New partnership will improve health care delivery at more than 130 clinics in Malawi

The USAID-funded Lilongwe Relief Fund Trust of Malawi (LMRFT), in collaboration with the University of North Carolina at Chapel Hill and several other public and private partners, has begun implementing the Safeguard the Family Project, which is aimed at decreasing mother-to-child transmission of HIV and reducing maternal and infant mortality.

This $8.2 million initiative will focus on improving maternal and child health in the central region of Malawi, which includes more than 130 clinics and about one quarter of the country’s population, or 3.8 million people. The program is a public-private partnership, with USAID contributing $4.1 million and partner organizations contributing a matching amount in cash and in-kind contributions.Safeguard the Family is based on a program currently being implemented in Malawi’s urban and rural Lilongwe district for the prevention of mother-to-child transmission of HIV. That program, a partnership between UNC Project-Malawi and the Ministry of Health of Malawi, incorporates testing for HIV and syphilis, a prevention, treatment and referral program for mothers who test HIV-positive, partner involvement and support group programs, recruitment of traditional birth attendants, and distribution of water purification packets, insecticide-treated bed nets, and infant food supplements.

Safeguard the Family will expand the current program, which serves 41 sites in Lilongwe district, to all health centers in the Central West Region of Malawi. It also will improve upon the current program by introducing an electronic tracking system linking mothers to children and partners, screening for tuberculosis, routine vaccinations and other services.

“Our current program

Malawian women and their children wait in a line for clinic services in 2005. Photo by Steve Meshnick, MD, PhD, professor of epidemiology.

reaches 70,000 pregnant women each year and prevents an estimated 1,000 HIV infections in these babies annually,” said Charles van der Horst, MD, professor of medicine at the UNC School of Medicine and senior technical adviser on the grant.

This new approach will address some of most critical problems in Malawi’s health care system. Currently, clinics in the region are staffed at approximately 25 percent of what is needed. When the program is implemented, some administrative health services will be shifted away from nurses and assigned to community health workers or volunteers. In addition, the program will tackle Malawi’s “silo” system of care – in which there are separate clinics, for example, for tuberculosis, reproductive health, and HIV – by introducing a comprehensive checklist designed to screen all patients for the most common medical concerns.

“It’s an ambitious program that will transform health care in the central region of Malawi,” said Innocent Mofolo, executive director of LMRFT and project leader for Safeguard the Family. “At the end of three years, we expect to be reaching 153,000 pregnant women and their families annually,” he added.

UNC’s School of Medicine and Gillings School of Global Public Health have been working in the sub-Saharan African nation of Malawi since 1990, when two faculty members provided assistance to the Malawi Ministry of Health to develop HIV/STD treatment guidelines. In 1999, UNC and the Ministry of Health established UNC Project-Malawi, an HIV/STD research, care and training center in Lilongwe. The UNC project now employs more than 250 people and has expanded to include other infectious diseases such as malaria and tuberculosis, internal medicine, surgery, cancer, obstetrics and gynecology, and pediatrics.

With support from UNC, the Lilongwe Medical Relief Fund Trust was established in 2001 to improve the health of Malawians. The trust previously has received grants from Elizabeth Glaser Pediatric AIDS Foundation, the Bill & Melinda Gates Foundation, Johnson & Johnson, and USAID. The previous experience with USAID helped the trust implement the systems for regulatory, financial controls and policies required by the U.S. government.

Other partners include Elizabeth Glaser Pediatric AIDS Foundation, Proctor & Gamble’s Children’s Safe Drinking Water, Northwestern University, the Burnet Institute, PharmAccess Foundation, Emory University, the Gilead Foundation, TherapyEdge, and Feed the Children.