MINISTRY OF HEALTH: ROAD MAP FOR ACCELERATING THE REDUCTION OF MATERNAL AND NEONATAL MORTALITY AND MORBIDITY IN MALAWI

Republic of Malawi
Ministry of Health
ROAD MAP FOR ACCELERATING THE
REDUCTION OF MATERNAL AND
NEONATAL MORTALITY AND MORBIDITY
IN MALAWI
October 2005

Malawi National Road Map for accelerating the reduction of maternal and newborn mortality 2005

TABLE OF CONTENTS
TABLE OF CONTENTS.................................................................................................... ii
LIST OF ACRONYMS ..................................................................................................... iii
FOREWORD...................................................................................................................... v
ACKNOWLEDGEMENTS............................................................................................... vi
EXECUTIVE SUMMARY .............................................................................................. vii
1.0 BACKGROUND.................................................................................................... 1
2.0 INTRODUCTION .................................................................................................. 3
3.0 THE ROAD MAP................................................................................................... 5
3.1 Rationale ................................................................................................................. 5
3.2 Vision...................................................................................................................... 5
3.3 Goal......................................................................................................................... 5
3.4 Objectives ............................................................................................................... 6
3.5 Strategies and interventions .................................................................................... 6
3.6 Monitoring and evaluation...................................................................................... 8
4.0 DETAILS OF INTERVENTION.........................................................................12
5.0 COSTING OF ROAD MAP................................................................................. 25
BIBLIOGRAPHY............................................................................................................. 32
Malawi National Road Map for accelerating the reduction of maternal and newborn mortality 2005
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LIST OF ACRONYMS
ANC Antenatal care
ART Antiretroviral Therapy
BCI Behaviour Change Intervention
BEmOC Basic Emergency Obstetric Care
CEmOC Comprehensive Emergency Obstetric Care
CFR Case Fatality Rate
CHAM Christian Health Association of Malawi
CMS Central Medical Stores
COM College of Medicine
CPR Contraceptive Prevalence Rate
DDCS Deputy Director Clinical Services
DFID Department for International Development
DHMT District Health Management Team
DHO District Health Officer
DHS Demographic and Health Survey
DIP District Implementation Plan
DNO District Nursing Officer
EHP Essential Health Package
EmOC Emergency Obstetric Care
FP Family Planning
FWCW Fourth World Conference on Women, held In Beijing, China, 1995
GNP Gross National Product
GTZ German Technical Assistance agency
HA Health Assistant
HEU Health Education Unit
HMIS Health Management Information System
HMIU Health Management Information Unit
HIV Human Immunodeficiency Virus
HR Human Resources
HSA Health Surveillance Assistant
ICPD International Conference on Population and Development
IMR Infant Mortality Rate
IPC Internal Procurement Committee
IPT Intermittent Presumptive Treatment
ITN Insecticide Treated Bed net
KMC Kangaroo Mother Care
MBTS Malawi Blood Transfusion Services
MDG Millennium Development Goal
MDHS Malawi Demographic and Health Survey
MMR Maternal Mortality Ratio
MNH Maternal and Neonatal Health
MOH Ministry of Health
MOLG Ministry of Local Government
Malawi National Road Map for accelerating the reduction of maternal and newborn mortality 2005
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MOU Memorandum of Understanding
NMCM Nurses and Midwives Council of Malawi
NSO National Statistics Office
PAM Physical Assets Management
PMTCT Prevention of Mother to Child Transmission
POA Programme of Action
POW Programme of Work
QECH Queen Elizabeth Central Hospital
RHU Reproductive Health Unit
SMI Safe Motherhood Initiative
SMP Safe Motherhood Project
SWAp Sector Wide Approach
TA Traditional Authority
TBA Traditional Birth Attendant
TOR Terms of Reference
UN United Nations
UNFPA United Nations Population Fund
UNICEF United Nations Children's Fund
USAID United States Agency for International Development
VCT Voluntary Counselling and Testing
VHC Village Health Committee
WHO World Health Organization
Malawi National Road Map for accelerating the reduction of maternal and newborn mortality 2005
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FOREWORD
The Government of Malawi has over the years provided sexual and reproductive health
services including maternal and newborn health care to its people. The Government with
the support from various development partners has implemented several safe motherhood
programmes in various districts of the country. Despite all these efforts the maternal
mortality has continued to rise.
A number of studies have helped to throw light on the maternal mortality situation in the
country. These studies have suggested an urgent need to further strengthen the Ministry
of Health for the provision of quality health care services in order to reduce the high
maternal and newborn mortality.
Consequently the Reproductive Health Unit of the Ministry of Health conducted a
national EmOC assessment to identify the capacity of the health care delivery system to
reduce maternal and neonatal mortality and to propose an action orientated plan: hence
the development of this road map.
This road map was developed with financial as well as technical support, from WHO,
UNFPA and UNICEF. It stipulates various strategies which will guide policy makers,
development partners, training institutions and service providers in supporting
government efforts towards the attainment of MDGs related to maternal and newborn
health.
I thank all those who, in diverse ways, helped to make the development of this road map
possible.

Dr. Hetherwick Ntaba
Hon. Minister of Health
Malawi National Road Map for accelerating the reduction of maternal and newborn mortality 2005

ACKNOWLEDGEMENTS
This road map is a culmination of efforts involving many individuals and organizations.
It was developed under the leadership of Mrs. Jane Namasasu, Deputy Director for
Clinical Services responsible for Reproductive Health.
The Ministry of Health would like to extend sincere gratitude and appreciation to
individuals and organizations that contributed to the development and finalization of this
road map.
Firstly, many thanks go to Dr Mothebesoane-Anoh and her team from WHO for
providing the necessary technical direction during the initial stage of developing this road
map.
Secondly, the following individuals worked tirelessly during this initial phase of the road
map development:
Lilly Banda-Maliro USAID
Rosyln Kalawa CHAM
Violet Kamfose DNO-Dowa
Edgar Kuchingale KCH-OBGYN
Dorothy Lazaro UNFPA
Bailah Leigh RHU-MOH
Valentino Lema OBGYN/UNFPA
Juliana Lunguzi UNICEF
Ken Maleta COM
Theresa Mwale WHO
Jane Namasasu DDCS(RH) RHU-MOH
Jonathan Ng’oma DHO-Ntheu
Jean Nyondo UNICEF
Esther Ratsma GTZ
Francis Sungani QECH-OBGYN
Ellen Thom UNFPA
The small technical working group comprising of Jane Namasasu, Dr Bailah Leigh,
Professor Valentino Lema and Juliana Lunguzi who finalized the document.
The final editing and costing of this Road Map was undertaken by the following:
Dr. Paul Dielemans, Dr. Helga Fogstad, Dr. Julia Kemp, Dr Bailah Leigh, Dorothy
Lazaro, Joyce Mphaya, Theresa Mwale, Jane Namasasu, Andy O'Connell, and Peter
Salilika.
Last but not least, WHO, UNFPA and UNICEF for technical and financial support.
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EXECUTIVE SUMMARY
This Road Map has been developed following a national EmOC assessment and in
response to the call by the African Union to its member states to accelerate the attainment
of the MDGs related to maternal and newborn health. The Ministry of Health undertook a
national assessment of availability, quality and utilisation of EmOC services to determine
the capacity of the health delivery system to reduce maternal and neonatal mortality. The
EmOC assessment comprised a complete enumeration of all hospitals in the 27 districts
in Malawi. In addition, 25% of health centres were randomly selected and included in
this study. Altogether 166 Health Facilities were included irrespective of ownership. The
Road Map also draws and builds on the Programme of Work (SWAp) and the Emergency
Resources Programme of Malawi.
The Road Map has a vision, rationale, a goal and the following objectives:
• To increase the availability, accessibility, utilisation and quality of skilled
obstetric care during pregnancy, childbirth and postnatal period at all levels of the
health care delivery system.
• To strengthen the capacity of individuals, families, communities, Civil Society
Organisations and Government to improve maternal and newborn health.
These are followed by nine strategies, which will guide policy makers, programme
managers, development partners, training institutions and service providers in
government efforts towards the attainment of MDGs related to maternal and newborn
health. Each strategy has interventions, which are presented in detail from page 12-24.
The interventions are costed.
The Road Map will be implemented within the context of the SWAp. Ninety five percent
of the total funds for implementing the first phase of this Road Map, including Human
Resources, is already costed in the Programme of Work of the SWAp. There is thus a
need for an additional five percent to make up for the funding gap.
Malawi National Road Map for accelerating the reduction of maternal and newborn mortality 2005


1.0 BACKGROUND
Malawi is a land-locked country in Central Africa. The United Republic of Tanzania borders it to
the North and Northeast; the Republic of Mozambique to the East, South and Southwest; and the
Republic of Zambia to the West and Northwest. It has a total surface area of 118,484 square
kilometres, of which approximately 80% is land. The remaining area is mostly composed of
Lake Malawi, which is about 475 kilometres long and runs down Malawi's eastern boundary
with Mozambique. Administratively, the country is divided into three regions, The North,
Central and South. The Southern Region is the largest in terms of size and population. There are
27 districts, out of which 12 are in the Southern Region, 9 in the Central Region and 6 in the
Northern Region. Each District is made up of several Traditional Authorities (TAs), which are in
turn composed of villages, the smallest administrative unit in Malawi (1).
The total population of Malawi is 11,937,934. Females comprise 51% of the total population, of
whom 42.2% is in the reproductive bracket, i.e. 15-49 years. Eighty five percent of the
population lives in the rural areas. The urban population has grown significantly over the past 10
years (1, 2).
Malawi is one of the poorest countries in the world with an estimated GNP per capita of US $
170.00 in 2000 (3). Its economy is predominantly agriculture-based, depending on tobacco
(providing the bulk), tea, sugar and coffee (1,3,). Sixty five percent of the population is defined
as poor and unable to meet their daily consumption needs, and over 50% of the population is
defined as food-insecure (2).
The country is reported to have one of the highest maternal mortality ratios globally, currently
estimated at 1120 per 100,000 live births up from 620 per 100,000 live births in 1992 (1).
Adolescent pregnancies comprise about 25% of all births and 20% of maternal deaths. The
lifetime risk of maternal death in Malawi is estimated at 1:7, one of the highest globally. Some
of the underlying causes of the high maternal death include early childbearing and the high
fertility rate. According to the MDHS (2000), the mean age at first childbearing was 19 years,
and the total fertility rate was 6.3. The neonatal mortality rate is equally high, estimated at
42/1000 live births (1).
Nearly all health care services in Malawi are provided by three main agencies. The Ministry of
Health (MOH) provides about 60%; the Christian Health Association of Malawi (CHAM)
provides 37% and the Ministry of Local Government (MoLG) provides 1%. There is a small
private-for-profit health sector limited to the urban areas as well as health services provided by
private companies, private practitioners, commercial companies, the Army and the Police.
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There are three levels in the health system i.e. primary level comprising of health centres, health
posts, dispensaries, and rural hospitals; second level made up of district and CHAM hospitals;
the tertiary level consisting of the central hospitals and one private hospital with specialist
services.
Malawi’s health system is grossly under-resourced. Per capita expenditure is about US $ 12,
which is inadequate for delivery of basic primary health care. In 2002, an extensive exercise to
determine the cost of delivering an “Essential Health Package” (EHP) of well proven and cost
effective health services that would deal with the main burden of disease, calculated a figure of
US $ 17.53 per capita per year (1).
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2.0 INTRODUCTION
The last three decades have witnessed significant renewed concern over women’s health,
particularly because of increasing poor reproductive outcomes such as maternal mortality, among
other issues. The Global Safe motherhood Initiative (SMI), launched in Nairobi (1987), brought
to the world’s attention the widespread problem of pregnancy-related deaths and disability. The
Conference called for reduction of global, regional and national maternal mortality ratios (MMR)
by 50% between 1990 and 2000. In response to that, Malawi, like many countries in the
developing world, established their national safe motherhood programme (5).
The International Conference on Population and Development (ICPD) held in Cairo, 1994,
established the reproductive health concept. This was reaffirmed by the Fourth World
Conference on Women (FWCW, Beijing, 1995) (6,7). The ICPD programme of action called for
reduction of MMR by 50% between 1990 and 2000, and a further 50% between 2000 and 2015.
The issue of women’s rights in matters relating to their sexuality and reproductive processes
were considered critical for the attainment of reproductive health and well-being and socioeconomic
development (6). It was hoped that with the broad based life-span approach advocated
in the concept of reproductive health with safe motherhood at its heart, pregnancy and childbirth
would no longer carry with them the risk of death and disability as had been the case hitherto.
Concerned by the worsening poverty situation and its relationship with health, especially for the
most vulnerable groups, the United Nations (2000) adopted the Millennium Declaration, which
led to the establishment of Millennium Development Goals (MDGs). The Millennium Summit
identified maternal health as an urgent priority in the fight against poverty. Four of the eight
MDGs (MDG 3, 4, 5, and 6) have direct bearing on maternal and newborn health. MDG 3 calls
for promotion of gender equality and empowerment of women; MDG 4 calls for reduction in
child mortality, MDG 5 calls for reduction of maternal deaths, and MDG 6 urges nations to halt
the spread of HIV/AIDS, control and prevent malaria and other infectious conditions. The MDGs
set targets and indicators for monitoring progress (8).
The enabling environment for making progress and eventually achieving the MDGs include
among others, peace and stability, a genuine democratic evolution, good governance, economic
growth and increasingly equitable distribution of the benefits of growth, social inclusion and
delivering on promises made by both national governments and international partners.
Notwithstanding this, there is now consensus that the MDGs cannot be achieved without
effectively addressing population dynamics and Reproductive Health issues (9)
Recent global evidence indicates that availability of Emergency Obstetric Care (EmOC) and
skilled attendance at birth are key to the reduction of maternal mortality. Cognisant of that
Malawi undertook a national assessment of availability, quality and utilisation of EmOC services
in 2005. The results of this assessment clearly show poor access and utilisation of EmOC
services, poor quality of health care services as evidenced by high case fatality rates. Some of the
barriers to the utilisation of maternal health care services include social and cultural/traditional
beliefs and practices (10).
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Concerned by the high maternal mortality ratios in various countries in Africa, the African Union
(2004) urged each Member State to develop a country-specific Road Map to accelerate
attainment of MDGs related to maternal and newborn health. The Regional Reproductive Health
Task Force together with other stakeholders developed a generic Road Map to accelerate the
attainment of MDGs related to maternal and neonatal health (11), to guide Member States in
developing theirs. Consequently, the government of Malawi has renewed its commitment to
address maternal health issues in a more comprehensive manner.
This national Road Map draws and builds on the Programme of Work (SWAp) and the
Emergency Resources Programme of Malawi. It is being developed in response to the current
maternal mortality crisis in Malawi, and indeed to the Global and Regional call for each country
to develop a country- specific Road Map. This is therefore in conformity with government
commitment to accelerate the attainment of the MDGs related to maternal and neonatal health in
Malawi.
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3.0 THE ROAD MAP
3.1 Rationale
Recent evidence indicates that availability of EmOC and skilled attendance at birth are
key to reducing maternal mortality. Cognisant of that, Malawi undertook a national
assessment of availability, quality and utilisation of EmOC services, which built on
previous studies. All these have underlined the following factors as contributing to the
high maternal mortality ratio in the country.
�� Shortage of staff and weak human resource management
�� Limited availability and utilisation of maternal health care services
�� Low quality maternal health care services
�� Weak procurement and logistics system for drugs, supplies and equipment
�� Problems of infrastructure
�� Weak referral systems
�� Weak monitoring, supervision and evaluation
�� Inadequate coordination mechanisms among partners and stakeholders
�� Weak community participation and involvement
�� Harmful social and cultural beliefs and practices.
As a result of the foregoing, the Malawi government has made a renewed commitment to
address the issue of maternal mortality and morbidity. Cognisant of the mother- newborn
dyad, the government has also included issues of newborn mortality and morbidity in its
renewed efforts, in line with the call by the African Union to each Member State to
develop a country-specific Road Map for the reduction of maternal and neonatal
mortality and morbidity. Consequently a multisectoral group consisting of government
and its development partners came together and developed this National Road Map for
accelerating the attainment of the Millennium Development Goals related to Maternal
and Neonatal Health.

3.2 Vision
All women in Malawi go through pregnancy, childbirth and the postpartum period safely
and their newborns are born alive and healthy through the implementation of effective
maternal and newborn health interventions.

3.3 Goal
To accelerate the reduction of maternal and newborn morbidity and mortality towards the
achievements of the Millennium Development Goals (MDGs).
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3.4 Objectives
1.0 To increase the availability, accessibility, utilization and quality of skilled
obstetric care during pregnancy, childbirth and postnatal period at all levels of the
health care delivery system.
2.0 To strengthen the capacity of individuals, Families, Communities, Civil Society
Organisations and Government to improve Maternal and Neonatal Health.
3.5 Strategies and interventions
Strategy 1: Improving the availability of, access to, and utilisation of quality Maternal and
Neonatal Health Care
Interventions:
1. Provide essential health care package for Maternal and Neonatal Health, with
priority on health centre level, particularly in rural and remote areas
2. Upgrade health facilities to be able to provide minimum package for Maternal and
Neonatal Health, with first priority to BEmOC facilities
3. Reinforce blood transfusion services at each hospital
4. Review, define and adopt minimum standards and protocols of care for Maternal
and Neonatal Health
5. Conduct maternal death reviews and clinical audit
6. Provide supportive supervision to enhance quality of care
Strategy 2: Strengthening human resources to provide quality skilled care
Interventions:
1. Ensure adequate staffing at health facility to provide the Maternal and Neonatal
Health essential health care package
2. Increase and improve training of Maternal and Neonatal Health staff
3. Build the capacity of training institutions to provide competency based training
4. Develop, review and update policies that enable health professionals to use their
skills
Strategy 3: Strengthening the referral system
Interventions:
1. Establish /strengthen communication system between health centre and referral
hospital
2. Establish/strengthen referral system including transport
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Strategy 4: Strengthening national and district health planning and management of Maternal
and Neonatal Health care
Interventions
1. Strengthening capacity of DHMT for better management of Maternal and
Neonatal Health services
2. Review the HMIS so that it captures all essential information on Maternal and
Neonatal Health for planning purposes
Strategy 5: Advocating for increased commitment and resources for maternal and newborn
health care
Interventions:
1. Develop advocacy package on Maternal and Neonatal Health with priority on
BEmOC services
2. Conduct National Health Accounts exercise
3. Maternal and Neonatal Health named as priority in DIPs and AIP
Strategy 6: Fostering of partnerships
Interventions:
1. Improving partnership collaboration and coordination
2. Promoting effective public/private partnership
Strategy 7: Empowering communities to ensure continuum of care between the household and
health care facility
Interventions:
1. Build capacity of HSAs to empower communities to utilise Maternal and
Neonatal Health services
2. Establish/strengthen community initiatives for RH including Maternal and
Neonatal Health
3. Raise awareness of the community on Maternal and Neonatal Health issues
including birth preparedness and danger signs
4. Empower communities, especially men, to contribute towards timely referrals
5. Review and define role of TBAs in Maternal and Neonatal Health
Strategy 8: Strengthening services that address adolescents’ sexual and reproductive health
services.
Interventions:
1. Establish/strengthen youth friendly health services
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Strategy 9: Strengthening monitoring and evaluation mechanisms for better decision-making and
service delivery of Maternal and Neonatal Health services
Interventions:
1. Strengthen MOH capacity for monitoring and evaluation
2. Operations Research
3. Evaluation of Road Map for impact
3.6 Monitoring and evaluation
Indicators have been developed to monitor and evaluate the Road Map. Most of these indicators
are included in the national HMIS. Greater emphasis will be placed on the routine collection and
processing of data on process indicators for monitoring progress towards maternal mortality
reduction.
1. Percentage of pregnant women receiving 4 focused ANC visits
2. Proportion of pregnant women screened for syphilis
3. Proportion of pregnant women receiving VCT
4. Proportion of HIV positive pregnant women receiving ART
5. Proportion of newborn of HIV positive mothers receiving ART
6. Proportion of births assisted by a skilled attendant
7. Proportion of all births in EmOC facilities
8. percentage of health centres offering Basic EmOC services.
9. Percentage of hospitals offering Comprehensive EmOC services.
10. Geographic distribution of EmOC services
11. Proportion of expected direct obstetric complications treated in EmOC facilities
12. Proportion of all expected births by Caesarean Section
13. Case fatality rate of direct obstetric complications
14. Proportion of health facilities with 24 hours coverage of skilled attendants to provide
emergency obstetric care
15. Percentage of health facilities conducting maternal death review and submitting to
national level
16. Proportion of expected maternal deaths reviewed in each district.
17. Proportion of Health facilities with protocols and guidelines in performance and quality
improvement including infection prevention
18. Percentage of hospitals with functional blood transfusion facilities
19. Percentage of facilities with functioning neonatal resuscitation facilities
20. Percentage of mothers and newborns receiving two postnatal care visits
21. Proportion of postnatal mothers receiving modern contraceptives
22. Proportion of mothers counselled on infant feeding
23. Proportion of mothers initiating breastfeeding within half an hour after delivery
24. Proportion of newborn receiving essential newborn care
25. Number of districts that prioritise provision of basic EmOC services in heir DIPs
26. Percentage of HSAs trained in providing Maternal and Neonatal Health care
27. Proportion of VHCs addressing Maternal and Neonatal Health issues
28. Proportion of health facilities with functioning communication system
29. Coverage of ambulances per population
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30. Proportion of health facilities receiving regular supportive supervision
31. Proportion of Low Birth Weight babies
32. Percentage of teenage pregnancies.
33. Maternal mortality ratio.
34. Neonatal mortality rates
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4.0 DETAILS OF INTERVENTION (activities in bold are priority in 2006)
Strategy 1: Improving the availability of, access to, and utilisation of quality Maternal and Neonatal Health Care
Intervention Activity Leading Baseline and Targets
agent(s)
Indicator
Baseline 2010 2015
DHO % of health facilities providing focused ANC 20 60 100
% pregnant women receiving 4 focused ANC visits 10 40 60
% of pregnant women screened for syphilis 20 50 90
% of pregnant women received VCT 10 40 60
% of pregnant women found to be HIV positive 25 20 15
% of pregnant women received iron/folate
supplementation
10 40 60
% of pregnant women received IPT 20 40 60
Provide Focused ANC
% of pregnant women using ITNs 10 40 70
DHO % of pregnant women receiving skilled care at
delivery
19 40 60
% of deliveries in EmOC health facility 19 40 60
% of HIV positive mothers received ART (e.g.
Nevirapine)
25 50 75
% of direct obstetric complications treated in EmOC
facilities
18.5 40 60
% of births by caesarean section 2.8 5 8
% of mothers initiating breastfeeding within half an hour
after delivery
20 50 70
% of Low Birth Weight babies 20 15 10
Provide Intra Partum Care,
with priority given to
implementing BEmOC
services
Case Fatality Rate (CFR) 3.4 2.5 2
% of health facilities with newborn
resuscitation services
40 80 90
% of newborn receiving essential
newborn care including resuscitation
30 50 70
% of newborn exclusively breast fed for 6 months 20 40 60
Provide Essential newborn
care
DHO
% of newborn of HIV positive mothers received ART 25 50 75
Provide Kangaroo Mother
Care (KMC)
DHO % of health facility providing KMC 5 20 40
% of mothers receiving postnatal care within 2 weeks 10 30 60
% of mothers receiving postnatal care at 6 weeks 20 30 40
% of postnatal mothers received Vitamin A
supplementation
20 40 60
1.1 Provide essential
health care package for
MNH, with priority on
health centre level,
particularly in rural
and remote areas
Provide Postnatal care DHO
% of postnatal mothers receiving modern contraceptives 21.5 40 60
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Ensure that under the
SWAp POW infrastructure
development plan,
upgrading health facilities
to provide BEmOC services
is given the highest priority
PAM % of health facilities offering BEmOC services 2% 50% 100%
Rehabilitate existing
hospitals to provide
Comprehensive EmOC
services
PAM % of hospitals offering Comprehensive EmOC
services
58% 80% 100%
Ensure that the MOH
consolidated procurement
plan has prioritised
equipment and drugs to
provide BEmOC services
RHU
PAM
CMS
% of health centres having the necessary equipment
and drugs to provide BEmOC services
2% 50% 100%
1.2 Upgrade health
facilities to be able to
provide minimum
package for MNH,
with first priority to
BEmOC facilities
Ensure with PAM that the
standard equipment list is
regularly reviewed and
updated to provide MNH
services, with priority on
BEmOC services
RHU Standard equipment lists updated in line with national
standards to provide MNH services
2003 updated updated
1.3 Reinforce Blood
transfusion services at
each hospital
Ensure with MBTS that
each hospital is equipped to
provide Blood transfusion
services
RHU
MBTS
% of hospitals with functional blood transfusion
services for maternity cases
20 100 100
Standards and protocols revised every 1.4 Review, define 5 years 2004 Updated Updated
and adopt minimum
standards and
protocols of care for
MNH
Ensure that the MNH clinical
protocols developed through
SMP are in place and kept
updated
RHU
% of health facilities with updated standards and
protocols in place
50 75 100
Institutionalise maternal
death reviews
RHU % of health facilities conducting maternal death
review and submitting to national/zonal level
1.5 Conduct maternal 20 100 100
death reviews and
clinical audit Analyse maternal death and
audit reports and compile
for the entire country
DHO
RHU
Reduction in CFR 3.4 2.5 2
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Ensure supportive
supervision for essential
maternal and neonatal care
is included in the MOH
integrated supervisory
checklist with priority on
BEmOC
RHU MNH included in MOH integrated supervisory
Checklist
- Checklist
available
Checklist
available
Review/update supervisory
check lists
RHU Check lists reviewed/updated every 5 years 2002 Updated Updated
Conduct quarterly
supervisory visits at all
levels
DHO % of health facilities receiving regular supervisory
visits
20 50 70
1.6 Provide
supportive
supervision to
enhance quality of
care
% DHO reporting on supervisory visits 60 80 100
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Strategy 2: Strengthen human resources to provide quality skilled care
Intervention Activity Leading Baseline and Targets
agent(s)
Indicator
Baseline 2010 2015
% of established posts filled:
Nurse/midwife technicians
Registered Nurse/midwives 36%
Clinical Officers (with midwifery and obstetric skills) 73%
Medical Assistants (with midwifery skills) 47%
Implement 6-year
Emergency Human
Resource programme
HR
Medical Officers with obstetric and neonatal skills 36%
Ensure that the deployment HR % of established posts in rural areas filled
and incentive programme
in the Emergency Human
Resource Programme
prioritises the deployment
of staff with BEmOC skills
to rural health facilities
Rural incentive scheme to support the deployment of
staff in rural areas in place
Incentive
scheme in
place
Incentive
scheme in
place
No. of health workers in place:
Nurse/midwife technicians
Registered Nurse/midwives 4717 7035
Clinical Officers (with midwifery and obstetric skills) 942
Medical Assistants (with midwifery skills) 718
Medical Officers with obstetric and neonatal skills 139
Volunteer specialist doctors
Nurse/Midwife tutors
Average norm of number of births to practising skilled
attendants
350 250 175
2.1 Ensure adequate
staffing
at health facility to
provide the MNH
essential health care
package
Ensure EMOC is the
highest priority in the
Emergency Human
Resource Programme for
re-engagement of staff, redeployment
of staff and
placement of volunteer
specialist doctors and nurse
tutors
HR
RHU
% of births attended by skilled health personnel 19 40 60
2.2 Increase and
improve training of
MNH staff
Revise curricula in line with
latest evidence and ensure
that BEmOC training (6
signal functions) is
compulsory in the preservice
training for
nurse/midwives, clinical
officers and medical
assistants
HR
RHU
Curricula revised and implemented - Revised
and
implement
ed
Revised
and
implement
ed
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Intake of enrolment of:
Nurse/midwife technicians 300
Registered Nurse/midwifes 90 600
Clinical Officers 110
Medical Assistants 150
Medical Officers 60
Lab technicians 25
Increase intake of
enrolment to ensure
adequate numbers of staff
for deployment
HR
Anaesthetic Officers 30
# of nurse/midwife technicians trained -
# of registered nurse/midwives trained -
# of medical assistants trained -
Implement an in-service
programme on essential
obstetric and neonatal care
with focus on BEmOC for
all registered
nurse/midwives,
nurse/midwife technicians
and medical assistants, with
priority given to health
centre based staff
HR
RHU
Trainin
g
Instituti
ons
# of HC staff trained in BEmOC -
Train tutors and lecturers to
provide competency based
training
HR
RHU
Training
Instituti
ons
# of tutors/lecturers that have received competency-based
training
2.3 Build the capacity 0 60 120
of training institutions
to provide competency
based training
Provide institutions with
teaching and learning
materials to provide
competency based training,
with priority focus on
BEmOC
HR
RHU
% of training institutions fully equipped 0 50% 100%
2.4 Develop, review
and update policies
that enable health
professionals to use
their skills
Revise the midwifery practice
policy to ensure that
midwives are able to provide
BEmOC services
NMCM
RHU
Updated policy - Policy
updated
Increased BEmOC services 2% 50% 100%
Malawi National Road Map for accelerating the reduction of maternal and newborn mortality 2005
17
Strategy 3: Strengthen the referral system
Intervention Activity Leading Baseline and Targets
agent(s)
Indicator
Baseline 2010 2015
% of facilities with functioning communication
system
3.1 Establish / 30 100 100
strengthen
communication
system between
health centre and
referral hospital
Install/repair radio
communication, ground
/mobile phone at all health
facilities, with priority to
facilities providing BEmOC
services in rural areas
PAM
RHU
% of health facilities in rural areas with
communication system
% of health facilities with referral system guidelines in
place
Review/develop relevant - 50 100
guidelines on referral system and
implement transport policy that
prioritises and ensures that
health facilities in rural areas are
able to provide BEmOC services
Admin
RHU
% of expected obstetric and neonatal complications
actually being referred
5 50 90
3.2
Establish/strengthen
referral system
including transport
Provide motorised ambulances
between health facilities
PAM # of motorised ambulances per 100.000 population 0.8 0.9 1
Malawi National Road Map for accelerating the reduction of maternal and newborn mortality 2005
18
Strategy 4: Strengthening national and district planning and management of Maternal and Neonatal Health Care
Intervention Activity Leading Baseline and Targets
agent(s)
Indicator
Baseline 2010 2015
RHU
Planning
Unit
Reports of meetings available - Meetings
conducted
Meetings
conducted
Provide guidance and support to
DHMT on planning,
implementation and monitoring
of MNH interventions and
ensure that MNH issues are
prioritised in the DIPs, with
special focus on health centres in
rural areas
DHO # of DIPs that prioritise provision of BEmOC
services in all health centres
0 15 27
Conduct meetings with DHMT for
information sharing, updating of
standards and policies, discussing
key issues
RHU % of health facilities implementing the full
MNH EHP
20 40 60
4.1 Strengthen
capacity of DHMT
for better
management of MNH
services
Review Terms of Reference and
membership of DHMT to reflect
prioritising MNH
Planning
DHO
RHU
# of DHMTs with revised TOR - 15 27
Review and update HMIS in line
with the Road Map, including
international agreed process
indicators
HMIS
RHU
Updated HMIS 2002 Updated
HMIS
Updated
HMIS
4.2. Review the
HMIS so that it
captures all essential
information on MNH
for planning purpose Train HMIS personnel, service
providers and managers to improve
on data and information
management of MNH
RHU
DHO
% of health facilities reporting on MNH
indicators
50 100 100
Malawi National Road Map for accelerating the reduction of maternal and newborn mortality 2005
19
Strategy 5: Advocating for increased commitment and resources for Maternal and Neonatal Health
Intervention Activity Leading Baseline and Targets
agent(s)
Indicator
Baseline 2010 2015
Develop advocacy materials RHU
HEU
Advocacy materials developed - Materials
developed
Materials
developed
Use advocacy materials to mobilise
resources
RHU
HEU
Advocacy materials developed and used - Materials
used
Materials
used
Hold annual meetings with the
parliamentary health committee
on MNH issues
RHU Increased budgetary allocation for MNH
care available
11% 13% 15%
5.1. Develop advocacy
package on MNH with
priority on BEmOC
services
Ensure that parliamentary health
committee briefs all MPs on MNH
RHU Increased budgetary allocation for MNH
care available
11% 13% 15%
Analyse health sector budget
commitment and expenditure on
MNH
RHU
Ensure that MNH is prioritised
within the existing commitments to
the health sector
RHU
Planning
Unit
% of total funds for MNH increased 100 150 250
5.2 Conduct National
Health Accounts
exercise
Advocate that available additional
MOH and donor resources are
committed to fill any gap
RHU Hold stakeholders meeting to advocacy for
additional resources
- Sufficient
resources
Sufficient
resources
5.3 MNH named as
priority in DIPS and
AIP
Advocate during the development
of DIPs and AIP the importance of
MNH, with priority on BEmOC
RHU
Planning
% of increased budgetary allocation within DIP
and AIP
25% 30%
Malawi National Road Map for accelerating the reduction of maternal and newborn mortality 2005
20
Strategy 6: Fostering Partnerships
Intervention Activity Leading Baseline and Targets
agent(s)
Indicator
Baseline 2010 2015
Transform the current Emergency
Safe Motherhood Taskforce into a
Technical Working Group to
oversee MNH policy development
and review progress on
implementation of the Road Map
RHU TORs developed for TWG and quarterly
meetings conducted
- TWG in
place and
functional
TWG in
place and
functional
Highlight MNH and progress
against the Road Map in the
Annual Health Sector Report
RHU
Planning
Annual Health Report reports on progress on
Road Map
- Progress
included
in annual
report
Progress
included
in annual
report
6.1 Improving
partnership
collaboration and
coordination
Ensure that MNH programme
review is included in annual SWAp
review
RHU
Planning
Report of annual SWAp review includes
MNH programme review
- Included
in annual
SWAp
review
Included
in annual
SWAp
review
Ensure that basic and
comprehensive EmOC services are
a priority within the currently
developed and implemented
Service Agreements with CHAM
Planning
RHU
# of districts with service agreements in place
that emphasises on EmOC
6.2 Promoting 3 15 27
effective
public/private
partnership
Explore more active involvement of
the private sector in MNH issues
Planning
RHU
# of service agreements / MOU - 3 10
Malawi National Road Map for accelerating the reduction of maternal and newborn mortality 2005
21
Strategy 7: Empowering communities to ensure continuum of care between the household and health care facility
Intervention Activity Leading Baseline and Targets
agent(s)
Indicator
Baseline 2010 2015
# of HSAs trained 2500 6000 12000
# of districts with EHP coverage of HSAs
(1:1000 population)
7.1 Build capacity of
HSAs to empower
communities to utilise
MNH services
Train HSAs to orient communities
on MNH issues including birth
preparedness and danger signs to
increase utilisation of services
HR
DHO
RHU
Utilization of services increased (skilled
attendants)
19 40 60
Liaise with relevant authorities to
revitalise Village Health Committees
(VHCs)
DHO % Functional VHCs 30 50 70
Train VHCs in MNH issues
including birth preparedness,
danger signs and collection of
maternal death data
DHO % of functional VHCs addressing MNH
issues
30 60 90
# of communities with functional emergency
preparedness committees
Establish emergency preparedness - 500 1500
committees
DHO
% of pregnant women with birth preparedness
plans
10 40 80
DHO reports on VHC activities available 5 25 50
# of districts implementing community
initiatives for RH issues at village level
4 20 27
# of villages implementing community
initiatives for RH in the districts
240 1600 3500
Establish mechanisms for
monitoring VHC activities with
respect to MNH issues
DHO
% of TAs addressing MNH needs 10 30 60
7.2 Establish /
strengthen
community initiatives
for RH including
MNH
Develop and support
implementation of verbal autopsy
at community level
DHO
RHU
# of communities implementing verbal
autopsy
- 500 1500
Ensure that health promotion
materials on birth preparedness and
danger signs are finalised and printed
RHU
HEU
% VHC with health promotion materials
available
10 30 50
Use community based organizations
to disseminate health promotion
information on MNH care
DHO Reports on dissemination through community
based organisations
- Reflected
in annual
health
report
Reflected
in annual
health
report
7.3. Raise awareness
of the community on
MNH issues including
birth preparedness and
danger sign
Disseminate BCI materials through
appropriate media
HEU Reports on dissemination through different
media (radio, TV, print, drama)
- Reflected
in health
report
Reflected
in health
report
Malawi National Road Map for accelerating the reduction of maternal and newborn mortality 2005
22
Mobilise Village Health # VHC’s with transport funds 500 1500
Communities to establish transport
plans
DHO
# of communities with transport plans for
referral
- 500 1500
7.4. Empower
communities,
especially men, to
contribute towards
timely referrals
Procure and maintain bicycle
ambulances
DHO
PAM
# of bicycle ambulances 120 500 1500
Conduct meetings to define role of
TBAs in MNH
RHU Role of TBAs defined and disseminated - Defined
role
7.5. Review and define
role of TBAs in MNH
Support TBAs in their new role DHO % of pregnant women delivered by TBA 20% 15% 10%
Malawi National Road Map for accelerating the reduction of maternal and newborn mortality 2005
23
Strategy 8: Strengthening services that address adolescents' sexual reproductive health issues
Intervention Activity Leading Baseline and Targets
agent(s)
Indicator
Baseline 2010 2015
Develop/Review training manual
to address adolescent sexual and
reproductive health
RHU
HR
Revised Training manual available - Manual
reviewed
Manual
reviewed
% of health facilities providing youth friendly
services
5% 25% 60%
Teen age pregnancies as % of total pregnancies 25 20 15
Provide youth friendly services
in all health facilities
DHO
Uptake of FP among adolescents 15 25 40
8.1.
Establish/strengthen
youth friendly health
services
Incorporate adolescent health
services into the pre-service
curricula
HR
RHU
Updated curricula - updated updated
Malawi National Road Map for accelerating the reduction of maternal and newborn mortality 2005
24
Strategy 9: Strengthening monitoring and evaluation mechanisms for better decision-making and service delivery of MNH services
Intervention Activity Leading Baseline and Targets
agent(s)
Indicator
Baseline 2010 2015
Officer responsible for MNH in place at
national level
Establish office for maternal 1 2 2
and neonatal health at national
level to coordinate collation
and analysis of data on
maternal and neonatal health
and disseminate the reports
HR
RHU
MNH reports available Reports
available
9.1. Strengthen MOH
capacity for
monitoring and
evaluation
Review existing maternal
mortality review forms to
include a section on neonatal
deaths
RHU Revised forms available Forms
available
9.2. Operations
research
Conduct research on identified
issues
RHU
Research
Research reports disseminated Reports
available
Conduct formative evaluation
after 5 years
RHU
Planning
Evaluation report available Report
available
9.3. Evaluation of
Road Map Impact
Conduct End term Evaluation in
2015
RHU
Planning
Final evaluation report Report
available
Malawi National Road Map for reduction of maternal and newborn mortality, 2005
25
5.0 COSTING OF ROAD MAP
The Road Map will be implemented within the context of the SWAp. Ninety five percent of the total funds for implementing the
first phase of this Road Map, including human Resources, is already costed in the Programme of Work of the SWAp. There is
thus a need for an additional five percent to make up for the funding gap
Costing of Road Map 2005-2010 (USD)
Intervention Activity Estimated
Cost (5 yrs)
Costed in POW (apportion) Funding gap Comments / Source(of funds)
1.1 Provide
essential health
care package for
Maternal and
Neonatal Health
• Provide Focused ANC
• Provide Intra Partum Care
• Provide Essential Newborn Care
• Provide Kangaroo Mother Care (KMC)
• Provide Postnatal Care
Total
33,961,232
Activity
2.1.2/2.1.3/2.1.4/2.1.5/2.1.6/2.
1.7 (25%)
Total
27,400,000 6,561,232
POW:
Procure EHP pharmaceuticals, medical and
lab supplies
Estimated cost:
EHP costing model, see Annex 1 for annual
breakdown
(costs for PMTCT and ITNs not included)
1.2 Upgrade health
facilities to be able
to provide minimum
package for MNH
• Ensure that under the SWAp POW
infrastructure development plan,
upgrading health facilities to provide
Basic EmOC services is given the
highest priority
• Rehabilitate existing hospitals to
provide comprehensive EmOC
services
• Ensure that the MOH consolidated
procurement plan has prioritised
equipment and drugs to provide
BEmOC services
• Ensure with PAM that the standard
equipment list is regularly reviewed
and updated to provide MNH services,
with priority on BEmOC services
Total
26,437,500
- Activity 4.2 (100%)
15,100,000
- Activity 4.1.3/4.1.4/4.1.5
(100%)
7,900,000
- Activity 3.1.1/3.1.2/3.1.3
(25%)
3,437,500
Total
26,437,500 0
POW:
- upgrade existing maternities / dispensaries
to HC level to support the full range of EHP
services
- rehabilitate existing health facilities to
support the delivery of the full range of EHP
services
- Procure and distribute essential basic
equipment
Estimated cost:
Assumed that POW costing is sufficient
1.3 Reinforce Blood
transfusion services
at each hospital
• Ensure that functional blood banks are
established at all hospitals in line with
the National Blood Transfusion
Services and that priority is given
within this programme to minimum
requirements for Comprehensive
EmOC services
0 0 0
Estimated cost:
Assumed that Malawi Blood Transfusion
Services meets all the costs
1.4 Review, define
and adopt minimum
standards and
• Ensure that the MNH clinical protocols
developed through SMP are in place
and kept updated
Activity 6.2.5.5.4 (25%)
500
POW:
Redevelopment and update of various health
services/interventions, standards, protocols
Malawi National Road Map for reduction of maternal and newborn mortality, 2005
26
Intervention Activity Estimated
Cost (5 yrs)
Costed in POW (apportion) Funding gap Comments / Source(of funds)
protocols of care for
MNH
Total
50,000
Total
500 49,500
and guidelines
Estimated cost:
Consultative meetings, printing and
distribution
1.5 Conduct
maternal death
reviews and clinical
audit
• Institutionalise maternal death reviews
• Analyse maternal death and audit
reports and compile for the entire
country
0 0 0
Estimated cost:
Included in M&E activities
1.6 Provide
supportive
supervision to
enhance quality of
care
• Ensure supportive supervision for
essential obstetric and neonatal care is
included in Zonal Office checklist with
priority on BEmOC
• Review/update supervisory check lists
• Conduct quarterly supervisory visits at
all levels Total
1,175,000
- Activity 5.2.3 (25%)
Total
1,175,000 0
POW:
- Routine supervision at sub-district level
Estimated cost:
Assumed that POW costing is sufficient (but
doesn’t include supervision costs made by
zonal and central level)
2.1 Ensure
adequate staffing at
health facility to
provide the MNH
essential health
care package
• Implement 6-year Emergency HR
Programme
• Ensure that the deployment and
incentive programme in the Emergency
Human Resource Programme
prioritises the deployment of staff with
BEmOC skills to rural health facilities
• Ensure EMOC is the highest priority in
the Emergency Human Resource
Programme for re-engagement of staff,
re-deployment of staff and placement
of volunteer specialist doctors and
nurse tutors
Total
171,600,00
0
Total
171,600,000 0
6-year emergency HR programme:
Target is 5776 nurse/midwives in 2010
Estimated cost:
Assumed that HR costing is sufficient to reach
40% skilled attendants (250 deliveries per
midwife), while 16% of nurse/midwives
actually work in maternity
2.2 Increase and
improve training of
MNH staff
• Revise curricula in line with latest
evidence and ensure that BEmOC
training (6 signal functions) is
compulsory in the pre-service training
for nurse/midwives, clinical officers and
medical assistants
• Increase intake of enrolment to ensure
adequate numbers of staff for
deployment
• Implement an in-service programme on
essential obstetric and neonatal care
with focus on BEmOC for all registered Total
Activity 6.2.1.1 (25%)
135,000
Total
POW:
Develop and coordinate pre- and in-service
training programmes for MOH
Estimated cost:
Training of 2500 health workers (MA, CO and
nurses) in BEmOC
Malawi National Road Map for reduction of maternal and newborn mortality, 2005
27
Intervention Activity Estimated
Cost (5 yrs)
Costed in POW (apportion) Funding gap Comments / Source(of funds)
nurse/midwives, nurse/midwife
technicians and medical assistants,
with priority given to health centre
based staff
5,000,000 135,000 4,865,000
2.3 Build the
capacity of training
institutions to
provide
competency bases
training
• Train tutors and lecturers to provide
competency based training
• Provide institutions with teaching and
learning materials to provide
competency based training, with
priority focus on BEmOC
Total
250,000 0
Total
250,000
POW:
No cost centre
Estimated cost:
Training of 100 tutors
2.4 Develop, review
and update policies
that enable health
professionals to
use their skills
• Revise the midwifery practice policy to
ensure that midwives are able to
provide BEmOC services
0 0 0
No cost
3.1.
Establish/strengthe
n communication
system between
health centre and
referral hospital
• Install/repair radio communication,
ground /mobile phone at all health
facilities
Total
1,900,000
Activity 4.1.1/4.1.2
(50%)
1,900,000
Total
1,900,000 0
POW:
Equip facilities with basic utility systems
(water, electricity and telecommunications) –
GOM/CHAM
Estimated cost:
Assumed that POW costing is sufficient
3.2
Establish/strengthe
n referral system
including transport
• Provide motorised ambulances
between health facilities
• Review/develop relevant guidelines on
referral system and implement
transport policy
25,400,000
50,000
Total
25,450,000
Activity 5.1.1/5.1.2 (100%)
25,400,000
Total
25,400,000 50,000
POW:
Equip district with vehicles and equipment
adequate for transport needs/finance routine
transport costs & maintenance
Estimated cost:
Assumed that POW costing for ambulances is
sufficient
Consultative meetings, printing and
distribution of guidelines is not costed in POW
Malawi National Road Map for reduction of maternal and newborn mortality, 2005
28
Intervention Activity Estimated
Cost (5 yrs)
Costed in POW (apportion) Funding gap Comments / Source(of funds)
4.1 Strengthen
capacity of DHMT
for better
management of
MNH services
• Provide guidance and support to
DHMT on planning, implementation
and monitoring of MNH interventions
• Conduct meetings with DHMT for
information sharing, updating of
standards and policies, discussing key
issues
• Review Terms of Reference and
membership of DHMT Total
500,000
- Activity 6.2.5.2.3 (25%)
112,800
- Activity 6.2.7.2.2 (25%)
37,850
Total
150,650 349,350
POW:
- Provision of support to the district
(institutional and capacity development) for
implementation tracking of DIPS
- Complete and implement the District
Management Manual
Estimated cost:
POW costing is insufficient for organising 6-
monthly meetings
4.2 Review the
HMIS so that it
captures all
essential
information on
MNH for planning
purpose
• Review and update HMIS in line with
the Road Map
• Train HMIS personnel, service
providers and managers to improve on
data and information management of
MNH
Total
387,375
- Activity 6.2.5.2.7 (25%)
37,375
- Activity 6.2.1.2/6.2.1.3 (25%)
350,000
Total
387,375
0
POW:
- Conduct POW M&E
- Develop/update and disseminate tools and
guidelines for HIM and use
- Provide tools and equipment required for
data collecting and processing
Estimated cost:
Assumed that POW costing is sufficient
5.1 Develop
advocacy package
on MNH
• Develop advocacy materials
• Use advocacy materials to mobilise
resources
• Hold annual meetings with
parliamentary health committee on
MNH issues
• Ensure that parliamentary health
committee briefs all MPs on MNH
Total
100,000 0 100,000
POW:
No cost centre
Estimated cost:
Development and printing of advocacy
materials
Conduct National
Health Accounts
exercise
• Analyse health sector budget
commitment and expenditure on MNH
• Ensure that MNH is prioritised within
the existing commitments to the health
sector
• Advocate that available additional
MOH and donor resources are
committed to fill any gap
0 0 0
No cost
MNH named as
priority in DIPS and
AIP
• Advocate during the development of
DIPs and AIP the importance of MNH,
with priority on BEmOC 0 0 0
No cost
Malawi National Road Map for reduction of maternal and newborn mortality, 2005
29
Intervention Activity Estimated
Cost (5 yrs)
Costed in POW (apportion) Funding gap Comments / Source(of funds)
6.1 Improving
partnership
collaboration and
coordination
• Transform the current Emergency Safe
Motherhood Task Force into a TWG to
oversee MNH policy development and
review progress on implementation of
Road Map
• Highlight MNH and progress against
the Road Map in the Annual Health
Sector Report
• Ensure hat MNH programme review is
included in annual SWAp review
Total
5,000
Activity 6.2.5.3.1 (100%)
5,000
Total
5,000 0
POW:
Coordinate inputs from development partners
to ensure adequate resourcing of the joined
POW
Estimated cost:
Assumed POW costing is sufficient
6.2 Promoting
effective
public/private
partnership
• Ensure that EmOC services are a
priority within the currently developed
and implemented service agreements
with CHAM
• Explore more active involvement of the
private sector in MNH issues
Total
242,000
Activity 6.2.7.2.4 (100%)
242,000
Total
242,000
0
Enhance inter-agency collaboration through
the implementation and monitoring of service
agreements, MOUs and Code of Conducts
with NGO and private sector partners
Estimated cost:
POW:
Assumed that POW costing is sufficient for
ensuring and exploring but does not include
the actual implementation of service
agreements
7.1 Build capacity
of HSAs to
empower
communities to
utilise MNH
services
• Train HSAs to orient communities on
MNH issues including birth
preparedness and danger signs to
increase utilisation of services Total
672,500
Activity 1.3.1 (10%)
672,500
Total
672,500 0
POW:
Integrated in-service training of health
workers
Estimated cost:
Assumed POW costing is sufficient
Malawi National Road Map for reduction of maternal and newborn mortality, 2005
30
Intervention Activity Estimated
Cost (5 yrs)
Costed in POW (apportion) Funding gap Comments / Source(of funds)
7.2 Establish /
strengthen
community
initiatives for RH
including MNH
• Liaise with relevant authorities to
revitalise Village Health Committees
(VHCs)
• Train VHCs in MNH issues including
birth preparedness, danger signs and
collection of maternal death data
• Establish emergency preparedness
committees
• Establish mechanisms for monitoring
VHC activities with respect to MNH
issues
• Develop and Support implementation
of verbal autopsy at community level
Total
60,000 0 60,000
POW:
No cost centre for training of VHCs
Estimated cost:
Training of 60 VHCs
7.3. Raise
awareness of the
community on MNH
issues including
birth
preparedness and
danger sign
• Ensure that the health promotion
materials on birth preparedness and
danger signs by HEU are finalised and
printed
• Use community based organizations to
disseminate health information on
MNH care
• Disseminate BCI materials through
appropriate media
Total
5,350,000
Activity 5.2.4 (25%)
5,350,000
Total
5,350,000 0
POW:
IEC and health education activities
undertaken
Estimated cost:
Assumed POW costing is sufficient
7.4. Empower
communities,
especially men, to
contribute towards
timely referrals
• Mobilise Village Health Communities to
establish transport plans
• Procure and maintain bicycle
ambulances Total
500,000 0 500,000
POW:
No cost centre for procurement of bicycle
ambulances
Estimated cost:
Procurement of 500 bicycle ambulances
7.5. Review and
define role of TBAs
in MNH
• Conduct meetings to define role of
TBAs in MNH
• Orient TBA’s on their new role 0 0 0
No cost, assumed that this activity will be
taken care of by HSAs
8.1.
Establish/strengthe
n youth friendly
health services
• Develop a training manual to address
adolescent sexual and reproductive
health
• Provide youth friendly services in all
health facilities
• Incorporate adolescent health services
into the pre-service curricula
Total
75,000
Activity 6.2.5.5.5 (100%)
15,500
Total
15,500 59,500
POW:
Develop a programme to train health workers
on customer care – attitudes, waiting times,
confidentiality and privacy
Estimated cost:
Assumed that POW costing is insufficient for
developing, printing and distributing a manual
Malawi National Road Map for reduction of maternal and newborn mortality, 2005
31
Intervention Activity Estimated
Cost (5 yrs)
Costed in POW (apportion) Funding gap Comments / Source(of funds)
9.1. Strengthen
MOH capacity for
monitoring and
evaluation
• Establish office for maternal and
neonatal health at national level to
coordinate collation and analysis of
data on maternal and neonatal health
and disseminate the reports
• Review existing maternal mortality
review forms to include a section on
neonatal deaths
Total
200,000
Activity 6.2.6.1.4 (25%)
200,000
Total
200,000 0
POW:
Host health information databank and health
resource centre and disseminate information
to specific and general users
Estimated cost:
Assumed POW costing is sufficient
9.2. Operations
research
• Conduct research on identified issues
Total
250,000 0 250,000
POW:
No cost centre
Estimated cost:
50,000 per annum
9.3. Evaluation of
Road Map Impact
• Conduct formative evaluation after 5
years
• Conduct End term Evaluation in 2015
Total
100,000
Activity 6.2.5.2.6 (100%)
10,000
Total
10,000 90,000
POW:
Design and implement an appropriate joint
annual POW review progress
Estimated cost:
Assumed that POW costing of 10,000 USD
for 5 years is insufficient
TOTAL 274,265,60
7 261,081,025 13,184,582
Additional 5% of funds required to
implement the Road Map till 2010
TOTAL (without HR) 102,665,60
7 89,481,025 13,184,582
Malawi National Road Map for reduction of maternal and newborn mortality, 2005
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BIBLIOGRAPHY
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