Presentation at the Global Maternal Newborn Health Conference, October 19, 2015
Background: Maternal mortality rates in Malawi remain high at 510 per 100,000 live births and 675 per 100,000 in the central region. Our project aimed to improve maternal and child health and reduce mortality by mobilising and empowering communities through participatory learning and action in women’s groups, male involvement, IEC activities and engaging village chiefs; and by training and mentoring healthcare staff. The project was implemented between 2010 and 2015 by the Ministry of Health Malawi’s Perinatal Care Project supported by Women and Children First (UK). Beneficiaries were 22,645 women of reproductive age in 144 villages and 244 health workers.
Methodology: A 400-household survey in 20 villages was selected randomly from a sampling frame of 118. A health facility (HF) assessment of the availability and quality of care used an existing tool and we led 20 key informant interviews and focus group discussions with 113 men and women. Purposive and snowball sampling identified men and women from 10% of the beneficiary villages for KIIs and FGDs. Data analysis used SPSS version 22; SAS JMP Genomics software 7.0, 2013; and transcripts and field notes were analysed through NVIVO 10. Primary research information was triangulated with the MICS 2014, DHS, 2010 HMIS, project surveys, reports and monitoring data.
Results: Demand for services and women’s satisfaction with care increased but quality of care in HFs was often compromised, mainly due to external factors. Key achievements: Intervention Baseline (2010) Endline (2014) Malawi Antenatal care, first trimester 9% 19% 12.4% (DHS, 2010) Institutional delivery 78% 94% 88.9%, (MICS, 2014) Skilled birth attendance 51% 93% 87.4% (MICS, 2014) Postnatal attendance within 7 days 49% 93% 81.3% within 2 days, (MICS, 2014)
Conclusion: Outreach activities and community mobilization contributed to the observed increases in accessing care with strong impact on skilled birth attendance and postnatal care.