The Government of Malawi is indebted to all the people and institutions that were involved in reviewing the Policy. Special appreciation goes to the World Bank, Canadian International Development Agency, United States Agency for International Development – through the Food and Nutrition Technical Assistance III Project, and the United Nations organisations for their financial and technical support.
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Despite progress in improving antiretroviral therapy (ART) for people with HIV in Malawi, the burden of HIV infections and HIV treatment outcomes among key populations is suboptimal. Client-centered differentiated service delivery approaches may facilitate addressing HIV prevention and treatment nee...ds of key populations in Malawi.
Methods
De-identified program data routinely collected as part of the LINKAGES project–Malawi were assembled from October 2017 to September 2019. HIV case finding was compared across different testing modalities for each population. Poisson regression was used to estimate the association between testing modalities and ART initiation.
Results
Of the 18 397 people included in analyses, 10 627 (58%) were female sex workers (FSWs), 2219 (12%) were men who have sex with men (MSM), and 4970 (27%) were clients of FSWs. HIV case finding varied by modality and population, with index testing and enhanced peer outreach demonstrating high yield despite reaching relatively few individuals. FSWs who tested positive through risk network referral testing were more likely to initiate ART within 30 days compared with those who tested positive through clinic-based testing (adjusted risk ratio [aRR], 1.50; 95% CI, 1.23–1.82). For MSM, index testing (aRR, 1.45; 95% CI, 1.06–2.00) and testing through a drop-in center (aRR, 1.82; 95% CI, 1.19–2.78) were associated with 30-day ART initiation.
Conclusions
These data suggest that differentiated HIV testing and outreach approaches tailored to the needs of different key populations may facilitate improved ART initiation in Malawi. Achieving 0 new infections by 2030 suggests the need to adapt treatment strategies given individual and structural barriers to treatment for key populations with HIV in high-prevalence settings.
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A poster advertising oral rehydration salts (ORS) and zinc, part of the SHOPS mass media campaign in Ghana, was distributed widely to pharmacies and over‐the‐counter medicine sellers to improve caregivers’ and providers’ awareness of the new diarrhea treatment protocols for children under 5.
The Country Cooperation Strategy is the World Health Organization (WHO)’s reference for country work guiding planning and resource allocation through alignment with national health priorities and harmonization with other development partners. It clarifies roles and functions of WHO in supporting t...he national strategic plan for health through the Sector-Wide Approach and Malawi Growth and Development Strategy II. The Country Cooperation Strategy is based on a systematic assessment of the recent national achievements, emerging health needs,
challenges, government policies and expectations. An evaluation of the previous CCS was conducted and jointly discussed with the Ministry of Health as well as other key stakeholders. This process led to the identification of the, achievements, challenges and shortfalls of the previous CCS. Through this process the areas where WHO needed to focus on were also identified. The CCS development has also been done in parallel with the formulation of the new Health Sector Strategic Plan (HSSP) to ensure that there is a linkage between the two.
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The coronavirus outbreak that began in 2019 (COVID-19) threatens to reverse years of hard-won gains in preventing and treating HIV. Fragile health systems are further stressed as health workers navigate an increased client load and demands at work while also being concerned for their own health and ...that of their families. Health facilities have been redesigned to care for patients with COVID-19, posing challenges to other services. Governments and civil society organizations have redirected scarce resources and shifted programming priorities to respond to the pandemic. Several countries have reported intermittent declines in HIV testing and diagnosis, antenatal care visits, collection of antiretroviral medicines (ARVs) by people living with HIV, and attendance at clinic appointments. Community-based education and support programmes have had to rapidly adapt to restrictions on movement and public gatherings. Children, adolescents, and women have experienced multiple deprivations due to the adverse impact of the pandemic.
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PEPFAR Malawi’s Country Operational Plan 2022 (COP22) embodies joint priorities from national and subnational dialogues building on the 2020-2025 National Strategic Plan for HIV/AIDS. The interagency team has developed a person-centered, district-tailored and Malawi Population-Based HIV Impact Ass...essment (MPHIA)-informed strategy through extensive engagement with Government of Malawi (GoM) and Civil Society Organizations (CSOs) to sustain HIV epidemic control. At the end of COP21, PEPFAR Malawi was commended for contributing to reaching epidemic control in strong collaboration with GoM and stakeholders including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). This includes enrollment of 88% of recipients of care on three or more months of antiretroviral treatment (ART), better outcomes for Malawian children through remarkable efforts in Orphans and Vulnerable Children (OVC) programming and progress made towards reaching men with more intentional and focused programming.
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This document defines the framework for Malawi’s National HIV Programs. Considering public health benefits and risks, as well as funding and resource implications, deviations from these guidelines are not supported by the Ministry of Health.
The third Malawi Growth and Development Strategy (MGDS III) has been formulated following the expire of its predecessor strategy, MGDS II, in June 2016. The strategy has been prepared at a time when Malawi has been experiencing multiple shocks including floods, drought and financial crises. While fo...od production improved in 2017, the cycle of food deficit and surplus has kept the country preoccupied with fighting disasters instead of pursuing its development agenda. It is for this reason that the theme of the MGDS III is "Building a Productive, Competitive and Resilient Nation". With this nation competing on the global stage while ensuring that the nation builds systems that deal with natural shocks and disasters.
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This country snapshot provides an overview of national data relating to sexual and reproductive health and rights (SRHR) throughout the life course. Realization of SRHR requires provision of comprehensive, people-centred services, that address the different elements of SRHR, and which are supported ...by an enabling environment, quality health systems, and meaningful community engagement. Multiple, synergistic cross-linkages exist within and between the different SRHR elements, leading to sequential outcome benefits throughout the life course.
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As our world changes, so too does the burden of disease. Globalisation, evolving trade and consumption patterns, and increased access to life-saving medical care are just some of the factors that have transformed the global health landscape.
Malawi is a landlocked country with a surface area of 118,484 km2. Administratively, the country is divided into three regions, namely the Northern, Central and Southern regions. The country has 28 districts, which are further divided into traditional authorities (TA) ruled by chiefs. The TAs are su...b-divided into villages, which form the smallest administrative units. The Village Development Committees (VDCs) under the TAs are responsible for development activities. Politically, each district is divided into constituencies that are represented by Members of Parliament (MPs) in the National Assembly for purposes of legislations. Constituencies are further divided into wards which are represented by a ward councillor at district assembly.
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In Malawi, the national Social Cash Transfer Programme provides unconditional monthly cash payments to the most vulnerable and ultra-poor households.
Malawi is a small and beautiful country in south-central Africa. It is divided into three administrative regions: south, central and north. The regions are further subdivided into 28 districts. The Southern Region is the most densely populated, while the Northern Region is the least populated.
The Social Cash Transfer Programme (SCTP)—locally known in Chichewa as Mtukula Pakhomo—is a non-conditional critical safety net for the most vulnerable, ultra-poor Malawians. By providing monthly cash transfers to over 1.3 million people annually, this programme helps ultra-poor families to meet... their basic needs and build resilience, with the ultimate goal of building human capital and moving them out of poverty.
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There has been a rapid expansion of cash-based, social protection programmes in sub-Saharan Africa (SSA) in recent years as Governments increasingly realise the enormous benefits cash transfers offer (World Bank, 2018). In fact, as an investment in human capital and inclusive economic development, ...social protection is arguably one of the most efficient uses of Government resources and “one of the smartest investments that policymakers can support” (Cummins, 2021).
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