In July 2015 the Malawian Ministry of Health (MOH) and partners celebrated the country’s achievement of Millennium Development Goal 4—Reduce Child Mortality. Despite this remarkable success, neonatal mortality remains high and Malawi is listed as having the highest PTB rate in the world (18.1/1,000 live births). LBW occurs in an additional 14% of births in the country (Situational Analysis of Newborn Health in Malawi, 2013). To catalyze action for improved newborn health the MOH launched Malawi’s Every Newborn Action Plan (ENAP) in July 2015. Major challenges in newborn care identified by the MOH include inadequate staffing and insufficient essential supplies, gaps in the quality of care at the time of birth and in newborn/KMC units, weak referral and follow-up systems after discharge to the community, and inadequate support to families during home-based care.
In Malawi Every Preemie will support the USAID-funded Njira project’s implementation of a community-based model for improved PTB/LBW newborn care in select areas of the Balaka district. The Malawi project is unique in that it employs a two-pronged approach—targeted technical assistance, and evaluation and learning.
Technical Assistance: Every Preemie will provide technical support for the implementation of a community-based model that integrates PTB/LBW newborn care into community networks, referral systems, and health services, extending Malawi’s ENAP strategy to the community and household level. With USAID/Malawi field support, Every Preemie will work with PCI’s USAID-funded food security project (Njira) to assess, evaluate and document community practice and service pathways for improved PTB/LBW newborn care in Balaka, Malawi. The Balaka district in central Malawi was chosen as the target area because it has high poverty, malnutrition, and maternal and newborn mortality rates and is a priority area for USAID/Malawi assistance.
The Njira project team and Every Preemie will work in close collaboration with the District MOH to ensure that evidence-based community interventions and practices are applied at critical points along the continuum of care from the health facility to the household level. This will include: linking quality-focused, client centered maternal and newborn health services from the community to the facility level; utilizing community platforms such as Care Groups that promote social behavior change and improved access to and use of community and facility care; promoting the identification of and outreach to pregnant and recently delivered women; supporting a framework of targeted interventions for intrapartum services that affect the well-being of mothers and PTB/LBW infants; the identification and referral of early/small babies to facility-based care; follow-up of women/newborns discharged from facility care; and support for care of early/small babies in community health services and at the household level.
Evaluation and Learning: Every Preemie, with a local research partner, will evaluate/test the Njira community-based model to determine if newborn outcomes are improved when families with early/small babies 1) access/receive health care information and community support, and 2) access health services from the household to the facility level with particular focus on improving post-discharge home-based care of small/early babies. The evaluation will also look at variables related to the potential for sustainability and scalability of this community approach. In addition, Every Preemie will develop a small research grant ($10,000) to work with a local organization to assess social factors that influence the acceptance/non-acceptance of preemies.