Malawi

Malawi has one of the highest HIV and AIDS prevalence rates in the world, with around 15% of those aged 15–49 years infected. I-TECH is collaborating with the CDC GAP Malawi, the MOHP, and other in-country partners to establish and evaluate the clinical attachment near the Lighthouse clinic for HIV and AIDS.

Spotlight: The HIV Fellowship Program

Beginning in 2009, I-TECH has worked with CDC and MOH to establish the Malawi HIV Fellowship Program. The fellowship is a 2-year, non-degree program designed to prepare and retain qualified and experienced Malawians to support the management of HIV prevention, care, treatment, and support services, and strengthen health management information systems (HMIS). Currently, through appointments at MOH, fellows in three specialties (HIV, Monitoring and Evaluation, and Information Technology) gain the expertise to support national HIV strategy, implement new initiatives, and replicate successful programs.

Under the mentorship of program officers and technical assistants at MOH, fellows gain leadership training and hands-on experience, and work in concert with mentors to advance Malawi’s HIV and related health programs. An assessment of the first year of the fellowship program, expected in 2010, will document lessons learned and best practices, and inform the program’s framework for future cohorts.

Overview

Since 2003, I-TECH has been working in Malawi in collaboration with the US Centers for Disease Control and Prevention Global AIDS Program (CDC GAP) to support capacity building initiatives. I-TECH activities primarily focus on providing technical assistance to extend the existing strengths of established programs and support the Malawi Ministry of Health (MOH). In 2009, I-TECH, with CDC and MOH, established the Malawi HIV Fellowship Program, designed to create a cadre of well-qualified health care workers to support, manage, monitor and evaluate HIV programs, and strengthen health management information systems (HMIS).

In 2010, I-TECH will begin a partnership with the Christian Health Association of Malawi (CHAM), an ecumenical umbrella organization of 171 Christian-owned health facilities and 10 training colleges in Malawi. The goal of this partnership is to support consistent and high quality pre-service training at CHAM’s 10 training sites in order to rapidly expand the number of qualified Nursing Midwife Technicians in Malawi.

Program Highlights

Ministry of Health Partnership. In 2007, I-TECH responded to a request from the MOH to place technical specialists within key units of the Ministry. The role of these experts is to help support the national response to the HIV epidemic by developing and implementing treatment and care models for HIV and AIDS (including continued scale-up of free antiretroviral therapy [ART]) and strengthening strategic information systems.

In December 2009, I-TECH also appointed a technical assistant in the Directorate of Planning and Policy Development to strengthen the MOH’s implementation of grants from the Global Fund for HIV/AIDS, TB and Malaria.

Drawing on technical experience in HIV care and treatment, training, and health systems strengthening, I-TECH’s primary role in Malawi is to work with MOH to continue to expand priority program areas.

Monitoring and Evaluation Capacity. In the last several years, I-TECH has also focused on supporting monitoring and evaluation (M&E) systems in Malawi. As HIV services are becoming a more established part of general health services, there is exerted effort to consolidate M&E systems and integrate them into HMIS. To assist these efforts, I-TECH seconded an M&E Technical Assistant and an M&E Fellow to the MOH. Both assist the Ministry to monitor and evaluate HIV and AIDS-related interventions throughout the country.

The crowning achievement for 2009 was the finalization of a 2-day curriculum to train professionals to use two new M&E “tools” (guides to proper execution of M&E tasks). One tool will guide monitoring and evaluation of antenatal clinics (ANC), and the other will support M&E for maternity care throughout the country. These successfully revised tools were highlighted as an outstanding achievement in the 2009 National AIDS Commission (NAC) external review.

Capacity Building: The Lighthouse Trust HIV/AIDS Clinic
The Lighthouse Trust provides a continuum of quality care, support, counseling and testing services to people living with HIV through several stand-alone clinics in the central region. Over 10,000 client visits per month are recorded at these clinics. The Trust supports capacity building of the national health workforce through the provision of formal trainings (classroom and practical attachments), development and piloting of optimal service delivery models, and operational research.Beginning in 2005, I-TECH identified and placed technical advisors at the Lighthouse to support the existing strengths of the program and build additional capacity around training and quality improvement.

Training Capacity

I-TECH works to build capacity in Malawi’s health sector through training, clinical mentoring, and health systems strengthening. To this end, technical advisors from I-TECH have worked in Malawi as seconded staff to enhance the skills of trainers at Lighthouse, MOH, DHOs, and other partners. Internally-focused capacity-building activities have included facilitation workshops and one-to-one mentorship opportunities. External capacity-building includes revising the national ART curriculum, and collaborating with the MOH’s Health Education Unit to develop information, education, and communication (IEC) materials.

Pre-Service Training: Supporting the Christian Health Association

Approximately 36% of the population in Malawi receives Malawi Nurse Assessment health care services through facilities operated under the umbrella of the Christian Health Association (CHAM). CHAM also provides pre-service training to health care workers through a robust network of 10 training sites. CHAM programs currently train more than 70% of the country's nurses. Graduates from the colleges generally begin work with the public health sector or in CHAM facilities.

In early 2010, I-TECH responded to a request from CDC to partner with CHAM to enhance its capacity to provide pre-service education to a new cohort of 250 nurses. Drawing on its extensive experience in health care worker training, I-TECH conducted a needs assessment in five nursing colleges. The focal areas of the assessment included faculty development, human resources for health (HRH), curriculum review, clinical practicum, skills laboratory, student assessment, infrastructure, leadership, and governance. The findings of the needs assessment will be used to identify priority areas for I-TECH's technical assistance to CHAM training colleges.

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