Health System Strengthening

Malawi EMPOWER employs a robust monitoring and learning approach guided by the logic model to monitor progress towards results by generating high quality data aligned with the Government of Malawi (GoM) and USAID/PEPFAR requirements. The project uses ICT to improve data visualization and increase access to real time data that communicate priorities to managers and to facilitate ongoing learning, through enhanced analysis of integrated project data sets. This is complemented by targeted implementation science and operations research, linked to a process of quality improvement (QI) involving stakeholders in structured forums at multiple levels.  Further, Malawi EMPOWER strengthens capacity of LP from the community through the national levels to produce, analyze, and apply high-quality data for improved service delivery.  monitoring throughout the project cycle will use performance, context monitoring and implementation science to compliment routine monitoring.

Malawi EMPOWER mentors and provides skills building to local implementing partners, and other stakeholders for them to be able to develop robust monitoring and evaluation systems that are responsive to donor and government of Malawi needs. The project ensures that its decisions are evidence based through maximum utilization of data and hence maintaining high quality data at all times is of the SI priorities for the project. To achieve this, the Malawi EMPOWER SI unit conducts the following interventions:

• In-depth monitoring and evaluation capacity assessments of local implementing partners.
• Capacity strengthening on monitoring and evaluation
• Routine data quality assessments.
• Rigorous data analysis using statistical packages like STATA, SPSS etc.
• Geo-spatial analysis.
• Data management
• Presentation of data through visual applications like Power BI software.
• Abstract developments.
• Project evaluations from baselines, mid-term evaluations and summative evaluations. Implementation science
• Development of quarterly data bulletins.
• Tool’s development
• Mobile data collection developments using OpenDataKit (ODK), Kobo, DHIS2 etc.

As Malawi nears epidemic control, PEPFAR-Malawi’s COP20 priority is to review how the roles and responsibilities of lay cadres supporting HIV services can be formally integrated into the government’s health system to sustain the HIV/AIDS program. This process is in line with the 2018 “WHO guideline on health policy and system support to optimize community health worker programs”. PEPFAR in collaboration with its implementing partners conducted several HRH analyses including analysis of the HRH inventory and an HRH analysis using the HRH Optimization Tool for Differentiated ART Service Delivery (HOT4ART) to better understand the PEPFAR HRH context in Malawi.

WHAT WE DO

As a PEPFAR/USAID funded project, Malawi EMPOWER has been instrumental in the task force that has been undertaking the standardization of lay cadres across USAID partners in Malawi as a first step in HRH sustainability planning.

HOW WE DO IT

Malawi EMPOWER Activity provides technical support to the harmonization process through participation in lay cadre harmonization Task Force meetings which is ensuring harmonization at two levels: at PEPFAR level first, and later, harmonization with government to facilitate transition of the lay cadres into the government structure.

The project’s participation in the Task Force meetings ensures consensus at each step to increase ownership of the process by all parties and commitment to implement the harmonized parameters. This standardization process is being guided by the PEPFAR program’s current and post epidemic control needs (rationalization of each lay cadre category), optimization (maximizing performance) of available lay cadres and feasibility of transitioning the lay cadre to GOM staff establishment.

This process will also strengthen government systems so that existing systems are utilized other than creating parallel systems. Lessons from partner experiences managing the PEPFAR program and lay cadres will inform the process as well as financial and human resource implications and implications on service delivery of the standardization process.

Strong supply chains systems are essential for positive health outcomes. Malawi EMPOWER Activity supports commodity security in all its service delivery points by ensuring that the right quantities of the right products (contraceptives, condoms, test kits, PPEs) are available at the right time for the targeted audience (AGYW) in mobile clinical outreach. Through the projects service delivery teams (Nurses and HIV Testing Counsellors) health commodity requests are submitted to the district pharmacy on weekly basis to support facility stocks accessed at health centre level for use during mobile clinical outreach. Commodity consumption and re-supply needs are reported in the Logistics Management Information System (LMIS) at district level for commodities accessed at district level and at health centre   for commodities accessed at health facility level.

The Malawi EMPOWER Activity ensures uninterrupted supply of health commodities at community level through trained Youth Community-Based Distribution Agents (YCBDAs) who distribute condoms and oral contraceptives and refer AGYW to health facilities or mobile clinical outreach for other contraceptive methods.

The Activity supports uninterrupted supply of health commodities at community level through strengthening the supply chain system that supports community cadres at facility level through mentorship, supportive supervision, and training of facility staff. YCBDAs report commodity consumption and submit requests for condoms and oral contraceptives on weekly and monthly basis to focal persons at health facility level.

To support Supply Chain Management (SCM) leadership at district level, the EMPOWER Activity developed supervision guidelines; identified a focal person for SCM and facilitated the establishment of a SCM committee which consists of programme coordinators and pharmacy technicians to support planning and operations, mentorship and supervision and relocation of commodities from facilities where they are in abundant to where they are in short supply. The SCM committee is responsible for mentoring facility staff during monthly facility-based meetings to ensure uninterrupted stocks; timely and accurate reporting into the country’s existing LMIS and to support their understanding on how to manage stocks for new products, such as PrEP or HIV self-tests. Sites that struggle to maintain appropriate stock levels as defined by the national supply chain, based on the sites’ consumption level are supported by the district level team to strengthen their capacity in stock management (quantification and supply planning).

In response to COVID19, the Malawi EMPOWER supported sites with the procurement of Personal Protective Equipment (PPEs), over and above PPEs accessed from the District Health Office to ensure that service delivery teams have the necessary supplies for implementation of effective infection prevention measures in all sites and to avoid service disruptions due to lack of PPEs. The project continues to track the availability of PPEs on weekly and monthly basis to avoid stockouts and service disruptions which can lead to missed doses of contraceptives resulting in unplanned pregnancies.