“Pregnancy and childbirth are supposed to be joyful occasions. For many mothers in Malawi, they turn into a very sad occasion that tears families apart. Too many women are dying giving life, and that is unacceptable, particularly when we know how to prevent it.”

— Esperance Fundira, United Nations Population Fund Representative

Aims and Objectives

Aim:

Reduce maternal and neonatal morbidity and mortality by 30 percent in Lilongwe, Kasungu, and Salima districts by 2012.

Objectives: 

In order to achieve success and meet the United Nations Millennium Development Goals 4 and 5 (which focus on improving maternal and child health), the Malawian Ministry of Health published a road map for action. MaiKhanda uses this road map as a foundation for the project’s work, which focuses on:

• Implementing measurable improvements in the quality of maternity services within health facilities;
• Developing local human capacity in quality improvement;
• Sustainably enhancing Ministry of Health capacity at both the facility and central levels to collect and use information for continuous improvement;
• Implementing parallel community-level interventions to simultaneously address the practical problems of health care delivery, as well as the cultural issues and practices within Malawian communities that directly contribute to maternal and neonatal mortality; and
• Sustainably enhancing community-level capacity to manage health, in particular, and empower women to take greater control of their own and their infants’ health.

Learn more about the United Nations Millennium Development Goals.

Maternal and Neonatal Health

Malawi has one of the highest maternal death rates in the world: nearly one in seven women face the risk of dying from complications due to pregnancy. Nearly half of all babies are born without the help of a skilled health care worker, making complications during labor hard to treat.

The focus of MaiKhanda's work within the Salima, Kasungu, and Lilongwe districts is the reduction of the Three Delays (seeking care, finding and reaching appropriate medical facilities, and receiving quality routine and emergency maternal and neonatal care).

Learn more about maternal and neonatal health in UNICEF’s The State of the World’s Children 2009.

Strategy

MaiKhanda works with the Malawian government’s Reproductive Health Unit to ensure that women and their children survive the birthing process. MaiKhanda works on several tiers to reach this goal:

• Women and Children First works in the communities and women’s groups to encourage better self-care and empowerment;  

• IHI works with health professionals and clinics to encourage improved quality of care; and 

• The Institute of Child Health measures the MaiKhanda’s impact by assessing the population-level effect of the program.

MaiKhanda also works closely with the Ministry of Health in order to build capacity at both the facility and central levels for continuous improvement and institutionalization of quality improvement principles.

Progress

Since MaiKhanda’s start, there has been an increase in the number of women giving birth in health facilities and a reduction of maternal and neonatal mortality rates across the districts. Excitement for and participation in the women’s groups, which help to support and educate women in the community, has increased dramatically since MaiKhanda began.

The Road Ahead

As the program continues, successful quality improvement within local resource constraints will continue to be the key focus. MaiKhanda is working to create sustainable systems for recording, tracking, and analyzing data to support these efforts.

More about Malawi

In Malawi, many women feel uncomfortable giving birth in a hospital or clinic because they view these facilities as unconducive to important traditional birthing rituals. Eating a special porridge after the birth of a child is one of the many traditions that women in Malawi value. In order to encourage women to give birth in a clinical setting, hospitals began to serve this porridge and allow traditional birth attendants to assist during labor.

Geography

Malawi is located in Southeast Africa and is landlocked by Zambia, Mozambique, and Tanzania. MaiKhanda works in the Kasungu, Salima, and Lilongwe districts.

Country Statistics

• Population: 13,571,000
• Life Expectancy: 49 (male), 51 (female)
• Under 5 mortality rate: 120/1,000 live births
• Doctor-to-patient ratio: 2/100,000
• The maternal mortality rate in Malawi is 984 per 100,000 live births and there are about 5,400 maternal deaths per year
• The HIV/AIDs prevalence rate is about 12%

[Source: World Health Organization, Country Statistics 2006]

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