Organized Network of Services for Everyone's Health Activity

Project Overview

The Organized Network of Services for Everyone’s (ONSE) Health Activity, USAID/Malawi’s flagship program for health, supports the Government of Malawi in its efforts to reduce maternal, newborn, and child morbidity and mortality. ONSE targets major improvements in health through sustainable approaches and increased country ownership. The five-year project delivers a package of health interventions to strengthen the health system and bring maternal, newborn, and child health; family planning and reproductive health; malaria; nutrition; and water, sanitation, and hygiene services to 16 districts, reaching more than half of the country’s population with primary health care services.

Led by MSH, ONSE works alongside the Government of Malawi to strengthen the capacity of the health system, particularly at the community and district levels, to deliver high-quality health services along the continuum of care.

In the first three years of project implementation (November 2016–September 2019), ONSE achieved significant gains, including:

  • Providing operational and technical support to expand the reach of integrated family health outreach clinics, which is key to realizing Malawi's national health strategy. As of September 2019, 2,284 integrated family health outreach clinics have been held, reaching 437,363 Malawians with family planning, antenatal care, immunization, outpatient consultations for children under five, HIV testing services, growth monitoring and promotion, and other services. By September 2019, 19,804 children under five received full immunization services through integrated outreach clinics in the 16 ONSE districts.

  • Providing infrastructure and technical support to renovate select facilities to improve space for maternity wards and obstetric care in high-volume delivery sites and fill gaps in equipment for basic emergency and comprehensive emergency obstetric care. Where training is needed, ONSE builds provider skills in an integrated approach for routine delivery and newborn care, including chlorhexidine for cord care, Helping Babies Breathe, post-abortion care, Kangaroo Mother Care, and respectful maternity and newborn care.

  • Increasing the number of public health facilities offering maternal and newborn health services in 11 ONSE-supported districts from 40% in November 2016 to 86% in September 2019. During this time, 623,174 women giving birth received preventive treatment for hemorrhage (uterotonics) in the third stage of labor or immediately after birth, and 22,299 newborns not breathing at birth were resuscitated.

  • Offering child health services at 90% of health service delivery points at the community level through mentorship, supportive supervision, and supply chain support for integrated community case management for common childhood illnesses. Between November 2016 and September 2019, 901,729 cases of child diarrhea were treated with oral rehydration solution and/or zinc.

  • Enabling access to a full mix of contraceptive methods at service delivery points in the community and across public health facilities, generating 2,084,087 couple-years protection (CYP). Annual CYP achievements increased from 355,501 between November 2016 and September 2017 to 843,979 between October 2018 and September 2019.

  • Treating 96% of suspected malaria cases across 10 districts by either microscopy or rapid diagnostic test; 100% of confirmed malaria cases received first-line antimalarial medication. Nearly half of pregnant women (45%) received three or more doses of intermittent preventive treatment during antenatal care.

  • Providing more than 66,000 people with access to a basic drinking water source and nearly 29,000 people with access to a basic sanitation service through support to rehabilitate community water systems. As of September 2019, 324 boreholes at the community level have been rehabilitated, in addition to 12 boreholes across 12 health facilities. 

  • Supporting 11 facilities to enable more than 1.2 million Malawians ages 10–24 to access youth-friendly services, including condom promotion; HPV vaccine counseling, vaccination, and peer education; antenatal care deliveries, and postnatal care for youth; substance abuse services; HIV prevention, counseling, and testing services; sexual abuse counseling; and voluntary male circumcision.

  • Supporting 1,529 community health action groups with 32,460 members in all 16 districts. The groups explore health challenges, plan interventions that address them, and respond together with the greater community.

  • Supporting the establishment of 58 Champion Communities in all 16 districts to work with health authorities and local leaders to decide which health priorities to address and how best to mobilize communities. Through these community-level efforts, 448 women’s, girls’, and youth groups have been supported to facilitate their role as change agents in their communities.

  • Dispersing $1,591,808 in competitive grants to local civil society and nongovernmental organizations to address priority health issues, including the uptake of malaria services, strengthening civil participation, and promoting the adoption and use of basic sanitation facilities and services.

ONSE provides crucial health systems strengthening assistance, including support to district health and health facility managers for planning, leadership and management, governance, and advocacy. ONSE’s approach to communities demarcates an important change from purely mobilizing demand and changing behaviors to actively engaging with communities to enable them to identify and tackle their own health issues and hold the system accountable for maintaining the availability and quality of services. In collaboration with the Ministry of Health and Population, ONSE introduced and scaled up innovative interventions, tools, and approaches, such as a digital integrated supportive supervision toolkit and dashboard that provides decision makers immediate and actionable updates and facilitates more rapid follow up and resolution to issues facilities face. 


Project Team