Saving in Central Malawi through empowering communities, health workers, managers and leaders
A major gap exists between what is known – the evidence base for effective maternal and neonatal health (MNH) – and what is practiced, especially in low- and middle-income countries. Interventions that can effectively close this gap in these settings depend on community engagement, reliable health systems, and effective leadership. Over the past four years, the Malawian NGO, MaiKhanda, has tested ways to improve health system effectiveness for MNH. Preliminary evaluation of a cluster randomized controlled study showed that a combination of interventions that focus on women’s empowerment and improving quality of care at facilities resulted in ~40% reduction in neonatal mortality. These results were achieved primarily through novel community and health facility systems improvement models, without significant addition of material resources. It now remains to be shown whether these results can be replicated and rapidly scaled after MaiKhanda transitions from direct support of communities and facilities to a more indirect approach where MaiKhanda engages and capacitates District and Zone Management teams. We hypothesize that transferring systems improvement methods to these management teams and use of peer-to-peer networking models to rapidly spread this approach will 1) sustain recent gains in MNH in the three prototype districts, and 2) improve outcomes for mothers and neonates across nine districts (population 5.5 million) in central Malawi.
We expect that proof of this hypothesis will result in the prevention of many maternal and neonatal deaths in Central Malawi, and produce a replicable model for improving MNH across Malawi and other low-income countries.