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Work in Malawi

14 April 2010

On Thursday 18th and Friday 19th March, local and international MaiKhanda
staff and partners attended the biannual MaiKhanda Partners' meeting in
Lilongwe Malawi. Tim Colbourn, Bejoy Nambiar and Anthony Costello of CIHD
took part in their roles as evaluators of the MaiKhanda programme. Progress
reports for both the community and facilities intervention (see description
of MaiKhanda below) were shared as were the latest findings from the evaluation
team. A number of interesting discussions followed. The focus of these were
on how successful the interventions have been to date and whether the
interventions have matured enough to be spread to other areas. Following
discussions with the partners it was agreed that further in-depth analysis
is required in order to answer the first question on success, and that the
answer to this question is a prerequisite for answering the second question
regarding spread. CIHD is leading detailed studies on the impact of the
interventions, the processes behind the interventions' successes or failures
(to enable adaptation and replication in other contexts), and the
cost-effectiveness of the interventions. All of these on-going studies are
crucial in order to determine the overall success or failure of MaiKhanda.

MaiKhanda aims to reduce maternal and newborn mortality and morbidity in
three districts of Malawi (Lilongwe, Kasungu and Salima) over a six year
period. Reductions in mortality will be achieved through two main
interventions: quality improvement in health facilities offering
comprehensive and basic obstetric care (supply side intervention), and a
community mobilisation programme working through women's groups to address
key issues in maternal and neonatal care (demand side intervention).
CIHD has been contracted to evaluate MaiKhanda. This includes the following:
.      The impact of the proposed interventions on maternal and newborn
mortality. This is via a cluster randomized controlled trial design, through
a population based surveillance system at the community level.
.      Understanding the processes adopted in achieving QI (Quality
Improvement) at the health facilities and community mobilization at the
village level; and understanding the context within which, and the
mechanisms by which, the interventions work.
.      The cost-effectiveness of the interventions and its implications for
scaling up.