Malawi German Health Programme

Programme description

Title: Health System Strengthening with a focus on reproductive health
Commissioned by: German Federal Ministry for Economic Cooperation and Development (BMZ), co-financed by the Bill & Melinda Gates Foundation
Country: Malawi
Lead executing agency: Ministry of Health and Population
Overall term: 2017 to 2020

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Context

Malawi is one of the poorest countries in the world and its health sector is heavily underfunded. Even though maternal and neonatal mortality have fallen by more than half since 1990, 439 women still die for every 100,000 live births; twice the global average. 27 out of every 1,000 infants die within the first month; fifty per cent more than in the rest of the world. In Germany, the numbers are six and three. 

Current progress has been achieved by bringing mothers into health facilities. Now most deliveries are assisted by trained health workers. The challenge that remains is to improve the quality of maternal and newborn care to further reduce avoidable deaths of women and babies.

Objective

The Malawi health system is strengthened to deliver higher quality maternal and newborn health services, especially in the target districts.

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Approach

The Malawi German Health Programme works with the national Ministry of Health and Population, the local governments of the four partner districts Dedza, Lilongwe, Mchinji and Ntcheu to create the conditions in which doctors, nurses and midwives can provide good maternal and newborn care. In line with the National Health Policy and the National Health Sector Strategic Plan II this includes: 

  • A better management of resources by matching funding to health care needs and passing more decision-making power to local actors
  • Improved quality management in maternal and newborn health care and planning through better access to and use of data
  • A better distribution and qualification of clinical and nursing staff in maternal and newborn health care

GIZ advises on policy, supports organisational development and supports trainings at the national Ministry, the local government and health facilities. GIZ implements on behalf of the German Government and with additional funding from the Bill and Melinda Gates Foundation, and is assisted in its implementation by the consulting firms EPOS and GFA.

Results

Since beginning its operation in 2017, the Malawi German Health Programme has assisted its Malawian partners to achieve remarkable results.

In October 2018, the Ministry of Health and Population launched the National Quality Management Policy that it had developed with intensive support from GIZ, preparing the ground for a national training initiative for health workers aimed at improving the quality of care. Several hospitals have been selected for an accreditation programme, which allows tracking quality improvements against international standards. The programme also supports its partner ministry to tailor health services better to meet the needs of young people, particularly girls and young women.

The new National Health Indicators, defined with GIZ’s support enable the Ministry of Health and Population to track progress on its strategic health objectives and to benchmark Malawi against neighbouring countries. GIZ in cooperation with the non-governmental organisation JEMBI supports the Ministry with the testing of a new, open-source electronic patient registry that will help doctors and nurses with the management of patients, starting in maternal and newborn health, and with a potential to expand to other health services.

The Malawi German Health Programme also supported the development of a new Human Resources for Health Strategic Plan, which provides a blueprint for closing the staffing gaps of the sector. A team of Integrated Experts deployed through the Centre for International Migration (CIM) assists the College of Medicine to implement the Plan and train specialist doctors and medical officers, especially in gynaecology, obstetrics, paediatrics and anaesthesia. To improve the skills of practicing nurses and midwives, the programme supports the Nurses and Midwives Council of Malawi in revitalising the continuous professional development programme, and trains skilled nurses and midwives to mentor less advanced colleagues.

The Programme also works with its partners on strengthening the capacities for planning and managing health services. The Malawi Cabinet in 2018 approved turning the tertiary care hospitals into public trusts. By increasing the power of the hospital management to make decisions and establishing hospital boards, it is expected that the accountability towards the surrounding communities and the efficiency of service provision will increase. In the target districts, the health management teams are supported in coordinating the resources of Government and the many partners and donors in the health sector so that all Malawi residents have the same change of accessing high quality services, particularly mothers and newborns.