Evaluation of A.I.D. child survival programs: Malawi case study.

In March 1992 a USAID Center for Development Information and Evaluation team went to Malawi to evaluate the USAID child survival program. Data collection methods were document review key informant interviews health worker interviews group discussions facility visits and observation of clinics and their supply inventories. The USAID/Malawi child survival program concentrates on strengthening the health care sector so it can be self-sustaining. Capacity-building assistance goes to personnel training (e.g. Ministry of Healths Manpower Development Unit) health planning research epidemiology and health information and education. It is heavily weighed toward preventive health measures. Child survival efforts have been integrated with broader health and population program goals. As of 1990 USAID/Malawi had granted $44 million over the planned life of more than 20 projects to the national health sector. Major diseases affecting child survival in Malawi are malaria (32% of child deaths) chronic malnutrition (56% of all children) and nutritional deficiencies (17% of child deaths). Pediatric AIDS is growing rapidly in importance. The team found that USAID/Malawi child survival programs improved effectiveness in water supply health education and sanitation promotion activities; HIV/AIDS control; and child spacing. Areas needing improvement are malaria control and oral rehydration therapy to control diarrhea. The team found that a reduction in child mortality and morbidity can benefit economic growth and that the returns on USAIDs investment in child survival warrant this investment. Initiatives to improve the likelihood of financial sustainability include policy dialogue with the government to increase budgetary support for health efforts to increase cost recovery through fees for curative services in 3 major hospitals and private sector provision of services. Infection rates have fallen. Poor measurement of results weakens programs.