Malawi is a small country, heavily reliant on agriculture as a source of income and food. Being one of the poorest countries with a population of over 17 million, the public sector faces enormous challenges to support and sustain quality health services.
Formed in 1994 with its core programs in HIV prevention and reproductive health, PSI/Malawi has grown into the country’s leading social marketer. Today, PSI/Malawi’s portfolio includes a range of products and services to include HIV self-testing, voluntary medical male circumcision, water-borne disease prevention, malaria prevention, male condoms (Chishango), female condoms (Care and Whisper), family planning services and products (Safe Plan) and Tunza franchise clinics.
PSI/Malawi estimates that in 2015, its products and services helped avert 702,618 DALYs, including, by health area:
- 147,967 Malaria DALYs
- 431,071 HIV DALYs
- 113,102 FP DALYs
- 9,246 MNCH DALYs
- 1,223 WASH DALYs
PSI/Malawi’s family planning programs also provided 288,217 couple-years of protection.
Nearly 1 million Malawians aged 15 years and older are living with HIV, representing a prevalence rate of 10.4%. PSI/Malawi plays an important role in HIV prevention through various interventions including condom distribution, voluntary medical male circumcision, HIV testing and counseling and the introduction of HIV self-testing.
PSI/Malawi’s role is twofold within the total condom market in Malawi: 1) facilitating the government’s free condom distribution and mass communication campaigns, as well as 2) distributing male and female condoms using social marketing. PSI/Malawi promotes three condoms, including Chishango (male condom) targeting sexually active young males, and Whisper and Care (female condoms) offering an alternative, female-initiated option in condom use. In 2016, over 22 million Chishango condoms were sold, representing over 67% of the paid condoms market share. PSI/Malawi is also involved in some of the largest health communication programs supporting both the government and other stakeholders, especially in behavior change communication, targeted outreach and interpersonal communication. PSI/Malawi continues to implement various behavior change communication campaigns such as Chishango Music Bash, Tilib, (‘We are Cool’) and a ‘Google Me’ campaign, to sensitize young people and other vulnerable populations on HIV prevention.
PSI/Malawi provides voluntary medical male circumcision (VMMC) services using mobile service delivery. Initiated in 2013, PSI/Malawi’s VMMC program currently covers eight districts in southern Malawi with mobile VMMC services. In 2016 alone, PSI/Malawi teams performed over 30,000 male circumcisions across five districts to help prevent HIV. PSI/Malawi’s VMMC interventions are built on local capacity to deliver VMMC services and serve as a model to inform VMMC scale up in Malawi, which could be replicated in other districts and the country as a whole.
PSI/Malawi provides HIV testing and counseling services in hard to reach areas using twelve mobile teams. PSI/Malawi also offers integrated HIV and family planning services through ten additional mobile service delivery teams. Mobile teams target high-risk areas for mobile testing and refer all patients testing positive to the nearest health facility for follow-up and care.
In 2015, PSI/Malawi with support from UNITAID launched Malawi’s HIV self-testing project, UNITAID/PSI HIV Self-Testing AfRica (STAR), to contribute to the global effort to achieve the 90-90-90 treatment targets set for 2020. The project is designed to reach populations particularly in the rural and peri-urban areas. The goal is to promote self-testing to better reach people with limited access to current HIV testing services due to privacy issues or lack of convenience, as well as encouraging re-testing among those at high risk. As such, the project has been dubbed a milestone to the south eastern country’s efforts in curbing the spread of HIV.
PSI/Malawi is a long time partner in implementing the National Malaria Strategic Plan aiming at scaling up malaria interventions towards attainment of the national vision of a “Malaria-free Malawi”.
For over ten years, PSI/Malawi has contributed directly to the fight against malaria through the distribution of long-lasting insecticide-treated mosquito nets (LLINs). On behalf of the Government of Malawi’s malaria prevention program and with additional support from the US President’s Malaria Initiative (PMI), PSI/Malawi supported the routine distribution of LLINs for free to pregnant women and caregivers with children under 5 years old through public health facilities for the past six years. PSI/Malawi also socially markets Super Chitetezo nets to both urban and peri-urban areas.
In addition to distribution and management of LLINs to public facilities in Malawi, PSI/Malawi has provided technical assistance to the National Malaria Control Program (NMCP) on the procurement and distribution of LLINs nationally in areas such as quantification and distribution planning, and refining of NMCP LLIN policy. This included but was not limited to identifying target groups; setting criteria for LLIN recipients; creating distribution strategies; as well as monitoring LLIN distribution and use.
In 2008, PSI/Malawi launched its reproductive health program with social marketing of short-term methods. This aimed at reducing pressure on the public sector health system, which was providing over 80% of reproductive health services.
The reproductive health program has grown to include service provision to women in rural and hard to reach areas through outreach teams and community-based distribution agents; women who can afford to pay for services can access them through the Tunza social franchise network. Communication activities help address knowledge gaps in family planning, reducing myths and misconceptions. The program has contributed to the growth in contraceptive prevalence in Malawi from 33% in 2004 to 59% by 2016.
With Malawi’s ailing economy and its high population growth, the public health sector has been over stretched and struggles to effectively meet health demand, ultimately leading to compromised and poor quality health service delivery. To bridge this gap, PSI/Malawi established the Tunza family health network, a social franchise, to provide quality, equitable and affordable health care through the private sector. Launched in 2012, Tunza has grown into a network of 69 franchisees based in the central and northern regions. Tunza’s approach has greatly improved service delivery in private clinics as PSI/Malawi provides training and ongoing mentorship in business and finance, quality assurance and youth friendly health services. In 2016, more than 20 Tunza clinics integrated HIV testing and counseling services into their offering to provide comprehensive sexual and reproductive health services to the population. Tunza continues to grow as a financially sustainable social enterprise, delivering health impact through the private sector.
Since 2014, PSI/Malawi, with support from UNICEF, has implemented communication activities with a goal of reducing diarrheal disease among children under five in Malawi. These activities have focused on water, sanitation and hygiene (WASH) and integrated community case management (iCCM) to reduce morbidity and mortality in children under five. Currently, PSI/Malawi is implementing behavior change communication activities in high risk areas for cholera.
PSI/Malawi also socially markets Waterguard, a liquid chlorine solution used to purify water and PUR for water purification. In 2016, PSI/Malawi distributed over 153,000 bottles of Waterguard and over 3 million sachets of PUR, contributing to a reduction in water-borne diseases.
- U.S. Agency for International Development (USAID)
- Canadian International Development Agency (CIDA)
- World Bank
- United Nations Children’s Fund (UNICEF)
- The Federal Republic of Germany through KfW Entwicklungsbank (the German Development Bank)
- WomanCare Global
- Swedish International Development Cooperation Agency (SIDA)
- UK Department for International Development (DFID)
- Malawi Ministry of Health’s National Malaria Control Program
- Malawi Ministry of Health’s HIV Unit, Environmental Health Unit and Reproductive Health Unit
- Ministry of Gender and Youth
- National AIDS Commission
- District Health Offices
- Other government ministries
- Johns Hopkins Malawi BRIDGE Project
- Procter & Gamble
- ACT Alliance
- Lighthouse Trust
- An Integrated Approach of Addressing GBV and HIV for AGYWs. The Case of DREAMS Project in Malawi (WEPED564)
Half of the 100,000 new HIV infections in Malawi occur among young people (15-24 years). Through the DREAMS initiative, PSI Malawi offer integrated health services including GBV to Adolescent Girls and Young Women (AGYW) in Machinga district. Health services on offer to AGYW's through mobile outreach clinics are STI screening, HIV testing and first-line support to survivors of GBV. Program data was used to understand the effectiveness of integrating GBV and HIV service for AGYW.
- Expanding Effective Contraceptive Options in Zambia and Malawi: Understanding the Consumer
Expanding Effective Contraceptive Options (EECO) is a USAID-funded project led by WCG with PSI and other partners to support the introduction of new contraceptive and dual protection methods. This case study presents EECO’s analysis of consumer insights and market data to develop a marketing strategy for the Woman’s Condom in Malawi and Zambia.
- Costs of Facility-Based HIV Testing in Malawi, Zambia and Zimbabwe
We sought to explore the costs of providing these services across three southern African countries with high HIV burden. Primary costing studies were undertaken in 54 health facilities providing HIV testing services (HTS) in Malawi, Zambia and Zimbabwe. The mean cost per individuals tested was US$5.17 in Malawi, US$4.24 in Zambia and US$8.79 in Zimbabwe. The mean cost per HIV-positive individual identified was US$79.58, US$73.63, and US$178.92 in Malawi, Zambia and Zimbabwe respectively. Both cost estimates were sensitive to scale of testing, facility staffing levels and the costs of HIV test kits.
- Shaping the Family Planning Market by Strengthening the Public Sector
PSI considers total market approaches to be critical for achieving universal health coverage, especially when it comes to contraception. This program brief presents cases, supported by several different donors, which take into consideration the total family planning market.
- Towards Subsidized Malaria Rapid Diagnostic Tests. Lessons Learned from Programmes to Subsidise Artemisinin-Based Combination Therapies in the Private Sector: a Review
Private sector subsidy programmes of ACTs have been effective in increasing availability of ACTs in the private sector and driving down average prices but struggled to crowd out antimalarial monotherapies. A subsidy of rapid diagnostic tests (RDTs) in the private sector has been recommended by governments and international donors to cope with over-treatment with ACTs and to delay the emergence of resistance to artemisinin. In order to improve the cost-effectiveness of co-paid RDTs, we should build on the lessons we learned from almost 10 years of private sector subsidy programmes of ACTs in malaria-endemic countries.
- Expanding Access to HIV Self-Testing: A Market Development Approach
PSI envisions a healthy market for HIVST to be one that is supported by multiple buyers and suppliers and that delivers on the 5As (Availability, Assured Quality, Appropriate Design, Awareness, and Affordability) to achieve public health goals. Realizing this vision for the HIVST market will require consideration of two key markets- public and private sectors. While HIV testing has traditionally been driven by the public sector, HIVST opens up the possibility of utilizing private sector pharmacies to expand and extend the reach of testing.
- Simplified Asset Indices to Measure Wealth and Equity in Health Programs: a Reliability and Validity Analysis Using Survey Data from 16 Countries
Many program implementers have difficulty collecting and analyzing data on program beneficiaries' wealth because a large number of survey questions are required to construct the standard wealth index. We created country-specific measures of household wealth with as few as 6 questions that are highly reliable and valid in both urban and rural contexts.
- Leveraging the Power of Markets for Family Planning Services: A Look at PSI/Malawi’s Approach to Social Franchising
This case study describes how PSI/Malawi's approach to social franchising has evolved as new challenges emerge and lessons are learned about how to most effectively deliver family planning services.
- Leveraging the Power of Markets for Family Planning Services: A Look at PSI/Malawi’s Approach to Social Franchising
In 2011, PSI/Malawi developed and implemented a new reproductive health and strategic plan that focuses on youth as well as long acting reversible contraception (LARCs). Analysis of the total market and growth of the private sector led PSI/Malawi to identify private sector franchising as a way to add significant value to the overall health system. This brief outlines PSI/Malawi’s approach to social franchising and its success.
- Using Commercial Marketing Techniques to Introduce New Contraceptive Products in Zambia and Malawi
PSI platforms in Zambia, Malawi and India are now marketing three new products: a contraceptive gel, diaphragm and female condom. This case study describes how PSI is working to make these new methods accessible and attractive to women.