Bringing child health services closer to rural communities in Malawi

November 2015

Malawi is making progress in its fight against child mortality by moving critical health services closer to families who live in remote, rural areas.

A community health worker, Frida Kabwango, diagnoses and treats 3 year old James Mabvuto for malaria at Matapila Village Clinic in Ntcheu District, Malawi.
A community health worker, Frida Kabwango, diagnoses and treats 3 year old James Mabvuto for malaria at Matapila Village Clinic in Ntcheu District, Malawi.
WHO / A. Gumulira

Malawi's Ministry of Health has been working with WHO to train community health workers to treat common childhood diseases under the Rapid Access Expansion (RAcE) programme– funded by the Government of Canada and launched in 2013.

The approach, known as the integrated community case management (iCCM) of childhood illnesses, focuses on treating diarrhoea, malaria and pneumonia, which together accounted for 45% of deaths among children younger than 5 years of age in the country in 2012.

“The incidence of preventable deaths among children underscored the need for the program years ago,” said Dr Storn Kabuluzi, Director of Preventive Health Services at the Malawi Ministry of Health. “So we adopted an aggressive strategy for child survival in 2008,” he said, noting that health workers were trained to treat fevers and other illnesses among children. “Thanks to these efforts, Malawi is now on track to achieve MDG 4.”

Dr Kabuluzi was referring to the Millennium Development Goal that calls for reducing the mortality rate for children younger than 5 by two-thirds, between 1990 and 2015. Malawi has already exceeded that goal. In 1990, the mortality rate for children under 5 was 245 per 1000 live births. By 2013, it was 68 per 1000, a reduction of 72%.

Better results through an unprecedented partnership

The women waiting in line at the Matapila village clinic in Ntcheu District, in the central region of Malawi, said they have noticed a difference.

“Frida Kabwango, the community health worker here, comes to the village clinic full-time Tuesdays and Fridays and the rest of the time we can go to her home,” said Priscilla Laimani, a mother of 4. “It’s a relief to have these services and medicines available for free, just a few doors away, when our children have fever.”

Previous iCCM strategies aimed to serve people outside an 8 km radius of the nearest health facility, the RAcE initiative has reduced that distance to 5 km.

WHO has been facilitating national policies for iCCM scale-up, and serving as the grant’s main financial steward. Save the Children Malawi and other nongovernmental organizations have been providing implementation support. When the iCCM programme started, there was 1 supervisor for 137 health workers and now there is 1 for every 3 community health workers. As a result, community health workers are better at providing appropriate diagnosis and treatment.

The programme is now expanding by providing maternal and neonatal care and introducing rapid diagnostic testing for malaria.

“The progress is encouraging, but we can save even more lives by developing the skills of community health workers and extending the coverage of their services,” said Dr Kabuluzi.

By starting small, big things will follow

But there is plenty of room for improvement. “Ideally, we would have 1 community health worker providing a complete range of services in each of the 46 000 villages in Malawi, but the government could not foot such a large wage bill,” said Humphreys Nsona, Head of the Integrated Management of Childhood Illnesses unit at the Ministry of Health.

When children have illnesses that require a referral to the district health facility, parents often do not have the means to take them there. Furthermore, community health workers often live far from where they work, which can make it difficult for them to provide services as needed.

Despite the struggles, Health Ministry staff, district hospital management teams, health workers, parents and community representatives said they were hopeful. “This treatment service is very valuable to us because it has been saving the lives of our children,” said Samson Gonondo, from Matapila village. “We would like to see it extended to the rest of the community—to individuals above age 5. I remain optimistic. My experiences have shown me that if we have a vision and work together on it, others will be inspired to help us. By starting small, big things will follow.”