Malawi: Our Impact

Erik Schouten

In 2011, Malawi implemented an ambitious and pioneering “test-and-treat” HIV strategy for pregnant and breastfeeding women, known as Option B+. Erik Schouten, MSH's Country Lead and Project Director of  the District Health System Strengthening and Quality Improvement for Service Delivery Project in Malawi, supported the roll-out of the program.

 {Photo credit: MSH staff}South SudanPhoto credit: MSH staff

UNICEF has comissioned MSH to develop a cost modeling tool and methodology that will help countries structure, plan, and finance integrated community health services. UNICEF, the United Nations Children's Fund, is a worldwide leader in promoting and supporting community health services as a key strategy to improve coverage of high-impact maternal, newborn, and child health interventions and reduce health inequities from pregnancy to adolescence and beyond.

 {Photo credit: Colin Gilmartin/MSH}A community health volunteer in Madagascar demonstrates how to provide Depo-Provera.Photo credit: Colin Gilmartin/MSH

Throughout sub-Saharan Africa, community health workers represent the foundation of the health system, addressing priority health areas ranging from maternal and newborn health to family planning and Ebola prevention. Not only do community health workers extend access to health services for the underserved and those living in hard-to-reach areas, they help countries accelerate certain health outcomes, and achieve the Sustainable Development Goals and related targets for universal health coverage.

MSH supported the roll-out in 2011 of an ambitious and pioneering public health program in Malawi known as Option B+, a test-and-treat strategy for pregnant and breastfeeding women. Under Option B+, all HIV-infected pregnant and breastfeeding women are provided with lifelong antiretroviral therapy (ART) regardless of their CD4 count or World Health Organization clinical stage.

 {Photo credit: Cindy Shiner/MSH}Geomack Banda, 21, has been studying at the Malawi College of Health Sciences in Lilongwe for a year as part of the training and bonding program.Photo credit: Cindy Shiner/MSH

Whether ill, pregnant, or simply needing to refill medication, many Malawians living in remote areas need to walk for several hours to reach a health facility. When they arrive, they might find it poorly stocked, inadequately staffed, or even closed. Hard-to-reach facilities are often difficult to staff because young people have limited opportunities for training as health workers, poor access to markets and other resources, and little chance to participate in meetings and other activities.

The online research section of the Bulletin of the World Health Organization (WHO) published the results of a cross-sectional survey aiming to document the prevalence of multidrug resistance among people newly diagnosed with, and those retreated for, tuberculosis (TB) in Malawi.

 {Photo credit: MSH}Staff at the new HTC site in Bvumbwe Prison test an inmate for HIV.Photo credit: MSH

In 2012, the US Centers for Disease Control and Prevention (CDC) initiated a program designed to improve the quality, access, and coverage of health services related to HIV in seven districts of Malawi. The Service Delivery Quality Improvement and Health Systems Strengthening project, led by Management Sciences for Health (MSH), works with local stakeholders to this end, including improving HIV prevention and care at prisons in these seven districts.

 {Photo credit: Zina Jarrah/MSH, Tanzania.}A community health worker takes blood to check for malaria.Photo credit: Zina Jarrah/MSH, Tanzania.

Diarrhea, malaria, and pneumonia are leading causes of child mortality, accounting for nearly 44 percent of deaths among children under five worldwide.

Ummuro Adano

Donors, national governments, civil society, and international partners are grappling with three realities in the domain of HIV and AIDS today: (1) the need to accelerate country ownership and leadership of HIV and AIDS programming; (2) diminishing donor resources; and (3) the need to strengthen local implementing organizations and institutions to sustain the AIDS response in terms of: access to prevention, treatment, care, and support services; addressing stigma, discrimination and human rights abuses that key populations continue to face in many parts of the world; and supporting orphan

Erik Schouten presents data on Option B+ in Malawi. {Photo credit: Sara Holtz/MSH.}Photo credit: Sara Holtz/MSH.

A Conversation with Dr Erik SchoutenWhen considering which public health intervention is best for a country or region for prevention of mother-to-child transmission (PMTCT) of HIV, the World Health Organization (WHO) provides a set of guidelines that provide options for various settings.

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