Malawi: Our Impact

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.

Community health workers in Malawi, with the mobile phones they are using to receive health information. {Photo credit: MSH.}Photo credit: MSH.

In the rural Salima district of Malawi, where the closest health facility is more than a day’s walk away, community-based health workers provide the first and often only line of care to families who need health services. While it is essential that these health workers remain up-to-date on current medical norms and knowledge, this proves challenging considering that most villages in Salima do not have electricity, let alone internet.Mobile phone technology has become a valued tool to connect rural health workers with the information they need.

As the international community gathered for the XIX International AIDS Conference last week, HIV & AIDS experts and key organizations voiced their support for a new approach to preventing mother-to-child transmission of HIV: Option B+. Option B+ calls for antiretroviral therapy (ART) for life for all HIV-positive pregnant women, regardless of CD4 levels.The government of Malawi, with the support of MSH, adapted the World Health Organization (WHO) guidelines on preventing mother-to-child transmission, to the needs of Malawi.

A Malawian woman receives a Depo-Provera injection through the CFPHS project. {Photo credit: MSH.}Photo credit: MSH.

Since 2007, the USAID-funded Community-based Family Planning and HIV & AIDS Services (CFPHS) project has partnered with the ministry of health and local organizations in Malawi to expand access to integrated family planning and HIV & AIDS services in rural areas through a network of community health workers.The CFPHS project, led by Management Sciences for Health (MSH), has had marked success, increasing contraceptive use from 20,000 to 39,000 couples in two years.A 2004 health survey in Malawi showed that the contraceptive method of choice for about 60 percent of married women was the

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