Malawi: Significant Progress in HIV/AIDS Awareness, Food Security and Access to Basic Health Services

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Update to the Global Board
(October 2008)

Executive Summary

Within the framework of the Epicenter Strategy and inline with the Millennium Development Goals (MDGs), The Hunger Project-Malawi's work in the six-month reporting period was in the seven epicenters of Jali, Nchalo, Nsondole, Mpingo, Ligowe, Champiti, and Kachindamoto.

With a broader aim of contributing towards the end of hunger and poverty, The Hunger Project-Malawi's work had twelve planned objectives:

  • To ensure household and community food security through increased food production and epicenter community food banks;
  • To commence and finalize construction of the new Champiti Epicenter, food bank and nurses' quarters;
  • To facilitate entry and rolling-out of phase one of the Epicenter Strategy in the new Kachindamoto Epicenter;
  • To promote gender equality and empower women through women group formation and credit;
  • To mobilize for loan repayments on all outstanding loans;
  • To roll-out phase two of the Oxfam Novib (The Netherlands)-funded HIV/AIDS prevention from a gender and sexuality perspective project;
  • While nurturing existing partnerships, develop working partnership with the Ministry of Health and Population for the new Ntcheu District Health Office in which the new epicenter of Champiti is located;
  • To ensure improved access to basic health services, including under-five services, for our partners through the epicenter dispensaries as well as improving maternal health;
  • To improve the literacy levels through Functional Adult Literacy and ensuring early access to education through epicenter nursery schools;
  • To ensure that partners have access to safe drinking water;
  • To commence upgrading works of Mpingo sub-epicenter into a full epicenter; and
  • To negotiate with Government of Malawi's Neno District Assembly to open the Ligowe Epicenter dispensary.

Tangible achievements were registered in each one of the above planned objectives except the final two. Amazingly, the epicenter community food banks of Ligowe (featured left), Nsondole, and Mpingo epicenters are not only full with grain but some grain is actually stocked in the epicenter community hall because the epicenter food banks are full to capacity. For example, the Ligowe Epicenter food bank is full to capacity with a total of 1,139-bags of 50 kilograms (kg) each of maize and a total of 450-bags of 50 kg each of maize grain is stocked at the back of the Ligowe Epicenter community hall.

Details on Progress

Areas of Achievement

Food security ensured

All epicenter food banks are fully stocked (except for Nchalo Epicenter food bank which is half-full because of floods problems) with grain totaling 302-metric tons of maize grain, and 14-metric tons of rice. This should be able to support households in a crisis period.

A total of 20-acres of land is now under irrigation farming in Nchalo Epicenter to supplement rain-fed agriculture since the area is prone to either drought or floods. With this, farmers are able to produce more than once per year.

HIV/AIDS awareness increased and access to related services improved

Oxfam Novib (Netherlands) produced a documentary to advocate for increased availability of female condoms. The work of The Hunger Project-Malawi's HIV/AIDS animators was featured in the documentary as evidence to support the case. The documentary was shown at the recent International HIV & AIDS Conference held in Mexico.

Mobile voluntary counseling and testing (VCT) services are now being offered right in the partner villages. A total of 1,635 people (900 women and 735 men) have used VCT services. Cumulatively, a total of 12,007 people (6,011 women and 5,996 men) have used VCT services out of whom 1,214 people (813 women and 401 men) tested HIV positive. All HIV-positive people were referred to the nearest ART clinic for staging (we will get the data on how many have been successfully enrolled on ART program in December 2008)

A total of 8,054 people (4,508 women and 3,546-men) participated in village-based HIV/AIDS and Gender Inequality Workshops. Cumulatively, a total of 201,766 people (122,126 women and 79,640 men). Some have taken it more than once.

A total of 27,711 female condoms have been distributed to a total of 5,424 people (3,482 women and 1,942-men).

New Champiti Epicenter constructed

Construction of the epicenter food bank (now already stocked with 37 metric tons of maize grain), nurses' quarters, and the main epicenter structure was commenced and finalized. Construction of public toilets and the kitchen commenced and are now at 95 percent completion stage.

Access to basic health services, including maternal health improved at Jali, Nchalo and Nsondole Epicenters

Epicenter dispensaries of Jali, Nchalo and Nsondole were functional during the reporting period and provided outpatient services to a total of 1,981 partners (1,339 women and 642 men). A total of 1,097 under-five children (703 girls and 394 boys) received various vaccinations. A total of 84 children were successfully delivered through trained TBAs (in Nchalo and Jali epicenters), while a total of 204 women received family planning services at Nchalo Epicenter dispensary.

Functional Adult Literacy running in each partner village

A total of 98 partner villages of The Hunger Project-Malawi each have a Functional Adult Literacy program running and each epicenter has a functional nursery school where children under the age of five years are fed with nutritious porridge when they come for lessons from Monday to Friday.

There are now a total of 1,045 adult learners (97 men and 948 women) in 98 FAL classes and 248 under-five children (139 girls and 109 boys) in five epicenter nursery schools. A total of 290 people from the FAL classes of Jali, Nchalo and Nsondole Epicenters were declared literate by the Ministry of Community Development in the reporting period.

Access to safe drinking water ensured in some villages

The 21 boreholes (drilled by The Hunger Project-Malawi from 2002 to 2007) in 21 partner villages (out of its 193 partner villages) continued to provide safe drinking water to a total of 15,400 people

Ensure access to credit for women & men

A total of K1,634,380.00 was disbursed to a total of 24 groups (8 for men & 16 for women), with each group comprising an average of about 10 people.

A total of K2,825,243.00 was repaid as compared to a total of K1,760,498.47 repaid during the same period last year. This improvement is due to increased loan repayment efforts which have been embarked upon to clear-off all outstanding loans in the old epicenters of Jali, Nchalo, Mpingo and Nsondole.

An example of the impact of the microfinance program is included in the attached Profile of Leaders page.

Areas of Challenge

Ligowe Epicenter dispensary was not opened as scheduled

More buy-in from local government is needed. Negotiations with local government should be done and completed before commencement of construction of the dispensary. A clear MOU should be signed

Mpingo sub-epicenter upgrading works did not start as scheduled

Negotiations with local government were finalized in September 2008 and work will commence in October 2008. This has affected our plans in two ways (i) our completion date of December 31, 2008 will not be achieved. Work may splash-over to first quarter of 2009; and (ii) the budgeted cost for the works has increased beyond the allocated funds, as such we will need to top-up with funds of the 2009-budget. Lessons learnt as above.

There still remains some partner villages who have no access to safe drinking water

Out of a total of 193 partner villages, The Hunger Project-Malawi has provided safe drinking water to a total of 21 partner villages. While the other partner villages are accessing safe drinking water from boreholes drilled by the government and other development partners, it is worth mentioning that about 30 partner villages still do not have access to safe drinking water. The Hunger Project-Malawi has the capacity to accelerate provision of safe drinking water in all these partner villages within a period of two months if funds would be available.

There still remains pockets of household food insecurity

Out of a total average of about 21,000 households in all epicenters of The Hunger Project-Malawi, The Hunger Project-Malawi's "improved access to farm inputs scheme" in 2007/2008 growing season directly positively impacted only 1,551 households. While the results of the scheme have been outstandingly positive, it is worth mentioning that the number of "not-reached" households is more than the number of "reached" households, and this may eventually curtail the positive results of the scheme. The Hunger Project-Malawi has the capacity to scale-up the impact of this scheme to the entire 100% households if funds would be available. It would therefore be recommended to increase funding levels to The Hunger Project-Malawi.

Recent Innovations

As a way of minimizing default on loan repayments, The Hunger Project-Malawi decided to strongly involve village chiefs to work strongly with loans committees before, during and after loan disbursements. This has been piloted in two new epicenters of Ligowe and Champiti. The results have been outstanding: in these two epicenters there has always been 100% loan repayments and no single default, members are saving their money and the micro-finance program in these two epicenters is much more vibrant than the other epicenters, and the partners have already embarked on the process of creation of rural bank ahead of our five-year schedule. We've now decided to take this approach to the other old epicenters of Jali, Nchalo, and Mpingo.

Monitoring and Evaluation (M&E)

  1. Data analysis and report writing of the baseline survey for the new Champiti Epicenter finalized.
  2. Facilitated entry of The Hunger Project-Malawi into the new district of Dedza and the new epicenter of Kachindamoto was identified and phase one commenced.
  3. A total of 94 village heads were briefed on roles of village heads in M&E and the reasons why M&E is important.
  4. Conducted monitoring exercises on compliance with the farm-inputs program to the set loan procedures. We discovered that all set procedures were being followed and that the maize in the food banks was of good quality. The monitoring exercise also allowed us to discover that some farmers had not yet repaid their farm inputs loans, and we immediately held a special meeting with concerned farmers who have since repaid their loans.
  5. With funding from Oxfam Novib, a special self-assessment exercise was conducted for staff of The Hunger Project-Malawi, a process which informed the programming processes of the project.
  6. A total of 556 animators from all the epicenters (except the new Kachindamoto Epicenter) have been trained in M&E and are now collecting data which has been inputted in the M&E website.
  7. On HIV/AIDS data, the increased number of VCT users is an indication of positive health-seeking behavioral change, which is largely due to two reasons (i) The Hunger Project-Malawi has brought VCT services close to the people: now people are tested right in their villages as opposed to when they could only access VCT in health posts which are far from most of the partner villages; and (ii) the stigma which surrounded VCT has been removed by the village-based workshops where issues around VCT are discussed.

Partnerships

Chikwawa District Hospital: Combating malaria and other diseases. (While we have been partnering with this hospital in the past, the partnership on the ITNs is a newly established one).

Through the Government of Malawi's "National Free Insecticide Treated Nets (ITNs) Programme," a total of 2,480 ITNs were distributed by the Ministry of Health to 13 partner villages of Nchalo Epicenter. The activity is still ongoing such that the other remaining 11 partner villages will also receive the ITNs.

MACRO: Provision of VCT services (this partnership has been ongoing since 2005).

MACRO is now offering VCT services not only at the epicenters but also mobile VCT services right in the partner villages of our epicenters of Jali, Nchalo, Nsondole, Mpingo and Ligowe.

UNFPA-Malawi: Provision of Female Condoms. (While this partnership has been ongoing since 2003, UNFPA recently upgraded us from 10,000FC recoup category to 30,000 category).

A total of 27,711 female condoms have been distributed (from January to August 2008) in The Hunger Project-Malawi's epicenters to a total of 1,942 men and 3,482 women. Most notably, female condoms (whose national availability The Hunger Project-Malawi strongly advocated for in the past recent years) have now become a national program being managed by the Government of Malawi's Ministry of Health, UNFPA and Population Services International (PSI).

Through this scale-up initiative, female condoms are now being socially marketed in hair-dressing salons and most pharmacies in Malawi, which has improved their availability.

NTCHEU District Hospital: Training of Community-based Organizations (CBOs) within the epicenter of Champiti in Home-based Care.

Building the capacity of the communities themselves to manage the impact of HIV/AIDS is an important integral component of the fight against HIV & AIDS. A total of 30 people representing three CBOs from Champiti Epicenter have been trained and will be supervised by the District Health Officers on Home-based Care of people suffering from AIDS.In-Country Funding Opportunities

Apart from the Oxfam Novib Euro 650,000.00 for the first period of January 2008 to December 31, 2010 in support of HIV/AIDS prevention from a gender and sexuality perspective, there was no other in-country funding and there are not any prospects for in-country funding yet.

Broader Awareness of The Hunger Project/Media Coverage

Television Malawi (state-owned) featured a story of the Chimbiya irrigation scheme in Nchalo Epicenter where the community leadership explained how the scheme is helping to fight hunger and poverty. Malawi Broadcasting Corporation (MBC) contacted The Hunger Project-Malawi for an interview on how the communities in The Hunger Project-Malawi epicenters achieve food security and what is the progress on epicenter community food banks. During the recent program monitoring visit by the Vice President, Dr. Fitigu Tadesse, Joy Radio (privately owned) and MBC joined during the visit to Ligowe Epicenter and featured the stories.

Profile of a Leader

Mrs. Chimombo (lady in blue in photo, speaking with Dr. Tadesse inside her shop) is a widow aged 54. She has nine children, of whom five are independent and four still depend on her for support (two are in primary school and two are in secondary school). Mrs. Chimombo is a farmer, and she also decided to establish a village shop in her village in 2006. But due to limited capital, her shop was empty most of the time, and she could not make any meaningful profit to support her family as a single mother. Before The Hunger Project came into her area, there was nothing she could do on this situation because there were not any microfinance lending institutions operating in her area from where she could get capital to boost her business.

Then The Hunger Project-Malawi came into Mwaiwagwa Epicenter in 2007 and started conducting Vision, Commitment and Action Workshops (VCAWs) and Mrs. Chimombo decided to attend an African Woman Food Farmer Initiative (AWFFI) VCAW during which she decided to borrow money to the tune of K5,000.00 (US$40.00) as an initial loan in November 2007. She invested the money into her village shop. She sells cooking oil, soaps, sugar, fabric, milk, salt, biscuits and so forth. By April 2008, Mrs. Chimombo had fully repaid her loan of K5,000.00 with interest of 17.5% (k850.00 = US$6.3). Further to that, Mrs. Chimombo has now learnt the importance of saving money and she now has a total savings of K5,700.00 in the Mwaiwagwa Epicenter savings account and she showed us her savings passbook.

Mrs. Chimombo has today (as of August 26, 2008) taken a bigger loan of K16,400.00 (US118.00) which she will further invest in the shop and hopes to make a bigger profit. She is expected to repay this loan in six months. Mrs. Chimombo now is able to support her children, including buying them school uniforms and better clothing.

Out of what she has seen in this short time, Mrs. Chimombo says her new vision is to generate more money so that she can buy and establish a maize mill as an income-generating activity and also to ensure that women in her area should not walk long distances. They now walk about 8 km to the nearest maize mill.

The success of Mrs. Chimombo has also inspired men to get loans from The Hunger Project-Malawi so that they can contribute to the food production and well-being of the community. Recently, we witnessed a total of 23 women and 13 men receiving loans worth K264,380.00 (about US$2000.00) as their second loan after they repaid the first one 100%.

Future Plans

Microfinance

  • Train AWFFI and SPIA groups in business management in readiness for new loan disbursements, and disburse new loans to Ligowe, Champiti, Mpingo and Nsondole Epicenters. Indication of success will be when 30 groups (20 AWFFI and 10 SPIA) are trained and a total of K2,000,000.00 is disbursed.
  • Capacity building of Nsondole SACCO through increasing SACCO membership for Nsondole SACCO, and conduct Annual General Meeting for Nsondole SACCO and facilitate for election of new SACCO Board of Directors SACCO. The indication of success will be when membership is increased to 500, and new SACCO Board is elected and trained.
  • Conduct MUSCCO awareness to partners in Champiti, Mpingo and Ligowe Epicenters. Indication of success will be when at least 1,000 people are aware of MUSCCO objectives and the process of creation of government recognized banks has commenced.
  • Enforce full loan recoveries of all overdue loans in the epicenters of Jali, Nchalo, Nsondole and Mpingo. The indication of success will be when a total of K5,985,703.68 loans are repaid in all the epicenters.
  • Build the capacity of all epicenter loan committees and rural bank or credit room clerks. The indication of success will be when all Epicenter Loan committees and bank clerks in all epicenters are empowered.

Monitoring & Evaluation (M&E)

  • Conduct baseline survey for the new Kachindamoto Epicenter to establish the basis for measuring any future progress. There is some concern that data entry will take too long, so the Country Director will liaise with other officers to block computers and hopefully accelerate the process.
  • Conduct refresher trainings on M&E and data collection for animators. The goal is to train at least 250 animators on M&E in Nchalo, Mwaiwagwa, Mpingo and Nsondole Epicenters. In order to address the concern of low attendance due to work in their fields, the dates of the training with be planned according to the animators schedules.
  • Train PLWHIV members in monitoring and evaluation and how to report progress/lack of it. The goal is to train two (2) executive committee members (total=20 members) in Nchalo and Mpingo in monitoring and evaluation and monthly report writing.
  • Conduct VCA Workshops in Mpingo's six new partner villages and Champiti and Kachindamoto Epicenters. The goal is to conduct at least 15 VCAWS (five in each epicenter). There might not be enough fuel to complete the whole exercise.

HIV & AIDS

  • Access and use of HIV and AIDS preventative and treatment services improved. The goals are to test 3,150 (50% of which are women); that at least 25% of the total people referred to the ART program though the Mobile-VCT are successfully linked an anti-retro viral (ART) dispensing point; and that a total of 3,500-women have access to female condoms.
  • Vulnerability of adolescent girls and women to HIV and AIDS reduced. The indicators of success are as follows: 1.) A total of about 21,420 boys and girls (school-going and non-school- going), participate in discussions on skills and knowledge on HIV/AIDS and Gender Equality. 2.) At least three action groups (one per epicenter) against gender-based violence (GBV)established in at least three epicenters. 3.) About 6,500 adults (men & women) participate in GBV community meetings. 4.) Three epicenters linked to the VSU of the nearest police unit. 5.) In at least 42-villages, all identified HIV/AIDS-endangering traditional practices are modified or abandoned
  • Improved access to support services for people infected and affected by HIV and AIDS. This will be accomplished when: there are two People Living with AIDS (PLWA) groups established at each of the two epicenters excluding Nchalo Epicenter, each of the established PLWA group (this means that two new and the old Nchalo group) provided with support according to the quality recommendations by Government of Malawi and at least 30% of all existing HBC groups provide quality care after being trained according to the quality recommendations by government of Malawi.
  • Advocacy and Dissemination. The district health authorities of the impact districts will scale-up the VCT and ART outreach using the mobile models. Also, The Village-Mobile-VCT-model and the Village-Mobile-ART-model will document and disseminate to at least 50 HIV and AIDS service providers. There is concern that authorities may fail to appreciate the need for these outreach models.

Finance and Administration

  • Facilitate conducting of 2007 Annual Audit. This report should be submitted to Global Office not later than 31st January 2008.
  • Facilitate production of 2009 annual budget. Hopefully the 2009 annual budget will be approved by Global Office.
  • Disposal of the old Pajero (vehicle) and replace it with a new vehicle in the 2009 budget. Allocated funds for 2009 may not be sufficient to purchase a new vehicle.

SPIA

  • Upgrade Mpingo sub-epicenter into full Epicenter.
  • Facilitate construction of nurses' quarters at each of the five epicenters of Jali, Nchalo, Nsondole, Mpingo, Ligowe so that nurses have dwelling places.
  • Promotion of increased food production. 2008/09 farm inputs loans should be disbursed not later than October 20, 2008 and all farmers should be trained in modern farming technology.
  • Promotion of adult literacy by facilitating assessment of all FAL classes by government of Malawi. Mpingo & Ligowe FAL classes will be assessed by GOM, the results released and a new learning cycle commenced.
  • Capacity building of epicenter committees through formation of sub-committees. The goal is to establish and train sub-committees in each of the MDGs.
  • Commence construction of the new Kachindamoto Epicenter. The goal is that all structures, including nurses quarters, will be constructed at the same time. Delays experienced at Mpingo upgrading because of slow-movement by local government may delay the process. The Hunger Project-Malawi hopes to commence buy-in of local government right away to avoid delays in opening of the dispensary.
  • Entry into one new epicenter area in Lilongwe district in the central region, to be finalized by April 2009.

Country Profile - Malawi

Population (male, female)13.2 million (6.5 male & 6.7 female)
Percent of population in rural areas83.3%
Infant mortality rate72/1,000 live births (76-male & 69-female)
Maternal mortality rate984/100,000 live births
Life expectancyAt Birth = 47 years (46 male & 48 female)
Percent population undernourished34%
HIV/AIDS - adult prevalence14.1% as percentage ages 15-49
HIV/AIDS - deathsAbout 80,000 people per year
HIV/AIDS - people living with HIV/AIDS780,000 - 1,120,000
Literacy rate (male, female)69% (77% male & 67% female)
Primary school enrollment (male, female)32,581 (15,896 males & 16,680 females)
GDP per capitaUS$161
Population earning less than $1/day41.7%