Malawi Government Research Articles

The Politics of Hunger in an SDG Era: Food Policy in Malawi

This study focuses on the relationship between politics and hunger and the national political discourse on food security in Malawi. Our aim is to better understand the role of local and national actors in pursuing policies that aim to achieve the 2030 Agenda and the Sustainable Development Goals (SDGs). The empirical focus is on the Farm Input Subsidy Program (FISP), introduced by the Malawian government in 2005–2006, which supports smallholder farmers to better access to agricultural inputs. We provide an overview of the food security discourse and highlight the importance of political commitment for policy coherence that is required for achieving the SDGs. Thereafter, we introduce the policymaking scene in Malawi and FISP before critically examining the policy narratives on food security in the country. Our goal is to examine why some issues are effectively dealt with and not others. We argue that food security policies in Malawi are influenced by the political incentives they provide for electoral campaigns and for securing a regular flow of financial resources in agriculture projects that are highly dependent on foreign aid.

The Impact on Farmer Incomes of a Nationwide Scaling Up of the Farmer Business School Program: Lessons and Insights from Central Malawi

Various models and approaches are being implemented to provide technical assistance and support to improve smallholder farmers’ market access and incomes. This study evaluates the impact of the farmer business schools (FBS) program that has been scaled up to nationwide in Malawi. We focus on measuring impacts on crop choices and incomes of smallholder farmers, using the case study of Dedza district in central Malawi. The FBS approach, which has been implemented nationally by the Government of Malawi since 2011, consists of 1 year of group training and learning sessions for smallholder farmers. Training is designed to help improve market access and teach farmers how to establish profitable agribusiness ventures. This study used a multistage sampling procedure to collect data from 455 smallholder farmers: 162 FBS graduates, 84 FBS dropouts, and 209 nonparticipants. Using matching and difference-in-difference techniques, crop incomes from four groups of farmers were evaluated: FBS participants and FBS nonparticipants, as well as FBS graduates and FBS dropouts. The study finds a positive yet very small impact of FBS participation on crop income (US$20 per year on average), and no significant difference in crop income and production for farmers who graduated from FBS versus those who dropped out. While most participants reported gaining improved knowledge from the training, it did not seem to translate into new business ventures and improved incomes. Only a few graduates experienced improvement in income after FBS graduation. Insights from the qualitative research component of this study suggest that this is primarily due to the limited financial resources that smallholder farmers have to implement the agricultural management practices and business skills taught in FBS.

Bringing the state back in to humanitarian crises response: Disaster governance and challenging collaborations in the 2015 Malawi flood response

Malawi is a disaster-prone country with a long history of flooding. Yet disaster response policies have been largely neglected and disaster risk reduction efforts are mostly donor-led. The 2015 floods showed that Malawi’s local and national state institutions struggled to respond adequately. To support the Malawi government, the United Nations implemented its cluster system to coordinate the collaborations between the state, humanitarian and nongovernmental organizations in the disaster response. Based on ethnographic fieldwork and interviews with relief intervention participants, we argue that a focus on the localization of aid without explicit attention to the affected state’s institutions is problematic in contexts characterized by limited state capacity and overall donor dependency.

English

Diarrhoea is one of the most common infections that under-five children suffer from across the world. Antibiotics remains one of the common measures used to treat the infection, which has led to increased usage; nevertheless, the extent to which an individual is prompted to use antibiotics in managing diarrhoea in the Malawian setting is not clearly known. This study was aimed at establishing the factors that prompt mothers/caregivers to use antibiotics in treating childhood diarrhoea. Women/caregivers with under-five children who suffered from diarrhoea two weeks before the study were recruited for the interviews (n=269). One-on-one interviews were conducted using a structured questionnaire and two focus group discussions were carried out to generate qualitative data. Quantitative data was entered in CSPro version 7 and exported to STATA version 12 for analysis. The study established that caregivers use antibiotics in managing diarrhoea due to long distances to the health facility (OR 1.93, 95% CI: 1.03-3.65; P<0.04), unavailability of drugs at the facility (OR 1.12, 95% CI: 0.60-2.10; P<.71), quality of medical care at the health facility (OR 1.11, 95% CI: 0.57-2.15; P<.75) and previous knowledge of the diarrhoea condition (OR 0.90, 95% CI: 0.49-1.66; P<.74). As a result of these findings, Government of Malawi should consider widening access to health facilities to its citizens such that citizens are encouraged to always visit the healthy facilities. Healthy professionals should always encourage caregivers to refrain from engaging in self-medicational behavior as it has devastating effects on increased drug usage which contributes to anti-microbial resistance.   Key words: Diarrhoea, under five children, anti-microbial, resistance, self-medication, over the counter,  determinants, prescription.

Factors affecting the intention to adopt e-government services in Malawi and the role played by donors

Despite many papers written on the adoption of e-government services in developing countries, authors have not approached their articles empirically. For those that have, obvious constructs critical to the development of e-government in developing countries were overlooked. This paper extends the technology-organization-environment (TOE) framework with a decomposed theory of planned behavior (TPB) and the technological acceptance model (TAM); it is guided by stimulus-organism-response (SOR) in its attempt to develop a successful model that can be used to study factors affecting the adoption of e-government services in Malawi, while taking into account missed constructs. Donor support was hypothesized to moderate the effect of e-government funding on perceived behavior control. Data were collected from 259 Malawian public servants, and structural equation modeling was used to evaluate factors affecting e-government services adoption. The study reveals that there is a need for the Malawian government to fund e-government projects to reduce over-reliance on donors.

The implementation of environmental health policies in health care facilities: The case of Malawi.

Establishing and maintaining safe and sufficient environmental health (EH) conditions in health care facilities (HCFs) is important to prevent and control infections. In 2018, the Government of Malawi finalized an environmental health policy that defines specific targets and programs for EH in healthcare settings. This and other related policies have been used since 2010 as a guide for EH practice in HCFs, but the implementation of these policies has been incomplete to-date. This study qualitatively examines the successes and shortcomings of implementing these policies in Malawi's public HCFs. Thematic analysis of interviews with 53 respondents from all levels of government was used to identify the successes of the policies and the barriers to effective implementation using Contextual Interaction Theory. The greatest identified strength lies in the design of the EH department and its ability to connect individual HCFs and EH actors directly to the policy-making level of government. Identified barriers to implementation include: insufficient financial support; lack of human resources; incomplete reporting; poor stakeholder coordination; and insufficient training of EH actors. We recommend refresher trainings for all EH actors, the establishment of a directorate level EH position, and strengthened coordination to improve the collection, analysis, and reporting of monitoring data to enable EH actors to advocate for the additional funding needed to develop programs for EH personnel and to apply effective EH interventions.

Stranded Assets as a Key Concept to Guide Investment Strategies for Sustainable Development Goal 6

The concept of Stranded Assets has been used for nearly 50 years across many sectors, most recently it has been a focus of investment portfolios in light of the possible impacts of climate change. However, to date there has been no in-depth determination of the impact of Stranded Assets for rural water supply, despite international development targets from Rio, through Millennium Development Goals (MDGs), and now the Sustainable Development Goals (SDGs). The limiting factor for carrying out such an assessment is the requirement of a full and detailed asset register recording all rural water supplies in a country. The Scottish Government Climate Justice Fund Water Futures Programme, in collaboration with the Government of Malawi, is undertaking a comprehensive asset audit across Malawi, and this paper introduces the concept of Stranded Assets for the rural water supply sector using Malawi as an exemplar. Here, we demonstrate how significant change in the implementation strategy for SDGs compared to the MDGs is needed to reduce the potential for Stranded Assets and meet its ultimate aim.

Weighing the options for delivery care in rural Malawi: community perceptions of a policy promoting exclusive skilled birth attendance and banning traditional birth attendants.

To address its persistently high maternal mortality, the Malawi government has prioritized strategies promoting skilled birth attendance and institutional delivery. However, in a country where 80% of the population resides in rural areas, the barriers to institutional deliveries are considerable. As a response, Malawi issued Community Guidelines in 2007 that both promoted skilled birth attendance and banned the utilization of traditional birth attendants for routine deliveries. This grounded theory study used interviews and focus groups to explore community actors' perceptions regarding the implementation of this policy and the related affects that arose from its implementation. The results revealed the complexity of decision-making and delivery care-seeking behaviours in rural areas of Malawi in the context of this policy. Although women and other actors seemed to agree that institutional deliveries were safer when complications occurred, this did not necessarily ensure their compliance. Furthermore, implementation of the 2007 Community Policy aggravated some of the barriers women already faced. This innovative bottom-up analysis of policy implementation showed that the policy had further ruptured linkages between community and health facilities, which were ultimately detrimental to the continuum of care. This study helps fill an important gap in research concerning maternal health policy implementation in Low and middle income countries (LMICs), by focusing on the perceptions of those at the receiving end of policy change. It highlights the need for globally promoted policies and strategies to take better account of local realities.

Government of Malawi's unconditional cash transfer improves youth mental health

We explore the impacts of Malawi's national unconditional cash transfer program targeting ultra-poor households on youth mental health. Experimental findings show that the program significantly improved mental health outcomes. Among girls in particular, the program reduces indications of depression by about 15 percentage points. We investigate the contribution of different possible pathways to the overall program impact, including education, health, consumption, caregiver's stress levels and life satisfaction, perceived social support, and participation in hard and unpleasant work. The pathways explain from 46 to 65 percent of the program impact, advancing our understanding of how economic interventions can affect mental health of youth in resource-poor settings. The findings underline that unconditional cash grants, which are used on an increasingly large scale as part of national social protection systems in Sub-Saharan Africa, have the potential to improve youth mental wellbeing and thus may help break the vicious cycle of poverty and poor mental health.

The availability, prices and affordability of essential medicines in Malawi: A cross-sectional study.

IntroductionThe Malawian government recently introduced cost-covering consultation fees for self-referral patients in tertiary public hospitals. Previously, patients received medicines free of charge in government-owned health facilities, but must pay elsewhere. Before the government implements a payment policy in other areas of health care, it is important to investigate the prices, affordability and availability of essential medicines in Malawi.MethodsData on availability and prices of 50 essential medicines were collected in 44 health facilities in two major cities and two districts. These included 12 public facilities, 11 facilities of the Christian Health Association of Malawi (CHAM), nine retail pharmacies, eight wholesalers and four private clinics/hospitals. Price, availability and affordability were assessed based on the methodology developed by the World Health Organization and Health Action International, which compares local prices to international reference prices.Results and discussionThe overall availability of medicines was 48.5% in public facilities, 71.1% in retail pharmacies, 62.9% in CHAM facilities and 57.5% in private clinics. The availability of essential medicines varied from 0% for ethosuximide to 100% for amoxicillin and cotrimoxazole tablets. Antibiotic formulations for adults were widely available, in contrast to the low availability of pediatric formulations. Several medicines for non-communicable diseases like sodium valproate, phenytoin, paraldehyde, captopril and simvastatin showed poor availability and affordability. The overall median price ratio compared to the international reference price was 1.11 for wholesalers, 2.54 in CHAM facilities, 2.70 in retail pharmacies, and 4.01 in private clinics, which is low compared to other countries. But nevertheless, for 18 out of 32 medicines assessed, the cost of one course exceeded the statutory minimum daily wage, making them unaffordable to a majority of the population. Therefore, continued provision of free public health care is still of critical importance for the foreseeable future until other financing mechanisms have been explored.

Government of Malawi's unconditional cash transfer improves youth mental

Government of Malawi's unconditional cash transfer improves youth mental

Government of Malawi's unconditional cash transfer improves youth mental

Government of Malawi's unconditional cash transfer improves youth mental

Characterization of Groundwater Discharge to Rivers in the Shire River Basin, Malawi

This study investigates groundwater discharge to rivers in the Shire River Basin, Malawi, using the base flow index (BFI) approach. The BFI represents the baseflow component of a river and is often used as a proxy indicator of groundwater discharge to a river. The smoothed minima method was applied to river flow data from 15 gauges in the Basin (ranging from 1948 to 2012) and the Mann-Kendall (MK) statistical test was used to identify trends in the BFI. The BFI results indicate that groundwater plays an important role in contributing to river flows in the SRB, especially in the dry season. Expressing the BFI as a percentage, these values indicate that annual groundwater discharge to the river’s ranges from 19% in the Rivirivi River to 97% in the Shire River. Seasonally, minimal difference was found between the annual and the wet season BFI. Generally, the dry season BFI was higher than those of the wet season with most rivers increasing to >75%. Groundwater data supported the seasonal fluctuations identified in the BFI data, however, there were no groundwater monitoring boreholes in close proximity to any of the river gauges for in-depth analysis. The results also showed long term trends in the BFI data indicating behavioural changes in the river baseflow and groundwater discharge. In some areas, the declines in BFI indicate that groundwater discharge has been reducing over time due to declines in groundwater levels. This is a concern for the sustainable management of water resources in the Basin. The findings of this study provide important new knowledge on the seasonal and long-term behaviour of groundwater discharge to rivers in the Basin which will be crucial for supporting sustainable water resources management practices. The results will be particularly useful to the new National Water Resources Authority within the Malawian Government, who will oversee catchment management plans.

The potential of insect meal in improving food security in Malawi: an alternative of soybean and fishmeal in livestock feed

It is reported that fish contribute 70% of the animal protein intake in Malawi. This may be currently lower, as per capita fish consumption is reported to have declined by 58% from 14 kg/person/year in the 1970s to 8.12 kg/person/year in 2014. The situation poses a serious national nutrition problem, if not put under control. The Malawi Government and other stakeholders were therefore prompted to promote fish farming to supplement the fish that are provided from capture fisheries on the market. Currently, Malawi Development Cooperation (MALDECO) Aquaculture is a prominent commercial aquaculture company in Malawi, with just above 6,000 small-scale farmers. Feed is a challenge due to the high prices of soybean and imported fishmeal. Most small-scale fish farmers use maize bran to feed their fish, but this is nonviable as it results in low yield and abandonment of fish farming by most farmers. This study seeks to provide information in search of a solution to address feed challenges in the fish sector. A literature review was conducted on approaches being used by fish farmers and current efforts to resolve these challenges, and the information gained was used to outline a roadmap for solving livestock feed challenges at household level in Malawi. It was observed that using waste from the farmyard, farmers could culture insects which have high protein content than soybean and highly digestible than fish meal. Insects can deal with environmental pollution by utilising waste. Incorporation of insect meal in fish feed can replace soybean and fish meal, hence turning the fish industry around in Malawi by making it more productive. The goal of making fish products adequately available on the market may rely on the potential of incorporating insect meal in fish feed. Insect inclusion in fish feed has a potential for increasing fish consumption per capita in Malawi, hence improving food security. However, challenges to be resolved are food acceptance, food safety issues and legislation, which can be dealt with by the coordination of government, industry and academia.

Health aid projects have both expanded and constrained the capacity of health facilities to deliver malaria services to under-five children in Malawi

ObjectiveThis article examines the potential pathways health aid may use to influence the availability of malaria services at a facility level and the utilisation of malaria services for children under...

Monitoring and evaluation design of Malawi’s Right Foods at the Right Time nutrition program

Child stunting is a public health problem in Malawi. In 2014, the Government of Malawi launched the Right Foods at the Right Time (RFRT) program in Ntchisi district delivering nutrition social and behavior change communication, a small-quantity lipid-based nutrient supplement to children 6–23 months, and nutrition sensitive activities. Monitoring and evaluation (M&E) systems are key aspects of successful program implementation. We describe these and the methodology for an impact evaluation that was conducted for this program. Two monitoring systems using traditional and electronic platforms were established to register and track program delivery and processes including number of eligible beneficiaries, worker performance, program participation, and to monitor input, output, and outcome indicators. The impact evaluation used comparative cross-sectional and longitudinal designs to assess impact on anthropometric and infant and young child feeding outcomes. Three cross-sectional surveys (base-, mid-, and end-line) and two longitudinal cohorts of children followed in 6-month intervals from 6 to 24 months of age, were conducted in sampled households in the program and a neighboring comparison district. Additional M&E included qualitative studies, a process evaluation, and a cost-effectiveness study. The current paper describes lessons from this program’s M&E, and demonstrates how multiple implementation research activities can inform course-correction and program scale-up.

Fresh Money for Health? The (False?) Promise of “Innovative Financing” for Health in Malawi

Since 2013, the government of Malawi has been pursuing a number of health reforms, which include plans to increase domestic financing for health through “innovative financing.” As part of these reforms, Malawi has sought to raise additional tax revenue through existing and new sources with a view to earmarking the revenue generated to the health sector. In this article, a systematic approach to assessing feasibility and quantifying the amount of revenue that could be generated from potential sources is devised and applied. Specifically, the study applies the Delphi forecasting method to generate a qualitative assessment of the potential for raising additional tax revenues from existing and new sources, and the gross domestic product (GDP)-based effective tax rate forecasting method to quantify the amount of tax revenue that would be generated. The results show that an annual average of 0.30 USD, 0.46 USD, and 0.63 USD per capita could be generated from taxes on fuel and motor vehicle insurance over the period 2016/2017–2021/2022 under the low, medium, and high scenarios, respectively. However, the proposed tax reform has not been officially adopted despite wide consultations and generation of empirical evidence on the revenue potential. The study concludes is that revenue generation potential of innovative financing for health mechanisms in Malawi is limited, and calls for efforts to expand fiscal space for health to focus on efficiency-enhancing measures, including strengthening of governance and public financial management.

2.5-O4The realities of providing universal health care for patients with chronic conditions in rural trans-border communities: a study in Malawi

Providing long-term care for people living with chronic conditions is a key component of universal health coverage (UHC). To achieve UHC and address social determinants of health, the Malawian government launched the second health sector strategic plan (HSSPII) in 2017. Achieving its targets would require an understanding of contextual factors and mechanisms influencing HSSPII implementation. We explore health stakeholders’ experiences of planning and delivering chronic care services for rural trans-border communities in Malawi. We conducted 15 semi-structured interviews with health stakeholders in Phalombe district, Malawi near the Mozambique border. Respondents were selected through snowballing and purposively to ensure diversity of responses. We applied a thematic approach to data analysis. Respondents reported mixed experiences with implementing the strategy on ‘paper’, with operational difficulties reflecting on-the-ground realities. A key concern for respondents from public facilities was high influx of migrant patients from border communities in Mozambique, due to user-fees charged in their healthcare system. This resulted to acute shortage of medical supplies and continuous pressure on health personnel in healthcare provision, which hindered the effective implementation of UHC. Respondents reported high patient-workload compromised quality of care provided and served as demotivating factors, which posed as major obstacles to UHC attainment. Health providers also experienced difficulties screening and assessing patient eligibility for free healthcare, given the integration of bordering communities. This was attributed to a lack of national identification system, which has severe financial and logistical implications for UHC implementation. While the HSSPII and UHC goals aim to increase coverage and make healthcare services geographical accessible, patient access was crippled by transportation and medication costs in paying health facilities. Health policy makers and planners need to utilise a sector-wide approach that takes into account the operational realities on the ground in implementing UHC, to design innovative interventions that target these findings.

The role of crop diversification in improving household food security in central Malawi

BackgroundThis paper concerns the role of crop diversification in improving household food security in central Malawi. In this country, the agricultural sector is dominated by smallholder farming and rain-fed food production systems that are facing increasing challenges from land degradation and declining soil fertility. Maize is the staple food crop, and as such, the majority of farmers grow it regardless of land suitability. This has led to what scientists have labeled as “maize poverty trap.” In the event of prolonged drought, maize fails thus leaving farmers food insecure. However, research in Sub-Saharan Africa has shown that crop diversification provides smallholder farmers with a diversity of diet, improves their income, and nutrition security. Due to increased cases of malnutrition and food insecurity, in the wake of climate change, government of Malawi has in the past few years intensified extension efforts for crop diversification.MethodsThe study is based on a sample of 271 randomly selected smallholder farming households from central Malawi. It investigates the influence of crop diversification and other household socioeconomic characteristics on the household Food Consumption Score and Household Food Insecurity Access Score. In our analysis, we rely heavily on a combination of ordinary least squares techniques and some descriptive statistics.ResultsOur results show that crop diversification, cattle ownership, access to credit and attaining of education have a positive and significant effect on the household Food Consumption Score. Precisely, crop diversification, cattle ownership and access to credit are all significant at 5% level, while education is significant at 10%. In addition, crop diversification and attaining of formal education by household head were found to have a negative and significant effect on Household Food Insecurity Access Score and were all significant at 1% level.Conclusion and policy recommendationBased on our study findings, we conclude that crop diversification is one viable option in smallholder farming that can ensure establishment of resilient agricultural systems that can contribute significantly to household food security. In terms of policy, the results imply that the current efforts by government of Malawi to intensify promotion of crop diversification should remain a priority policy direction due to the continued malnutrition and food insecurity threat. This is particularly so in this era of climate variability that poses an extra burden to farmers.

Mobile Health Initiatives in Malawi

Mobile health (mHealth) has emerged as a tool to enhance efficiency of healthcare service delivery in developing countries especially in hard-to-reach areas. The purpose of this article was to review the mHealth initiatives implemented in Malawi as a developing country, since 2010-2017 and their impact on health outcomes. Data was gathered through published reports, peer-reviewed papers, grey-literature on electronic health (eHealth), telemedicine and mHealth. The findings reveal that although the majority of mHealth projects have registered positive impacts, implementation challenges still exist. The study also revealed that the majority of mHealth projects are driven and funded by Non-Governmental Organizations (NGO) and have not moved beyond pilot phase. There is also lack of funding model on part of the Malawi Government to scale-up the mHealth programmes. Based on the challenges, the article makes some recommendations.