Malawi – Factfile
Malawi, officially the Republic of Malawi, is a landlocked country in southeast Africa. It is bordered by Zambia to the northwest, Tanzania to the northeast, and Mozambique on the east, south and west. The country is separated from Tanzania and Mozambique by Lake Malawi. Malawi is over 118,000 km2 (45,560 sq mi) with an estimated population of more than 13,900,000. The country is also nicknamed ‘The Warm Heart of Africa’.
Malawi is a Southern African country hit hard by HIV and AIDS with an adult national HIV prevalence (15 – 49 years) of 11 % (13 % for women and 8% for men), according to the 2010 Demographic and Health Survey. This group is the target population for HIV and AIDS control programmes in the county. The majority of HIV infections are sexually transmitted or associated with pregnancy, childbirth and breastfeeding.
Integra research in Malawi has focused on operations research, strengthening the integration of HIV and SRH services, and on youth-friendly outreach services provided by the Family Planning Association of Malawi (FPAM), an affiliate member of the International Planned Parenthood Federation. One model of integration has been studied:
Model 3: Integrated HIV and SRH services – Includes family planning, maternal and child health services, HIV testing, HIV care, STI services, cervical cancer screening, and services for youth. This model is being studied at three SRH sites in Lilongwe, Dowa and Ntcheu.
The objectives of the research are:
- To explore youth preferences for integrated SRH and HIV services in a selected community.
- To measure and evaluate the costs of providing youth-friendly integrated SRH and HIV services.
- To support the design of a youth-friendly package of services that can be delivered through the existing outreach service delivery model.
Operational research and an economic study, which aims to assess the cost and cost-effectiveness of providing integrated SRH and HIV services, have been conducted. At the outset of the study, young people’s preferences for a range of SRH and HIV services to be delivered by a mobile clinic in a community with no permanent government or private health services was assessed. A model, informed by the survey results, was also developed to understand client choices and try to predict the probability of service uptake. A package of health services, including SRH services and HIV testing and counselling, was then introduced into the community on an outreach basis. In the six months following their introduction, the uptake of the services has been monitored and interviews conducted with users to explore their responses to the services and possible reasons for any differences between predicted and actual use. The costs of providing the services have also been measured and evaluated.
For information about research findings to date, click here.
The aim of the project in Malawi is to stimulate scaling up of the lessons learnt on SRH and HIV integration and linkages. The project focuses on catalytic action in three selected pilot districts; Mangochi, Nkhata-Bay and Dedza.
Expected outcomes
- Implement effective approaches that would reduce/eliminate stigma and discrimination by and towards health care providers and increase involvement of men and vulnerable groups
- Build capacity of service providers in government and community based organisations to implement SRHR and HIV integrated services
- Address security of RH and HIV/AIDS commodities with Malawi-specific priority interventions
- Define contribution of non-health sector (educations, law enforcement and gender) in successful models and make recommendations for their inclusion of the coordinated programmes of support
- Document lessons learned and identify best practices models at the policy system and service delivery levels and disseminate them
- Participate in regional knowledge sharing forums with other project countries to share Malawi’s linkages/integration experiences through south – south cooperation. This perform as an evidence -based advocacy tool for leveraging and mobilizing additional resources to scale up linkages efforts
Partners
- Ministry of Health, Malawi
- UNFPA
- UNAIDS
- National AIDS Commission (NAC)
- Family Planning Association of Malawi (FPAM)
To find out more about this project click here
Resources
Research
Chirwa, M., Kamkwamba, D., Umar, E. (2011). The People Living with Stigma Index – Malawi.
In 2010, The People Living with HIV Stigma Index, a community-based research initiative measuring HIV-related stigma and discrimination, was implemented in Malawi. Over 2,000 people living with HIV were interviewed regarding their experiences of stigma and discrimination in the previous 12 months. This report provides details of the research process, findings, conclusions, and recommendations, and will be of interest to national policy and programme managers, health service providers, and development partners, and donors, as well as people living with HIV.
Other national research
Studies conducted in Malawi are contributing to the growing body of research related to HIV/SRH integration. The following studies have been published in peer-reviewed journals from 2009 onward.
Aarnio, P., Olsson, P., Chimbiri, A., Kulmala, T. (2009) ‘Male involvement in antenatal HIV counseling and testing: exploring men’s perceptions in rural Malawi.’ AIDS Care, Vol 21(12): pp1537-46. This qualitative study explored married men’s perceptions of HIV in pregnancy and male involvement in antenatal HIV testing and counselling in southern Malawi. The study found that men were largely unaware of antenatal HIV services and, overall, perceived it problematic to attend female-oriented health care services.
Dlamini, P., S., Wantland, D., Makoae, L., N., Chirwa, M., Kohi, T., W., Greeff, M., Naidoo, J., Mullan, J., Uys, L., R., Holzemer, W., L. (2009) ‘HIV stigma and missed medications in HIV-positive people in five African countries.’ AIDS Patient Care and STDs, vol 23(5): pp377-87. The objective of this study was to explore the relationship between perceived HIV stigma and self-reported missed doses of antiretroviral (ARV) medications in a cohort of HIV-positive individuals living in five African countries, including Malawi. The study found a significant and stable correlation between perceived HIV stigma and missed medication over time.
Levy, J., M. (2009) ‘Women’s expectations of treatment and care after an antenatal HIV diagnosis in Lilongwe, Malawi.’ Reproductive Health Matters, Vol 17(33): pp152-61. This paper examines women’s decisions about HIV testing and their experience of PMTCT and HIV-related care in one clinic in Lilongwe, Malawi. The study found the programme only poorly met their expectations for a range of reasons including a focus on infant health and not the mother, a lack of integrated care and timely referral, and defining HIV exclusively as a medical issue and ignoring the social determinants of health.
Makoae, L., N., Portillo, C., J., Uys, L., R., Dlamini, P., S., Greeff, M., Chirwa, M., Kohi, T., W., Naidoo, J., Mullan, J., Wantland, D., Durrheim, K., Holzemer, W., L. (2009) ‘The impact of taking or not taking ARVs on HIV stigma as reported by persons living with HIV infection in five African countries.’ AIDS Care, Vol 21(11): pp1357-62. This cohort study, conducted in Lesotho, Malawi, South Africa, Swaziland, and Tanzania, examined the impact of HIV stigma over time on two groups of HIV-positive individuals, one taking antiretroviral (ARV) medications and the other not taking ARV medications. Whilst both groups reported significant decreases in stigma over time, the group taking ARV medications experienced significantly higher stigma.
For further information about the SRHR and HIV linkages project in Malawi, please contact:
Thandiwe Mijoya
UNFPA Malawi Country Office
Email: mijoya@unfpa.org
Mobile: + 265 888891808
Hans Katengeza
Ministry of Health Malawi
Email:hanskatengeza@yahoo.co.uk
Mobile +265 888377136,
For further information about the Integra Initiative in Malawi, please contact:
Mathias Chatuluka
Family Planning association in Malawi FPAM
email: ghatsha@yahoo.co.uk
Chinguni Hills Nature Reserve, Malawi
