Last week, the Lancet Global Health published a new Countdown case study on Malawi and how it met Millennium Development Goal (MDG) 4, to reduce under-5 mortality by two-thirds by 2015.
Our Evidence for Action (E4A) programme played a critical role in compiling evidence from the report and coordinating and disseminating the findings through the MamaYe campaign.
The case study shows that Malawi has dramatically improved child survival since 1990, when 1 in 4 Malawian children died before reaching the age of five; by 2013, only 1 in 14 failed to survive to their fifth birthday. However, progress has been much slower in addressing newborn survival, and the research highlights Malawi’s need to provide universal access to high-quality care at birth, including for small and sick babies. The study notes that, at 18%, Malawi has the world’s highest recorded rate of babies born prematurely.
Following a full review of the new evidence, E4A compiled the information into clear messaging that focused on the fact that although Malawi should celebrate its progress in reducing child mortality and achieving MDG4 early, the benefits were mainly for children over one month old, leaving an unfinished agenda for newborns.
Working with partners and the media, the messaging was tailored for a range of key audiences including national policy makers, reproductive, maternal, newborn and child health stakeholders, healthcare workers, faith leaders and the Malawian public. Various materials were produced, including a series of infographics, highlighting the urgent need for political action to reduce stillbirths and improve newborn survival.
E4A helped to influence the Ministry of Health’s decision to combine the Countdown dissemination workshop with the launch of the new Child Health Strategy, the launch of the Every Newborn Action Plan, and the dissemination of the 2015 Emergency Obstetric and Newborn Care (EmONC) assessment data, making more effective use of resources, and enabling a more powerful, integrated event.
Malawi’s achievement of MDG 4 was driven by its early adoption and effective implementation of key evidence-based policies and programs to address the major causes of child deaths. Sharp increases in national coverage for treatment and prevention of childhood pneumonia, diarrhea, and malaria, and effective implementation of programs to reduce child undernutrition, were key contributors to the country’s success. Analysis with the Lives Saved Tool (LiST) showed that Malawi prevented an estimated 280,000 child deaths between 2000 and 2013 through scale-up of these and other high-impact child health interventions.
In contrast with many other countries in Africa, the rural poor in Malawi were not left behind in these advances in national coverage, and equity gaps were narrowed for a number of key child health interventions. However, the study also showed that wide geographic disparities still exist, and the authors suggest that more research is needed to better explain the determinants of success at the district level so that remaining inequities can be addressed and reduced.
This Countdown study is the first to synthesize and analyze data from nationally-representative surveys, a range of published articles, policy documents, and information gained from interviews with key national and district-level program and finance staff to document and investigate Malawi’s dramatic success in improving child survival. The study was led by the Malawi National Statistical Office, and the paper’s authors also include scholars from University College London, the Johns Hopkins Bloomberg School of Public Health, University of Malawi, Malawi College of Medicine, the London School of Hygiene and Tropical Medicine, the Malawi Ministry of Health, UNICEF, and the World Health Organization.