Malawi has some of the worst health and social indicators in the world. According to the 2010 Malawi Demographic and Health Survey maternal mortality ratio was estimated at 675 deaths per 100,000 live births, under five mortality rate at 112 per 1,000 live births and infant mortality rate at 66 deaths per 1,000 live births. Further over the last decade, the prevalence of malnutrition among under-five children has remained constant at 47% and contraceptive prevalence rate is estimated at 43% and that fertility rate is at 5.6. HIV prevalence is still high at 10.6%. Other communicable diseases such as tuberculosis and malaria are still a challenge. Currently non-communicable diseases (NCDs) are emerging and constitute one of the major causes of morbidity and mortality in Malawi. The majority of Malawians suffer from health conditions which could effectively be prevented, treated and managed but this is compromised, among other factors, by the fact that access to health care is still a major challenge mainly due to inadequate funding, lack of medicines in health facilities, long distances to health facilities and shortage of health workers.

 

The Health Sector Strategic Plan (HSSP) for Malawi (2011-2016) has identified 13 conditions that have been included in the Essential Health Package (EHP) and these are: HIV/AIDS; ARIs; Malaria; Diarrhoeal diseases; Perinatal conditions; NCDs (including trauma); Tuberculosis; Malnutrition; Cancers; Vaccine preventable diseases; Mental illness (including epilepsy); Neglected Tropical Diseases (NTDs); and Eye, ear and skin infections. EHP conditions affect the majority of Malawians who are poor and for such conditions services are provided free of charge. The HSSP highlights some of the most cost effective interventions that will be implemented in order to address these conditions. The HSSP also highlights specific interventions that will be implemented in order to address health system challenges such as human resource, health financing, essential medicines and supplies, quality assurance and monitoring and evaluation among other issues.With support from the Health Capacity Research Strengthening Initiative funded by the Wellcome Trust and DfID, over the period 2009-2011 the NCST commissioned studies that reviewed studies conducted on the 13 conditions in the EHP including some of the health systems themes such as human resource.

 

These studies further identified critical research gaps for each of these conditions. Based on these results the NCST and the Ministry of Health (MoH) developed the National Health Research Agenda (NHRA) which has identified priority research areas in Malawi’s health sector. These studies will generate evidence which will be used to develop policies and interventions that will improve access to health care by Malawians and consequently their health status.Over the 4 years of this strategic plan, the CSR will contribute towards the implementation of the NHRA by developing proposals and implementing studies on key priority health social science and related research as identified in the NHRA. The CSR will design and implement independent and comprehensive ethnographic studies to explore people’s perceptions and uptake of EHP interventions. For example the emergence of NCDs pauses a big challenge for Malawi which is resource constraint to effectively deal with such conditions.

 

CSR’s research on these diseases will focus on exploring people’s understanding of these diseases and barriers and determinants of the uptake of NCD interventions. The results will be used to inform development of policies and interventions that will contribute to the achievement of the health and related goals of the HSSP and the MGDS.With regard to health systems, CSR will work very closely with the MoH and stakeholders in the health sector to generate evidence for the development and implementation of health systems innovations and evaluate their impact especially in hard to reach and under-served areas and populations. For instance CSR will be interested to do research on, among other issues, health financing, impacts of task shifting on service delivery and impacts of decentralisation on service delivery. The CSR will continue to work very closely with other GoM agencies including the National AIDS Commission (NAC) to conduct studies commissioned by them. While these studies will contribute to theoretical understanding of these issues and advance scholarship, they will also contribute to the design of interventions to improve access to EHP services.

 

National surveys such as the DHS demonstrate that disparities exist in the coverage and uptake of EHP interventions for example use and ownership of ITNs, timely treatment of EHP condition such as malaria and diarrhoea, use of contraceptives and assistance at delivery. Some districts in Malawi consistently perform poorly on various health indicators. Over the next 4 years the CSR will design comprehensive qualitative studies that will help determine factors that are responsible for prevailing disparities among different districts in Malawi and engage with stakeholders to discuss interventions that would address such disparities. Of particular interest in this context is the low contraceptive prevalence rate (CPR) and high malnutrition rates prevailing in Malawi. Exploring factors responsible for such poor indicators will help design interventions to deal with such issues. CSR has a strong comparative advantage in research on these social and cultural dimensions of public health as exemplified by the huge number of studies of this nature that it has conducted and the expertise that is available.