Health systems strengthening with a focus on reproductive health

Programme description

Title: Health systems strengthening with a focus on reproductive health
Commissioned by: German Federal Ministry for Economic Cooperation and Development (BMZ)
Country: Malawi
Lead executing agency: Ministry of Health (MoH)
Overall term: 2009 to 2016

Malawi. Midwifery students at Nkhoma College of Nursing use the skills laboratory to improve child-birthing skills. © GIZ


Despite positive overall development, Malawi’s health sector still faces significant challenges. Figures released by the Ministry of Health in October 2014 showed a maternal mortality rate of 574 deaths per 100,000 live births and an infant mortality rate of 29 deaths per 1000 live births, still very high by international standards. One of the main reasons for this is a lack of access to essential health services of a sufficiently high quality.


The Malawian Ministry of Health, in co-operation with non-state actors, ensures effective and efficient health care services of satisfactory quality, with special consideration for the health of mothers and newborns.

Malawi. An outpatient waiting room at a typical Malawian health centre. The women are seeking medical care. © GIZ


The Malawi German Health Programme (MGHP) is aligned with the Malawi Health Sector Strategic Plan (2011 – 2016) and covers the following work areas:

  1. Access to health care services of satisfactory quality;
  2. Human Resource management and development;
  3. Partnerships with non-state actors.

GIZ is serving the goals of the programme by working closely with non-governmental and para-statal organisations, private-sector agencies, private companies, and educational institutions.

In the first area of activity, GIZ is collaborating with EPOS Health Management to assist the Ministry of Health at national level in setting up a secretariat to steer quality-assurance measures throughout the country. Advice is being provided at local and regional level to selected district hospitals and health centres to help them improve their quality management systems, thereby ensuring that health services meet national standards for reproductive health and infection prevention.

In the second area of activity, GIZ is working closely with the national Reproductive Health Directorate to set up a mentoring programme for midwives, nurses and clinical officers. Funding is also being provided for the further training of 70 clinical officers at the University of Malawi's College of Medicine.

A PPP unit is being set up at the Ministry of Health to create a statutory framework for partnerships between governmental and non-governmental actors. One of the key criteria of this framework is that the private sector be directly integrated into the partnerships as a provider of health services.


Significant progress has been achieved throughout Malawi as a result of the coordinated implementation of the agreed health strategy following the introduction of the sector-wide approach (SWAp) in the country's health sector in 2004. 89 per cent of women give birth in health care facilities and 96 per cent of women take advantage of antenatal care services. Because the MGHP is aligned with the Malawi Health Sector Strategic Plan (2011 – 2016), it also contributes to achieving targets on the cross-cutting issues of HIV/AIDS and gender equality.

With GIZ's help, strategies have been developed at national level for institutionalising a quality-management secretariat, setting up a health information management system, accrediting health care institutions, and establishing and implementing public-private partnerships. Accreditation plans are being implemented at six primary, secondary and tertiary health care institutions. By entering into a public-private partnership with the company Illovo Sugar Ltd., it has been possible to improve the quality of health care, access to clean drinking water and health education in the south of the country in cooperation with the private sector, a range of actors at district level, the government, and traditional authorities.

Malawi. Symon Mtambo coordinates Baylor's Teen Clubs in Malawi. Before the psychosocial activities begin, the children form a big circle to welcome new members.  © GIZ

The health administrations of the four target districts Balaka, Dedza, Mchinji and Ntcheu are also working with the management teams of the respective district hospitals to implement action plans for improving quality management and health information management. Collaboration with the mentoring programme for midwives and nurses is increasing the quality of clinical services in the field of maternal and infant health.