The Health Foundation is an independent charity working to continuously improve the quality of heatlhcare in the UK

Improving Healthcare Quality in Malawi (MaiKhanda)

In brief

Our work in Malawi – the MaiKhanda programme – ran from 2006 to 2013. It aimed to reduce by 30% the number of maternal and neonatal deaths in the Lilongwe, Kasungu and Salima districts of Malawi, working within the strategy already established by the Malawi Ministry of Health’s roadmap for maternal health. We are funding the programme until 2015 to embed the approach into the Malawi healthcare system.

MaiKhanda – which means ‘mother and baby’ in Chichewa – was led on the ground by the Institute for Healthcare Improvement, working in partnership with Women and Children First, and also working with the Institute of Child Health at University College London (now the Institute for Global Health) who we commissioned to undertake an independent evaluation of the programme.

MaiKhanda worked with 11 hospitals and 32 health centres to improve obstetric services. At the same time, it used a community mobilisation approach to educate and empower women through 729 women’s groups.

We believe that this dual approach – first, to ensure that clinical facilities are of a higher quality and second, to ensure that the people who live in these districts have the knowledge and confidence to use those facilities most effectively – was critical.  

The work of the programme was underpinned by the well-established ‘Three delays’ model (delays in the decision to seek care, delay in getting to the place of care, and delay in delivering care).

We hope to secure a legacy of durable improvements in maternal and neonatal healthcare, working with district health systems to sustain improvements in clinical care, data monitoring and community mobilisation.

Are you still funding Malawi now, even with the suspected corruption in their health care system?
Thank you for your comment. It is a complex issue but we believe we have robust systems in place to monitor and manage the funds we send to Malawi. We believe that women and their newborns have a right to quality healthcare which is why we are continuing to support this important work.
Just a thought that, would be an ideal to improve transport systems in order to reach people in remote areas and also make sure the aid is getting to the right people.
Whilst we understand that transport is key to enabling people to access services, this is not the focus of our work in Malawi.
I am Dr.HASHEM GHANE a General practitioner with a bout 16 years at service at ER WARD of Dr.Behesti hospital and out patients clinic
As my Study and Researches the Best way to decrease of incidence and complication's ARE Increase health knowledge of populations and Patients Education By any medical provider
Our Foundation is newly registered charitable organization with the ultimate aim and objectives of improving the lives of vulnerable women and children. Surveys were done some time back and strategic paper was designed but no supports as yet which can facilitate the implementation of the said plans.As a new organization how can you help to implement this strategic plans for women and children?
Thank you for your comment. I will email you separately about your enquiry.
Where does the Health Foundation get its funding in order to support this MaiKhanda programme in Malawi?
The Health Foundation was set up with a large endowment. It uses the income from the endowment for all of it's activities and grant-making. The funding for the Maikhanda programme has now ended.
What were the main motivations/reasons for funding the MaiKhanda programme? Also, in terms of the two main approaches to the programme - community mobilisation and improving the quality of healthcare, why were these different methods chosen?
Thank you for your enquiry.

From 2001 to 2005, the Health Foundation invested around £1m each year supporting projects to improve health in the developing world. In 2004, the Board decided that work in the developing world should be more closely aligned with the Foundation’s work in the UK. It was agreed that the Foundation should develop a programme of work that would focus on improving the quality and performance of healthcare systems in East Africa.

The Board gave approval to the proposed aims of a new programme entitled Quality Improvement in East Africa. The Health Foundation narrowed the intent to a focus upon maternal and child health.

Our research at the time indicated that Malawi was one of the poorer countries in sub-Saharan Africa with 39% of the population living below the poverty line.

It had high population growth. At baseline, the evaluation found a MMR of 336 deaths per 100,000 live births in Malawi. The rate in developed countries is 9 deaths per 100,000 live births.

Maternal complications in labour carry a high risk of neonatal death, and poverty is strongly associated with an increased risk. 99% of maternal deaths occur in developing countries. In sub-Saharan Africa the lifetime risk of maternal death is 1 in 16; for developed nations this is 1 in 2,800.

In 2005 Malawi developed a Road Map8 to accelerate the attainment of the Millennium Development Goals related to maternal and newborn health. This aligned with our decision to focus on the improvement of maternal and child health in East Africa.

The programme’s aims were determined to be the reduction of maternal and neonatal mortality. It was decided that programme delivery should be undertaken through a consortium of organisations put together specifically for this purpose by the Foundation, so as to benefit from the expertise and experience of the organisations already working in the field.

The programme set out to support development work simultaneously in the community and the relevant health services in order to contribute to increased capacity in the country for the continuation of the improvement activity and for national and local measurement of maternal and neonatal mortality and morbidity in the longer term.

The Health Foundation learned a lot from this programme but currently has no plans for further work outside of the UK.
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