Malawi Government Research Articles

Setting up a new radiation therapy centre in Malawi: Opportunities and challenges

Radiotherapy (RT) is one of the three pillars of cancer treatment (with surgery and systemic therapies) and has proven to be a cost–effective modality for curative and palliative treatment. In low and middle-income countries, access to RT treatment is limited posing many challenges to patients and caregivers. Many patients living in low and middle-income countries (LMICs) such as Malawi spend enormous sums of money to be treated abroad, through Government schemes, or, more commonly, go without treatment. This paper reviews the progress of the Malawi Government in establishing the first dedicated cancer treatment center with RT facilities at Kamuzu Central Hospital in Lilongwe. Malawi is expected to have a fully functional dedicated RT centre towards the end of 2024 equipped with one cobalt machine, two linear accelerators (LINAC), and a high dose rate (HDR) Brachytherapy unit. More cancer patients will have access to RT services locally, resulting in the Government saving on the foreign currency required to treat patients out of the country. While there has been great progress towards establishment of services in Malawi, careful and strategic planning is needed for the sustainability of required resources to avoid long-term disruption of treatments.

The State, Religion, and Violence in Colonial and Postcolonial Malawi

In the histories of both colonial and postcolonial Malawi, there have been cases of religious-related violence, both in its physical and non-physical forms. Such cases have led to the deaths of the “perpetrators” of violence and ‘innocent’ believers, destruction of property, prison detentions, and even the forced removal of citizens from the country. This paper analyzes two case studies, one in which private citizens perpetrated the violence, led by a preacher called John Chilembwe, of the Providence Industrial Mission (PIM), challenging British colonial authorities during the second decade of the twentieth century. In the second case, the focus is on the independent Malawi government, which used violence against members of the Jehovah’s Witness (JW) religious sect from the early 1960s to the early 1990s, owing to the Witnesses’ disassociation from the demands of the secular state. Using data primarily drawn from various archives and other published studies, this paper argues that the use of ‘religious-based violence’ is not just a domain ‘reserved’ for those experiencing oppression, exclusion, and marginalization. Rather, authoritarian governments, like the one that emerged in postcolonial Malawi and other parts of Africa, also resorted to using ‘religious-based violence’ to serve as a tool for eliminating ‘non-conforming’ religious sects and organizations. In doing so, this paper contributes to the various fields of scholarship, including the relationship between religion and violence in modern Africa and the dynamics and operations of the state in both colonial and postcolonial Africa.

The Response of the Dutch Reformed Church Mission to Labour Migration from Malawi to South Africa 1889–1994: A Leaf to be Borrowed by the 21st Century African Churches

This article mainly highlights what southern African Churches can learn and borrow as a leaf from the contribution of the Dutch Reformed Church Mission to labour migration from the Central Region in Malawi to South Africa between 1889 and 1994. It is argued that although push factors for labour migration were the legacy of Western economic imperialism, the Malawi government’s inability to create jobs for its citizens and some Malawians’ belief that migration from Malawi to South Africa was a means to fulfil their heart-felt and lifetime desire for economic opportunities, the mission played an important role in responding to labour migration. While it is understandable that the contexts of the 19th century and 21st century are different. Also, the truth that the Dutch Reformed Church in South Africa supported the apartheid government, this article arguably stresses that there are important lessons the Southern African Churches may learn from the mission’s response to labour migrants.

COVID-19 vaccination hesitancy among Malawians: a scoping review

BackgroundThe best chance of eradicating the COVID-19 pandemic lies in a successful vaccination campaign against the virus. There is still hesitancy among some of the Malawians over the use of COVID-19 vaccines that are readily available. This review’s objective was to currently analyze COVID-19 vaccination hesitancy among Malawians.MethodsThis scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. An electronic database search was performed using CINAHL, OVID Medline, PubMed, and Google Scholar for studies published between January 1, 2020, and July 10, 2023, on the topic of reluctance toward COVID-19 vaccine in Malawi. A review of the journal titles and abstracts was performed to establish a match within the selection criteria. Based on the parameters of interest, this paper included publications that explicitly mentioned COVID-19 vaccine hesitancy in Malawi.ResultsA total of seven articles were identified as meeting the inclusion criteria. Some of the eligible Malawian population’s poor response to COVID-19 vaccination was due to hesitancy. Misinformation is primarily to blame for COVID-19 vaccine reluctance. COVID-19 vaccines are viewed as dangerous or intended to cause harm such as the myth that the COVID-19 vaccine would cause infertility, severe disability, and even death. The review revealed that some people choose not to receive vaccines due to religious convictions and beliefs. Some individuals also think that getting the COVID-19 vaccine could result in receiving a triple-six (666) mark from the devil. There were also reports that the COVID-19 vaccination is being considered experimental and ineffective.ConclusionsThe Malawi government should focus on fear and misinformation regarding COVID-19 vaccination campaigns, using interventions, motivational interviews, and individual sensitization. Traditional, religious, and youth-led organizations should provide practical information on COVID-19 vaccine safety and efficacy.

Farmer preference for macadamia varieties and constraints to production in Malawi.

Macadamia nuts constitute a vital component of both nutrition and livelihoods for smallholder producers in Malawi. We conducted a comprehensive mixed-methods study, combining qualitative and quantitative analyses, to explore varietal preferences and production challenges among these farmers. Leveraging cross-sectional data from 144 members of the Highlands Macadamia Cooperative Union Limited, our study underscores several significant findings. Our findings reveal that the majority of smallholder macadamia farmers (62%) are aged over 50, with farming as their primary occupation. Varied preferences are driven by yield-related traits, including high yield potential (38%), nut quality (29%), and extended flowering patterns (15%). Among the macadamia varieties, the top five choices, grown by over half of the farmers, include HAES 660 (18%), 800 (10%), 791 (9%), 816 (8%), and 246 (7%). Additionally, our study identifies five primary constraints faced by smallholder macadamia farmers: insect pests (81%), diseases (34%), limited market access (33%), wind damage (25%), and inadequate agricultural advisory services (17%). Based on these findings, we propose two policy recommendations to enhance smallholder macadamia production and productivity in Malawi and other regions. Specifically, we advocate for informed breeding programs that align with farmer preferences to promote greater adoption of macadamia varieties. Additionally, we emphasize the crucial role of the Malawian government in the macadamia value chain, suggesting active participation in providing extension services and marketing support, akin to its support for other cash crops.

Lived Experiences of Widows Living in Mzuzu City, Malawi

The aim of the study was to understand the experiences of widows in Mzuzu city, Malawi. The study utilizes a qualitative narrative inquiry to explore the experiences of widows. Participants were identified in Chibanja, Zolozolo, and Chasefu townships within the city of Mzuzu. Ten participants were purposively selected and consented to be interviewed. Data were analyzed using Reisman’s approach of thematic narrative analysis. The study has revealed that some widows had their property seized following the death of their husbands. The findings have shown that most of the deceased husbands had small-scale businesses and were living on what they had earned that day. This study recommends the Government of Malawi introduce social service programs where widows could be economically empowered through grants and monthly upkeep to help widows who are facing challenges in meeting their needs and to reinforce policies to prevent widows from facing challenges.

The changes in health service utilisation in Malawi during the COVID-19 pandemic.

The COVID-19 pandemic and the restriction policies implemented by the Government of Malawi may have disrupted routine health service utilisation. We aimed to find evidence for such disruptions and quantify any changes by service type and level of health care. We extracted nationwide routine health service usage data for 2015-2021 from the electronic health information management systems in Malawi. Two datasets were prepared: unadjusted and adjusted; for the latter, unreported monthly data entries for a facility were filled in through systematic rules based on reported mean values of that facility or facility type and considering both reporting rates and comparability with published data. Using statistical descriptive methods, we first described the patterns of service utilisation in pre-pandemic years (2015-2019). We then tested for evidence of departures from this routine pattern, i.e., service volume delivered being below recent average by more than two standard deviations was viewed as a substantial reduction, and calculated the cumulative net differences of service volume during the pandemic period (2020-2021), in aggregate and within each specific facility. Evidence of disruptions were found: from April 2020 to December 2021, services delivered of several types were reduced across primary and secondary levels of care-including inpatient care (-20.03% less total interactions in that period compared to the recent average), immunisation (-17.61%), malnutrition treatment (-34.5%), accidents and emergency services (-16.03%), HIV (human immunodeficiency viruses) tests (-27.34%), antiretroviral therapy (ART) initiations for adults (-33.52%), and ART treatment for paediatrics (-41.32%). Reductions of service volume were greatest in the first wave of the pandemic during April-August 2020, and whereas some service types rebounded quickly (e.g., outpatient visits from -17.7% to +3.23%), many others persisted at lower level through 2021 (e.g., under-five malnutrition treatment from -15.24% to -42.23%). The total reduced service volume between April 2020 and December 2021 was 8 066 956 (-10.23%), equating to 444 units per 1000 persons. We have found substantial evidence for reductions in health service delivered in Malawi during the COVID-19 pandemic which may have potential health consequences, the effect of which should inform how decisions are taken in the future to maximise the resilience of healthcare system during similar events.

Controlling the first wave of the COVID-19 pandemic in Malawi: Results from a multi-round study.

We investigated behavioral responses to COVID-19 in Malawi, where a first wave of the pandemic occurred between June and August 2020. Contrary to many countries on the African continent, the Government of Malawi did not impose a lockdown or a stay-at-home order in response to the initial spread of SARS-CoV-2. We hypothesized that, in the absence of such requirements to restrict social interactions, individuals would primarily seek to reduce the risk of SARS-CoV-2 transmission during contacts, rather than reduce the extent of their social contacts. We analyzed 4 rounds of a panel survey spanning time periods before, during and after the first wave of the COVID-19 pandemic in Malawi. Five hundred and forty-three participants completed 4 survey interviews between April and November 2020. We found that the likelihood of attending various places and events where individuals work and/or socialize remained largely unchanged during that time. Over the same time frame, however, participants reported adopting on a large scale several behaviors that reduce the transmissibility of SARS-CoV-2 during contacts. The percentage of panel participants who reported practicing physical distancing thus increased from 9.8% to 47.0% in rural areas between April-May 2020 and June-July 2020, and from 11.4% to 59.4% in urban areas. The percentage of respondents who reported wearing a facial mask to prevent the spread of SARS-CoV-2 also increased, reaching 67.7% among rural residents in August-September 2020, and 89.6% among urban residents. The pace at which these behaviors were adopted varied between population groups, with early adopters of mask use more commonly found among more educated office workers, residing in urban areas. The adoption of mask use was also initially slower among women, but later caught up with mask use among men. These findings stress the importance of behavioral changes in containing future SARS-CoV-2 outbreaks in settings where access to vaccination remains low. They also highlight the need for targeted outreach to members of socioeconomic groups in which the adoption of protective behaviors, such as mask use, might be delayed.

<span><span>Possible Violation of Public Finance Management Act Through Use of Public Trusts by the Government of Malawi - Case Studies of National Food Reserve Agency (NFRA), Central Medical Stores Trust (CMST) and Smallholder Farmers Fertiliser Revolving Fund of Malawi (SFFRFM)</span></span>

<span><span>Possible Violation of Public Finance Management Act Through Use of Public Trusts by the Government of Malawi - Case Studies of National Food Reserve Agency (NFRA), Central Medical Stores Trust (CMST) and Smallholder Farmers Fertiliser Revolving Fund of Malawi (SFFRFM)</span></span>

The Role of the Ombudsman in Promoting Good Governance in Malawi: A View from Public Accountability

In Malawi, the Ombudsman is one of the governance institutions that provide oversight over other public agencies. A plethora of institutions addressing governmental accountability not only has direct implications on the separation of powers, but also raises important questions about their institutional authority, role and place in the governance mechanism. The present study endeavours to determine and contextualise the scope, role, functions and challenges of the Ombudsman institution in promoting good governance, specifically public accountability. The study adopted the mixed method of research. Using data from documents, 40 questionnaires and 6 interviews, the study finds that even though the institution faces challenges including poor funding, a lacking mandate and poor accessibility, it plays a huge role in promoting public accountability through its investigations and recommendations. The study recommends that the Ombudsman find ways to get stable funding, improve its visibility, remit, accessibility as well as relations with other oversight actors.

A study on capital budgeting with reference to micro, Small and Medium Enterprises (MSMEs) - Lilongwe City, Malawi

Capital budgeting involves planning and controlling long-term and short-term investments in fixed assets. It requires investing cash now with the expectation of recovering it over more than a year. Evaluating these decisions means assessing the investment and its future cash flows, which come from added revenues, cost savings, or cost reductions. Most numbers used in these analyses are estimates. Capital investment decisions are crucial for organizations' strategic goals. This study explores the capital budgeting practices of MSMEs in Malawi by surveying ten manufacturing companies. Results show that 70.3% of these MSMEs use capital budgeting for short- and medium-term investments, often employing forecasting analyses, and some use cost-benefit analysis and executive decision-making. Most MSMEs struggle with capital budgeting due to limited knowledge, time constraints, and data issues. While 50.9% understand the "Decision Rule" in capital budgeting, 40% cite lack of knowledge as their biggest challenge, followed by time, manpower, and data availability. Capital budgeting in Malawian MSMEs is developing as they adapt to globalization's opportunities and challenges. It is therefore suggested that the Malawian government, non-governmental organizations, and business development providers should offer training in capital budgeting and proper business record-keeping to Malawian Micro, Small, and Medium Enterprises.

E-Government implementation and service delivery in rural Malawi

E-government deployment in rural areas is crucial for improving public service delivery and governance. In Malawi, egovernment initiatives aim to improve transparency, efficiency, and accessibility of public services. This paper examines the implementation of e-government and service delivery in rural Malawi. Despite challenges such as low digital literacy, limited internet connectivity, poor ICT infrastructure, and budget constraints, e-government projects have shown potential to reduce bureaucratic inefficiencies, overcome geographical barriers, and improve responsiveness. This has a positive socio-economic impact, promoting inclusive development, empowerment of marginalized communities, and grassroots good governance practices. By addressing these obstacles and utilizing digital technologies, the Malawian government can realize the transformative potential of e-governance in rural communities.

Tracing the Audit Trail of Government of Malawi’s Loss of Shares in a Public Limited Company in Excess of MWK22.00 Billion <br>

Tracing the Audit Trail of Government of Malawi’s Loss of Shares in a Public Limited Company in Excess of MWK22.00 Billion <br>

360 Degree Review of the Legality of the Government of Malawi's Joint Venture in Salima Sugar Public Limited Company - Litmus Test for Public Finance Management Act 2022

360 Degree Review of the Legality of the Government of Malawi's Joint Venture in Salima Sugar Public Limited Company - Litmus Test for Public Finance Management Act 2022

Can women’s empowerment in livestock farming improve household food security? Empirical evidence from rural households in Malawi

BackgroundOver the years the Government of Malawi has launched several initiatives to improve food security in the country. Despite these efforts there have been limited improvements in food security, raising the spectre of persistently elevated levels of food insecurity. Efforts to reduce food insecurity may involve women who play a central role in the production, processing, preparation and control of vital livestock products for food security. However, women’s ability to achieve food security is limited by their lack of access to productive resources and limited ability to participate in decision-making. The main objective of this study is to estimate the impact of women’s empowerment in household livestock production and marketing decisions on household food security.MethodsThis study uses data from a proportionate random sample of 400 households in two major livestock producing Extension Planning Areas in the Nsanje district to estimate the relationship between women’s empowerment and household food security in rural households in Malawi.ResultsTobit regression results show that the empowerment of women in the livestock sector, especially in decisions pertaining to agricultural production, nutrition, and income control, improves household food security. In addition, factors such as household income, household size, and the main occupation of the household head play a significant role in ensuring household food security.ConclusionThe results suggest that nutrition-sensitive programmes should target women’s agency in livestock production and nutrition decisions for improved food security among rural households in Malawi. As part of their food security strategy, Government of Malawi could develop programs to sensitize households on the importance of enhancing women’s agency in agriculture and nutrition decision-making, while also providing targeted income-support for women.

Financing child rights in Malawi

BackgroundNearly all countries have ratified the United Nations Convention on the Rights of the Child and, therefore, support children having access to their rights. However, only a small minority of children worldwide have access to their environmental, economic, and social rights. The most recent global effort to address these deficits came in 2015, when the United Nations General Assembly agreed to a plan for a fairer and more sustainable future by 2030 and outlined the Sustainable Development Goals (SDGs). One remediable cause is the lack of revenue in many countries, which affects all SDGs. However, illicit financial flows from low-income to high-income countries, including international tax abuse, continue unabated.MethodsUsing the most recent estimates of tax abuse perpetuated by multinational companies and tax evasion through offshore wealth, and precise econometric modelling, we illustrate the potential regarding child rights (or progress towards the SDGs) if there was an increase in revenue equivalent to tax abuse in Malawi, a low-income country particularly vulnerable to climate change. The Government Revenue and Development Estimations model provides realistic estimates of government revenue changes in developmental outcomes. Using panel data on government revenue per capita, it models the impact of increased revenue on governance and SDG progress.ResultsIf cross-border tax abuse and tax evasion were curtailed, the equivalent increase in government revenue in one country, Malawi, would be associated with 12,000 and 20,000 people having access to basic water and sanitation respectively each year. Each year, an additional 5000 children would attend school, 150 additional children would survive, and 10 mothers would survive childbirth.ConclusionsMore children would access their economic and social rights if actions were taken to close the gap in global governance regarding taxation. We discuss the responsibility of duty bearers, the need for a global body to arbitrate and monitor international tax matters, and how the Government of Malawi could take further domestic action to mitigate the gaps in global governance and protect itself against illicit financial flows, including tax abuse.

Farmer preference for macadamia varieties and constraints to production in Malawi.

Abstract Macadamia nuts constitute a vital component of both nutrition and livelihoods for smallholder producers in Malawi. We conducted a comprehensive mixed-methods study, combining qualitative and quantitative analyses, to explore varietal preferences and production challenges among these farmers. Leveraging cross-sectional data from 144 members of the Highlands Macadamia Cooperative Union Limited, our study underscores several significant findings. Our findings reveal that the majority of smallholder macadamia farmers (62%) are aged over 50, with farming as their primary occupation. Varied preferences are driven by yield-related traits, including high yield potential (38%), nut quality (29%), and extended flowering patterns (15%). Among the macadamia varieties, the top five choices, grown by over half of the farmers, include HAES 660 (18%), 800 (10%), 791 (9%), 816 (8%), and 246 (7%). Additionally, our study identifies five primary constraints faced by smallholder macadamia farmers: insect pests (81%), diseases (34%), limited market access (33%), wind damage (25%), and inadequate agricultural advisory services (17%). Based on these findings, we propose two policy recommendations to enhance smallholder macadamia production and productivity in Malawi. Specifically, we advocate for informed breeding programs that align with farmer preferences to promote greater adoption of macadamia varieties. Additionally, we emphasize the crucial role of the Malawian government in the macadamia value chain, suggesting active participation in providing extension services and marketing support, akin to its support for other cash crops.

Solar home systems in Malawi: Commercialisation, use and informal waste management

To address electricity deprivation, the Malawi Government aims to provide off-grid solar products to 45 % of the country's population by 2030, currently in the absence of a waste management strategy. This paper addresses research gaps in the life cycle of solar home systems (SHSs) in Malawi, describing the flow of materials from import to waste disposal, to investigate potential environmental and energy justice issues relating to the national electrification policy. Fifty semi-structured interviews were conducted to describe the practices and perspectives of the actors in the SHS life cycle and informal waste management chain surrounding Malawi's capital city of Lilongwe: users, electronics repairers, scrap dealers, and informal lead-acid battery recyclers. The life cycle of SHSs is highlighted to be significantly impacted by the unregulated market landscape that suffers from a lack of supplier accountability, users' affordability constraints and a low understanding in SHS design and operation, resulting in frequent SHS failures. An established network of informal repairers and scrap dealers is described, effectively compensating for SHS faults and aggregating valuable waste fractions to sell to international buyers. The SHS waste flow is found to be dominated by lead-acid batteries, and the first description of an active informal lead-acid battery recycling industry in Malawi is made – posing severe health risks from the release of significant quantities of lead pollution into densely populated communities. Accordingly, Malawi's national electronification strategy is criticised for unjustly placing the responsibility for the management of the toxic off-grid solar waste flow onto energy-poor communities that are not aware of the associated hazards and do not have means for safe waste disposal. Finally, key principles for the development of effective safe waste management interventions are outlined from an energy perspective: fairly distributing responsibilities by recognising the perspectives and valuable roles of the existing actors within the waste management chain.

Tariff setting for the sustainability of communal water points in Mangochi District, Malawi

Abstract The Malawian Government adopted a community-based management model for rural water supply systems, which assumes that users would cover costs related to the operation and maintenance (O&M) of their communal water points through regular cash contributions. These communal water points are mostly boreholes fitted with Afridev hand pumps. However, studies have shown that Afridev hand pumps continue to fail within 3–5 years after installation, despite having a design lifespan of 10–15 years, mostly due to insufficient O&M. Therefore, this study assessed the adequacy of tariffs being used at different water points in Mangochi District in Malawi through a household (HH) survey with a sample size of 288 HHs and a market prices survey. The results showed that 90% of the HHs were making contributions that could not sustainably support the lifecycle O&M costs or the afterlife replacement of the Afridev hand pump. This study suggests a consistent minimum annual water point fund collection of MWK142,050 (US$172.29)1. It is recommended that the study be replicated in other areas. It is also recommended that further studies should focus on HH affordability with respect to the recommended tariff.

Perspectives of agriculture, nutrition and health researchers regarding research governance in Malawi. Using a leadership, ethics, governance and systems framework

BackgroundResearch ethics is intertwined with and depends on building robust and responsive research governance systems alongside researchers. Globally there has been substantial investment in agriculture, nutrition, and health (ANH) research motivated by the need to improve health outcomes, such as micronutrient deficiencies in Sub-Saharan Africa. Although there has been a notable focus on ethical issues inherent in ANH studies, there has been scanty research examining researchers’ attitudes related to ANH research. This study was conducted to explore the perspectives of researchers who conducted an agronomic biofortification study in Malawi.MethodologyIn-depth interviews were conducted with a purposive sample of ten ANH researchers. Interviews were conducted online via Zoom, audio-recorded, transcribed verbatim, and thematically analysed using the Leadership, Ethics, Governance and Systems Framework.ResultsFour core aspects emerged: Leadership: The relevance of building ethics leadership and ethical competence among researchers. Ethics: There is a need to develop a framework that operationalises core ethical values that can guide the implementation of ANH research. Governance: Research guidelines were perceived to be too generic to guide ANH research. Systems: Researchers’ recommended the establishment of a specialised ANH research ethics committee.ConclusionsThe findings highlight the significance of building ethics leadership and supporting ethical competency amongst researchers. Researchers recommended the development of tailored approaches rather than utilising generic governance systems and frameworks that are drawn from medical research and thus not fit for purpose in this field. In Malawi, specialised ethics review committees are needed to guide ANH research.