Antenatal Care (ANC) and Skilled Attendance at Birth:
According to the 2015-2016 DHS, nearly 95% of women receive ANC from a skilled provider at least once in their pregnancy, and 90% of births are assisted by a skilled provider.
Featured Faith-based Organizations in Malawi
The Christian Health Association of Malawi (CHAM) is an association of church-owned health facilities and training colleges in Malawi. CHAM is co-owned by the Episcopal Conference of Malawi and the Malawi Council of Churches. CHAM provides healthcare services, with a special focus on providing care to the poor and underserved, providing 75 percent of health care services in rural areas.
The Evangelical Association of Malawi (EAM) is a Christian umbrella organization for evangelical churches and Christian organizations that seeks to mobilize, unite and equip churches for the holistic proclamation of the love of God, through word and deeds. EAM has a membership of more than 120 church denominations and Christian organizations spread throughout the country.
LifeNet International operates in four countries, has 220 health center partners, 73 team members and provides health services to a catchment population of 4,060,000, as of 2020. LifeNet expanded its operations to Malawi, a major step toward the organization’s 2023 vision of impacting healthcare in 10 African countries, and has partnerships with 37 local health facilities across Malawi. World Renew began working in Malawi in 1989 and works to improve health care and service delivery in various areas of public health.
Contributions in Health Systems Strengthening
Using the Capacity Plus Assessment model, CHAM assessed the capacity of nine health facilities in the areas of human resource and health service delivery. Results revealed that some of the health facilities were underperforming and needed capacity strengthening. These results helped CHAM devise appropriate solutions, such as training health workers and volunteers on resource management and healthcare facility operation. According to Elled Mwenyekonde, Health Services Manager for CHAM, ongoing evaluation of health facility operation helps CHAM identify areas for improvement.
LifeNet Malawi provides technical training to health center workers on proper management and operation of health facilities, improve the quality of health care delivery and reduce the waste of resources. The organization also provides training to health workers on basic health education in maternal and newborn care and disease prevention, both at the health facility and community level.
Expanded Access to Information
Many people in rural areas travel long distances to access health services and information. In order to make health information easily accessible in communities, World Renew localized access to health information by adopting a Care Model system, which functions through community peer groups. Each community has a designated peer group member – usually a community health volunteer – who provides health information to community members.
Many people in rural areas travel long distances to access health services and information. In order to make health information easily accessible in communities, World Renew localized access to health information by adopting a Care Model system, which functions through community peer groups.
According to Lemon Chipwatali, Project Manager, World Renew Malawi, “Since health volunteers live in these communities and know some of the health needs of the people, they are in a trusted position to address basic health questions that community members have.” Mr. Chipwatali believes that this Care Model encourages health-seeking behaviors, which can increase the utilization of health services.
Both CHAM and EAM have family planning projects to increase family planning access and provide sexual and reproductive health education across Malawi. So far, CHAM has reached nearly 25,000 adolescent girls with family planning, gender-based violence, and sexual and reproductive health education. CHAM also helped to establish community groups for men in order to promote family planning dialogue among men. Furthermore, CHAM uses community health structures to increase access to family planning services by the communities through Health Surveillance Assistants (HSAs) and Community-Based Distribution Agents (CBDAs).
The Christian Health Association of Malawi uses community health structures to increase access to family planning services by the communities through Health Surveillance Assistants (HSAs) and Community-Based Distribution Agents (CBDAs).
EAM focuses family planning outreach efforts to Muslim and Christian faith leaders. In order to increase awareness and demand for services, EAM established a church referral program for family planning and trained health counselors to go door to door in the community to provide health messages on family planning and cervical cancer.
Challenges to Family Planning
CHAM and EAM have faced challenges with religious leaders who prohibit family planning use due to the belief that contraception violates God’s plan for procreation.
CHAM works to engage religious leaders in family planning by being careful to ensure the messages and methods do not conflict with their religious beliefs. CHAM also engages community health workers in FP, which has helped communities access family planning services which are not available in most Catholic facilities.
“We use Christian radio and TV channels to reach Christians with reproductive health messages and information.” Howard Kasiya, Evangelical Association of Malawi
Howard Kasiya, National Coordinator of EAM, said that for some church denominations, family planning discussions are very difficult. According to Mr. Kasiya, EAM has held meetings with religious leaders on sexual and reproductive health and sexual and gender-based violence to find common ground. “We also use Christian radio and TV channels to reach out to Christians with reproductive health messages and information,” said Mr. Kasiya. “We have one-hour interactive reproductive health programs on these issues, including FP and youth-friendly health services.” In addition, EAM has trained church leadership, both clergy and lay people for church reproductive health programs.
EAM’s family planning programs also face resistance from parents who prohibit adolescent girls from accessing family planning education under the belief that family planning promotes promiscuous behavior. Shortage of family planning commodities is another challenge
Improving Immunization Coverage
CHAM utilizes Health Surveillance Assistants to help provide vaccines and health outreach at health facilities and in communities. Similarly, EAM uses media campaigns to promote vaccines in Malawi, with a particular focus on increasing male engagement in antenatal activities. LifeNet educates community health workers about the importance of vaccines and trains community health workers to conduct vaccine surveillance in various communities.
Engaging Faith Leaders in Vaccines
Both CHAM and EAM use churches as outreach centers for vaccine delivery and education. Faith leaders also assist with promoting vaccines within their respective churches. For instance, when CHAM introduced the new human papillomavirus (HPV) vaccine, faith leaders were sensitized and trained to distribute information in various communities to increase vaccine acceptance. Faith leaders helped increase the uptake of HPV vaccine by informing the community of its importance.
Through the financial support of the Danish Church, CHAM provided communities with farming materials such as water cans and crop seeds so that farmers can grow food and address nutrition issues at the household level. Through funding from the United Nations Children’s Fund (UNICEF), CHAM operated 54 nutrition rehabilitation unit centers for severely malnourished children, who were rehabilitated for two weeks and discharged after their nutrition health improved.
World Renew is currently conducting a nutrition project in the central region of Malawi within seven communities to reduce stunting. This nutrition program also includes projects related to gender, and water, sanitation, and hygiene education.
Through its Right to Food Program, EAM works with traditional leaders to advocate for land ownership for women and promotes equal access to food for women, children, and youth. In addition, EAM promotes equal share of food production after harvesting to prevent women from experiencing food insecurity.
According to Howard Kasiya of EAM, women often experience food insecurity after a harvest because all food production is owned and managed by men, as men have land ownership. EAM also trains farmers and community members on proper food storage to prevent food waste.
More importantly, a component of the Right to Food Program focuses on teaching community members to construct eco-friendly cooking stoves that use less firewood and produce less smoke. According to Mr. Kasiya, “Since girls and women are the ones who cook, we want to ensure that they don’t suffer from the health effects of smoke inhalation.” In addition, EAM manages animal husbandry activities such as rearing goats and chickens to promote food security and protein intake in communities.
Advocacy and Policy Work
Since 85 percent of CHAM’s work is in rural areas, the organization advocates at the governmental level for universal health care access for the rural population. CHAM entered into an agreement with the government of Malawi for the government to cover the cost of health care services at CHAM health facilities in rural areas, eliminating the need for people to travel long distances to access health care services from government-owned public health facilities.
Currently, 154 out of CHAM’s 179 health facilities have Service Level Agreements (SLA) with the Malawian government. Under these agreements, the government covers the cost of maternal, neonatal and child health services. The government also pays for salaries for almost all CHAM facilities and the government supplies CHAM facilities with free commodities like vaccines, MNH-FP commodities, Malaria drugs and supplies, ART/TB treatment and other drugs and supplies that are mostly supported by donors. SLAs do not cover overhead costs, so facilities use the revenue they generate from the SLA to pay for drugs, pay utilities, and overhead costs.
EAM developed a child protection and safeguarding policy for the church to reduce gender-based violence in communities. According to Mr. Kasiya of EAM, “We wanted to ensure that the church is equipped with adequate tools to respond to the health and social service needs of communities, particularly those that affect adolescent youth.” In addition, EAM is empowering adolescents to speak up against child labor and abuse and participate in activities that improve their health and well-being.
Road Ahead for Faith-Based Organizations
“The church is our biggest advocate and the backbone of the work we do to improve the lives of those we serve. The support we receive from faith leaders helps us to strengthen our work and increase the reach. Without the support of the church, we cannot stand strong.” – Lemon Chipwatali, World Renew Malawi
The work of the Christian Health Association of Malawi, the Evangelical Association of Malawi, LifeNet Malawi, and World Renew demonstrates the critical role the Church and faith leaders play in health service delivery and the promotion of health behavior change in rural communities.
According to Mr. Chipwatali of World Renew Malawi, “The church is our biggest advocate and the backbone of the work we do to improve the lives of those we serve. The support we receive from faith leaders helps us to strengthen our work and increase the reach. Without the support of the church, we cannot stand strong.”
As faith-based organizations continue to improve health care access in rural areas, it is critical to remember that their success has been aided by their faith networks, which have been maintained for decades. The call to action is to continue building the capacity of faith leaders and the church so that they can champion various health activities in their respective churches and the larger community.
The CCIH Country Spotlight Series features Christian health services in a number of countries, including those provided through facilities, communities and churches. The aim is to help identify Christian health organizations and highlight key partnerships and initiatives that improve health for those in need. These publications are illustrative and will not represent or reflect the entirety of important Christian contributions to the design and delivery of health services.
CCIH Intern Patience Mhlanga, MPH conducted research and writing for this report.