Malawi has one of the world’s highest rates of maternal deaths during childbirth. Recent figures from the Malawi Demographic and Health Survey show that 984 mothers die for every 100,000 live births and that 27 babies die for every 1,000 births. Furthermore, nearly half of all deliveries (44%) occur outside of healthcare facilities, making it difficult to provide timely and effective treatment when complications occur during childbirth.
In March 2006, The Health Foundation launched a £2.7 million, six-year programme dedicated to improving the quality of healthcare for babies and mothers in Malawi. An international consortium of leading experts was formed to work alongside local healthcare professionals and the Malawi government.
We have chosen to invest in Malawi as there is an urgent need to improve the quality of care for mothers and babies and because Malawi already demonstrates a clear and impressive commitment to improving the quality of its health services. From the extensive groundwork undertaken, it is evident that our investment and areas of expertise will complement and enhance existing government efforts to address maternal and infant mortality.
What are we doing?
We are taking a two-pronged approach of both supporting government efforts to improve care inside hospitals and providing support directly to village communities, empowering and educating local people to improve care for pregnant women and newborn babies. We are also working with the Malawi government on a national audit of births and deaths so that health officials can monitor improvements and identify areas where enhanced work is needed.
If successful, this scheme could make a substantial contribution to achieving one of the UN’s Millennium Development Goals, namely to reduce the under-five mortality rate by two thirds between 1990 and 2015 across the globe.
The Health Foundation has partnered with two organisations to plan and carry out the work in Malawi. These were selected on the basis of their diverse and complementary expertise and their existing experience of working in Malawi.
The organisations are:
- The Institute of Healthcare Improvement (IHI)
- Women and Children First (WCF).
The IHI is providing the programme’s expertise in the area of quality improvement of maternal and neonatal health services within hospitals and clinics. WCF is responsible for setting up and managing the community-based side of the programme including the women’s group activities. In addition, IHI is responsible for the overall programme management, financial management and grant management functions on behalf of the consortium.
The consortium is carrying out work in three districts in Malawi: Lilongwe, Salima and Kazungu. These districts are home to approximately two million people.
Three core areas of activity have been identified:
- improving the quality of health facilities provided in hospitals and clinics
- working with women’s groups in the community to improve care for mothers and babies at home
- developing sustainable systems for measuring maternal and neonatal mortality rates outside of hospitals and clinics.
The programme will feed into and support the government’s existing strategy to reduce maternal and neonatal morbidity and mortality and will work closely with the Ministry of Health’s Safe Motherhood Taskforce and Quality Assessment Task Force to ensure that it becomes an integral part of existing government efforts to improve the quality of care.
Professor Anthony Costello at the Institute of Child Health, University College London, is leading an evaluation team who will monitor the progress of the three year programme. The aim of the evaluation is to assess whether the programme has led to a reduction in maternal and neonatal mortality and morbidity and to identify factors associated with its success.
The Health Foundation remains committed to reviewing its investment in Malawi and will make a decision about extending the programme after three years. Irrespective of this, an integral focus of the programme is to ensure that any improvements seen are sustainable and embedded into long term practice.
References
- Malawi Ministry of Health. Emergency Obstetric Care Services in Malawi, Report of a Nationwide Assessment. Lilongwe, July 2005.
- National Statistics Office Malawi and ORC Macro. Malawi Demographic and Health Survey 2000. Zomba, Malawi and Calverton, Maryland, USA, 2001. McCoy, D., Ashwood-Smith, H., Ratsma, E., Kemp, J., Rowson, M. Going from bad to worse: Malawi’s maternal mortality. Durban: Health Systems Trust and Global Equity Gauge Alliance, November 2004.
