Parent And Child Health Initiative (PACHI) with funding from UNICEF is implementing integrated C4D for Increasing demand for Primary Health Care Services (COVID-19, MNCAH and Malaria). The project is in the following 5 districts namely (Mzimba, Kasungu, Neno, Mangochi and Mulanje) and urban settings of (Blantyre city, Lilongwe city, Zomba city, Mzuzu city)
The recent surveys by UNICEF indicates that many have to zeal to follow all Covid-19 guidelines and prevention measures. COVID-19 has also created a situation where health-seeking behaviours have been affected. C4D needs to promote continuity of service through demand creation among caregivers. Recently there has been a development of COVID Vaccination, which is planned to be rolled out in Malawi. Insights gathered in communities and on social media indicate some level of hesitance in the population, which requires motivation individual and mobilization of communities to improve uptake.
MNCAH Social Accountability & Accountability to Affected Populations
Citizens have the right to participate in developing district plans that are aimed at improving their health and other areas of development. This can be done through participation in different feedback groups e.g. Village Forums, Area/Village Development Committees and Health Center/Hospital advisory committees. Some of the standards based on the Malawi Health Sector Strategic Plan include minimum staffing, functional health committees, functional water supply, electricity and communication system (land phone and mobile in maternity), functioning ambulance: Population ratio (1: 25,000), functioning motor cycle ambulance at the health center, availability of basic delivery package, youth friendly services, availability of vaccines (including Penta III, Measles II), and children with diarrhea receiving oral rehydration solution (ORS). These service standards need to be known and claimed by citizen in open fora which are culturally appropriate but not intimidating for the villager.
Malawi registered an increase from in malaria from 5.8 million in 2017 to 6.9 million cases in 2018. It is a leading cause of morbidity and mortality in children under five years and pregnant women. There has been an observed increase of Malaria in school going children too in the past two years. . Malaria accounts for over 23% of outpatient visits and 18% of in-patients (HMIS 2019) in Malawi. Inpatient malaria deaths are at 13 per 100,000 population (HIMS 2019) and malaria has a serious socioeconomic impact on families and the nation through work hours lost, school absenteeism and high levels of expenditures for prevention and treatment.
To reduce the trend, there is need to employ innovative approaches not explored before besides maintaining effective interventions. Some of the critical interventions to sustain the current gains are Political, Private Sector and community engagement through the global Zero Malaria Starts with Me Campaign. To lessen the burden among school going children the Malaria SBC strategy recommends communication and social mobilization activities in school and religious institutions.
Sexual and Reproductive Health and Gender
Access to reproductive health services among the youth is affected by inadequate knowledge about availability of services as well as attitudes and norms about access to such services. Change of community norms targeting the youth, parents and service providers is envisaged as one of the important community engagement interventions to promote access to services, especially among adolescent girls.
Data indicates that there is low access to immunization in the second year of life. In addition, there are low performing districts that need to improve services and systems to promote access to all vaccinations. To achieve this, social accountability needs to be coupled with behavior change interventions to promote perception of safety of vaccines, knowledge about required visits and benefits of vaccines. More emphasis has to be put on urban immunization.
Children with Disabilities
Children with disabilities have special needs of privacy, health, hygiene and protection. This becomes aggravated in emergencies. It is important to put special attention in all development endeavors to ensure these children have support, including access to immunization, birth registration, immunization, nutritious food, and protection from abuse and violence. Children with albinism deserve greater attention in Malawi due to their increased vulnerability. It is important that in all community engagement issues affecting these and other children are addressed.
Child marriage remains a serious problem in Malawi despite the 2017 constitutional amendment, which raised the marriage bar from 14 to 18 years of age for both boys and girls. About 46% of the get married before they reach 18 and 9% before they reach 15. According to UNICEF, Malawi has the 12th highest prevalence rate of child marriage in the world.