Malawi

Our programs in Malawi provide comprehensive, layered support for children, adolescents, and families through people-centered service delivery. We scale proven models to prevent new HIV infections, strengthen pediatric case findings, and improve HIV treatment outcomes for children and adolescents. We provide tailored technical assistance to the Government of Malawi aligned with country priorities to improve coordination across the sectors of social welfare, health, and education and strengthen Malawi’s existing National Case Management System.

Country Overview
Health and HIV
Economic Strengthening
Education
Social Protection
Systems Strengthening
Adolescent Girls and Youth

Malawi

Though Malawi is on track to achieve 95-95-95 goals, children and adolescents living with HIV lag behind adults in status awareness and viral load suppression. While HIV prevalence for children is only 0.7% compared to 8.1% for adults, children represent 15% of AIDS related deaths annually. HIV prevalence rates for girls and young women ages 15-24 are more than double that of their male counterparts (3.6% vs. 1.5%) and nearly three times higher among women ages 25-29 (13.6% vs. 4.7%).

To address these challenges, we work in close collaboration with clinical partners to scale evidence-based HIV prevention services and to extend the continuity of care for children and adolescents living with HIV using a structured community case management system.

To prevent new HIV infections, we deliver age-appropriate layered HIV prevention interventions including HIV screening/testing, family planning and contraception, PrEP, psychosocial support, economic strengthening, education support, and violence prevention and response. Our HIV prevention interventions targeting adolescent girls and young women increase self-confidence and promote goal-oriented actions, including the ability to negotiate safe sex.

To improve HIV treatment outcomes for children and adolescents living with HIV, we coordinate and deliver integrated wrap-around services while continuously monitoring progress to ensure they can access needed services across the care continuum. Trained community teams support and track children and caregivers from intake through care plan achievement.

Innovations:

To improve viral load suppression rates for children and adolescents living with HIV and strengthen service delivery for families, we developed an “OVC Viral Load Coverage and High Viral Load Management Tracker” (VL Tracker). The VL Tracker is a game changer because it enables OVC and clinical partners to jointly monitor viral load coverage, track viral load trends, document root causes for non-suppression, and record the services provided by each partner.

We developed an HIV Exposed Infant (HEI) Tracker that is used in tandem with our Early Childhood Stimulation curriculum to prevent mother-to-child transmission of HIV by promoting HIV testing and ART adherence. We work with health facility staff to conduct individualized service delivery at the household level and ensure that parents appreciate the importance of testing for HIV exposed infants. We engage clinical partners to promote family-friendly scheduling so that caregivers and HIV exposed infants can receive services at the same clinic visit.

We rolled out a closed user group (CUG) that enhances peer support and supervision networks for community case workers, their supervisors, clinical providers, and government social workers using mobile phones.

We are mainstreaming mental health and psychosocial support (MHPSS) through our DREAMS program in tertiary institutions to promote and sustain good mental health by focusing on maintaining a school-life balance , managing stress, and asking for help when needed. We are also partnering with the EdTech Center at World Education and with Adobe to use “PDF Liquid Mode” to create readable digital job aids that community case workers can access offline on their phones.

Health and HIV

To contribute to HIV epidemic control, we scale platforms and interventions that significantly aid identification, screening, testing, linkage, and retention in treatment for HIV-positive children, adolescents, and their families. We placed community OVC cadres in high-volume HIV health clinics where they work closely with clinical staff to generate joint strategies for improved HIV treatment outcomes.

We develop innovative training, job aids, and supportive supervision mechanisms to upskill community case workers so that they can monitor HIV outcomes at the community level. Leveraging clinic and case file data, community case workers respond quickly when children miss clinic appointments, need ART refills, or require viral load testing. For complex cases, community case workers conduct multi-sectoral case conferencing with clinical partners to identify and address barriers and coordinate timely and appropriate follow-up services. For non-suppressing children and adolescents, we provide an increased frequency of home visits, nutrition support, transportation to attend clinic sessions, and enhanced adherence counseling.

Economic Strengthening

Household Economic Strengthening: We support the socio-economic resilience of families through a range of household economic strengthening interventions. We have linked over 27,000 caregivers to Village Savings and Loan Associations (VSLAs), provided business skills training to over 28,000 caregivers, and delivered financial literacy training to over 23,000 caregivers. As a result, over 17,000 caregivers either expanded their current income generating activities or started new small enterprises. We also provide market facilitation for caregivers in mature VSLA groups, linking over 3600 caregivers with enhanced income generating opportunities in various sectors, including domestic trading, retail, food processing, and contract farming.

Youth Economic Strengthening: Our age-appropriate economic strengthening activities for adolescent girls and young women under DREAMS strengthen self-efficacy, independence, and decision-making to bolster HIV prevention by decreasing reliance on transactional sex to meet basic needs. We provide age appropriate financial literacy (through Aflatoun, Aflateen, and Aflayouth) to all DREAMS participants and have linked over 68,000 adolescent girls and young women over the age of 15 to Youth Village Savings and Loan Associations (YVSLAs). For adolescent girls too young to participate in YVSLAs, we linked their caregivers to adult VSLAs to improve household financial stability.

Through Siyakha, we provide comprehensive workforce readiness that includes life skills and vocational training, internships/apprenticeships, and post-completion monitoring support for self-employment or employment. More than 1500 adolescent girls in Malawi have completed Siyakha. They are now earning livelihoods in a range of high growth, high opportunity sectors (including traditionally male-dominated sectors) such as smart agriculture and agri-processing, carpentry, clothing and textiles, cosmetology, hospitality and tourism, motorcycle repair, refrigeration/air conditioning repairs, videography and production, welding.

Education

Through DREAMS, we provide education subsidies to keep adolescent girls and young women in school, and support young women in tertiary institutions to remain HIV-free. The Siyakha Workforce Readiness program ensures adolescent girls and young women can access short vocational training courses. Our early warning systems prevent drop out by mobilizing caregivers, Mothers Groups, school officials, teachers, and traditional leaders to identify those at risk of leaving school and advocate for children’s education.

“In 2019, I got pregnant after sitting for standard 8 examinations. Luckily I passed my examinations, but my parents failed to support me with school fees to progress with my studies at Bangwe Secondary School. When our DREAMS Club Facilitator was doing screening for Education support, I was one of the lucky ones selected to be on the school fees bursary. At school, people mocked me as I was a teen mother, but APA-trained mother groups supported and encouraged me. My ambition is to be a nurse. Being part of DREAMS, I have not just benefited from the educational support, I have also benefited from knowing different family planning methods and also how I can protect myself from HIV. I have also learned how to value myself and how worthy I am.”

Bester, 16 years old, Bangwe-Blantyre
(from FY22 annual report)

Social Protection

We support the ongoing efforts of the Government of Malawi to strengthen the National Child Protection and Case Management System and enhance the coordination of care, protection, and support services. We are assisting the Government in updating the National Child Protection and Case Management training for community case workers to make it more HIV-sensitive, and supporting the improvement of the MIS system for tracking OVC (orphans and vulnerable children) data nationally. To strengthen family resilience, we use age-appropriate parenting programs that help families improve communication, mutual respect, budgeting, and conflict resolution. To reduce violence, we scale evidence-based HIV and violence prevention curricula targeting adolescent girls and boys.

Systems Strengthening

We work to enhance the capacity of local and national government structures to coordinate HIV prevention and response for children, adolescents, and families. We are supporting efforts to develop a national OVC database for Malawi, and helping the Department of Social Welfare with technical review meetings and supportive supervision. To close gaps between health and social protection services, we are assisting the Government of Malawi in strengthening the National Child Protection Case Management System.

Adolescent Girls and Youth

Through DREAMS, we provide a combination of behavioral, structural, and bio-medical interventions that address the complexities of the lives of adolescent girls and young women in Malawi. Moving away from siloed and vertical programming, we provide a layered package of multi-sectoral, evidence-based interventions to address the factors that elevate the risk of adolescent girls and young women to HIV. We tailor interventions based on age, HIV risk profiles, and individual circumstances so that adolescent girls and young women receive the sexual and reproductive health (SRH) and social protection services most relevant to helping them stay HIV free.

Layering is critical to the success of DREAMS, and it requires tracking and coordination with a range of partners to ensure that every adolescent girl and young woman completes the full package of interventions that increase their self-confidence, assertiveness, goal-oriented behaviors, and ability to negotiate safe sex. The key layers include economic strengthening (especially for older and out-of-school adolescent girls and young women), financial literacy, violence prevention, family planning to avoid unwanted pregnancy, PrEP, psychosocial support, education support (school fees, uniforms, textbooks), HIV screening/testing, and referrals for post-violence care.

We collaborate closely with facility-based partners to conduct joint planning and create routine schedules for bringing SRH and HIV testing services to DREAMS clubs at the community level. In collaboration with the Ministry of Health, we trained DREAMS Clubs Facilitators to serve as distribution agents for HIV self-test kits and certified them to conduct initial screening and referrals for PrEP.

Photo to the left: Fazila Kazambe, 20, DREAMS Club Facilitator

“In my community, most girls had no idea where to get help when faced with GBV. Some had dropped out of school due to parental negligence. I am happy that I have seen at least 18 girls go back to school after my interactions with their parents/caregivers as well as the girls. This motivates me a lot.”