Malawi

PENNIES TO POWER FINAL REPORT

Globally, women have access to 10% of the available credit, 7% of the training on productive activities and are 40% less likely to have access to agricultural inputs than men. Women also have limited technological inputs and market access, and only 4.3% of women have access to agricultural extension services. Although women provide about 50% of the agricultural workforce, they still lack equal access to productive resources.

Due to looming threats including climate change, an estimated 20% increase in hunger is predicted by 2050. The COVID-19 pandemic and its economic aftermath likely will push 426 million more people into poverty in the next three to five years. Responding to these challenges requires creative solutions that prioritize the most vulnerable, including women and young people. To this end, CARE implemented the Pennies to Power program with generous support from the Arthur M. Blank Family Foundation. This final report describes the program’s accomplishments over the full implementation period (June 1, 2019 to June 1, 2022).

Pennies to Power played a critical role in building resilience and increasing the capacity of people to cope with crises. Moreover, it helped create thriving and sustainable communities, where farmers prosper, people are empowered, and the planet is healthier. CARE implemented the program in Malawi, Nigeria and Tanzania to build resilience, unlock market access for women and youth, and ensure they are economically and socially empowered through savings groups known as village savings and loan associations (VSLAs). Moreover, the program contributed to the achievement of the following U.N. Sustainable Development Goals (SDGs): No Poverty (SDG 1), Zero Hunger (SDG 2), Gender Equality (SDG 5), and Climate Action (SDG 13).
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VSLA By the Numbers: A Comprehensive Analysis of the Impact and ROI of VSLAs

Village Savings and Loans Associations (VSLAs) have been a foundational programmatic approach at CARE since 1991. Since then, CARE has helped over 13.7 million people join savings groups. The savings group model has been adopted and adapted by a variety of organizations globally. Through this report, we will examine the social and financial effects and returns of savings groups as well as how groups affected members’ resilience to COVID-19. The results gave an overview of the financial return on investment (ROI), group economic outcomes, savings groups costs, and individual and household effects for savings groups both inside and outside of CARE.

In order to calculate a return on investment, the financial benefit for a typical participant over three years was considered as well as the financial benefits for a replicated VSLA for two years related to the cost that the donor/implementer spends to set up and oversee the VSLA for its first cycle. Using internal CARE data such as budgets, evaluation, and impact reports, the average ROI of costs to establish a saving group was between 7:1 and 20:1. For every $1 invested by CARE, there is evidence for the savings of a typical VSLA participant to increase between $7 and $20. For the average VSLA participant, median income increased by $9.35 (+/- $0.55 USD) within the first year of joining the group for each $1 USD invested. Additionally, average income increased by $18.85 (+/-$1.15 USD) within five years of each $1 USD invested. Using industry data and internal CARE data, this analysis showed that for every $250 USD invested three net new children attended school.

The financial effect of a VSLA appears to outlast the formal lifecycle of the group. Evaluation of VSLAs as they phased out found that the return on savings (ROS) was 50% (+/-10%) during the supported formal lifecycle of the group and decreased to around 35% (+/-19%) after the VSLA is phased out. However, the positive outcomes and impact of participating in VSLAs continue even after project phase out. Members continue saving and getting benefits. Share value even increase for 57% (+/-13%) of groups in the available data.
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CARE Malawi COVID Vaccine Delivery Situation January 2022

“The vaccines are here but support for delivery is most needed, especially at the last mile.” – District Health Management Team member, Ntcheu
As of January 10, 2022, Malawi had delivered 1.84 million doses of vaccine out of the 3.12 million doses it has received so far.1 Many doses in country have rapidly approaching expiration dates, and if they do not get to people fast, they risk expiring on the shelves. To make sure the 1.26 million doses left go to the people who need them most, we must invest more in communication, engagement, and delivery. The $37M granted by the World Bank over the past year is sufficient for covering only 8% of Malawi’s total population. What is more, as the highly contagious Omicron variant spreads worldwide, it is even more critical that more people are vaccinated now. We cannot assume that the Government of Malawi and its current health system can do it alone.

The government and other health actors in Malawi are working tirelessly to vaccinate people, while facing multiple health crises. The health system is building on a base of committed (if overstretched) health workers, an openness to community feedback, and a long expertise of delivering The government is coordinating closely with many actors to reduce gender gaps, get vaccines to the last mile, and keep existing health services open. Nonetheless, the Ministry of Health is under-resourced, and operating in a global system where the vaccine supply that arrives may be close to expiring. For example, doses of the Astra-Zeneca vaccine had to be destroyed in the spring, after arriving in Malawi with only two and a half weeks left before their expiration date.

More investment is needed. To take just one example, the national government has been able to provide one van per district to support mobile vaccination sites, to get vaccines to the last mile. Mobile vaccinations are the most effective way to serve people who live far away from health centers and do not have access to easy forms of transportation. That means that in Ntcheu, one van is expected to serve a target population of 214,929 people living over 3,424 square kilometers. One van cannot serve those people fast enough to make sure vaccines get where they need to in time, especially when an inconsistent and unpredictable vaccine supply could have doses expiring at any time. Read More...

SANI (Southern Africa Nutrition Initiative)

The Southern Africa Nutrition Initiative (SANI) is a $29,487,135 CAD project to address undernutrition in women of reproductive age (15-49) and children under 5 years in Malawi, Mozambique and Zambia. A partnership between CARE, Cuso International, Interagency Coalition on AIDS and Development (ICAD) and McGill University and the Governments and communities of implementing countries, SANI aimed to improve the nutritional status of women of reproductive age (15-49 years) and children under-5 years old. SANI was designed to align with national health and nutrition strategic priorities of Malawi, Mozambique and Zambia, and has been implemented in close collaboration with the Ministries responsible for Health, Agriculture, and Gender in each country, as well as national and district-level nutrition coordination committees (NCC and DNCC). Between June 2016 and March 2021, SANI contributed directly to the improved health of 234,000 women, children and men directly and over 498,000 individuals indirectly.
This final report covers the implementation period of the original SANI contribution agreement and project implementation plan finalized in February 2017.
Key project achievements:
Outcome 1100 aimed to improve nutrition practices and services for women of reproductive age, boys, and girls under 5 by strengthening the delivery of community-based nutrition services at the intersection between community health and the health system. Growth Monitoring and Promotion (GMP) and Community Management of Acute Malnutrition (CMAM) programs built this link, working on the continuum of prevention of malnutrition and early detection and treatment of moderate and severe acute malnutrition. Training and support on Maternal, Infant, and Young Child Nutrition (MIYCN), CMAM, and GMP was provided to health service workers and community health workers, and Care groups were established to support families to learn about and apply gender-sensitive MIYCN practices. Interactive teaching was also done at scale through participatory education theatre and cooking demonstrations using local nutritious foods. Social Analysis and Action (SAA) dialogues encouraged families involved in the program to identify, discuss, and challenge traditional social norms and practices that affect women’s health, nutrition, and empowerment.
Endline data revealed the following increases in nutrition-specific indicators from baseline:
- All three countries had considerable increases in rates of exclusive breastfeeding of children up to 5 months, increasing by 15-percentage points in Zambia (from 70% to 85%), 25- percentage points in Malawi (from 61% to 86%) and 17-percentage points in Mozambique (from 65% to 82%)
- Minimum Acceptable Diet (MAD) for children 6 to 23 months increased by 24-percentage points for boys and girls in Malawi (from 7% to 31%) and in Zambia by 7-percentage points for boys (from 24% to 31%) and by 13-percentage points for girls (from 17% to 30%)
- Knowledge of men and women on MIYCN practices improved by 6-percentage points for men (from 79% to 85%) and 4 percentage points for women in Malawi (from 90% to 94%), by 12- percentage points among women (from 59% to 71%) in Mozambique, and by 11-percentage points for women (from 81% to 92%) and 14-percentage points for men (from 72% to 86%) in Zambia. Read More...

Community Scorecard for COVID-19 Vaccines in Malawi

The significant amount of misinformation surrounding COVID-19 has deteriorated trust in governments and health systems, leading the World Health Organization to claim it as an “infodemic.” As the massive vaccine roll-out efforts launch, systematic trust-building and social accountability approaches are vital to ensure that civil society can hold governments accountable for equitable and people-centered vaccine roll-out that reaches the last mile. CARE knows that epidemics, like COVID-19 and Ebola, start and end with communities, which is why we are working to build meaningful citizen engagement into national vaccine roll-out frameworks to increase trust, accountability, and information dissemination.
CARE’s Community Score Card
The Community Score Card (CSC) was developed by CARE Malawi in 2002 and has been effectively used in a wide range of settings and sectors to ensure that public services are accountable to the people and communities they serve. CSC has demonstrated impact on power-shifting and improving service quality and trust building within and between communities and government actors. When COVID-19 arrived in Malawi during March 2020, CARE adapted CSC for remote use. The remote CSC includes an SMS platform and WhatsApp groups through which groups of men, women, youth, community and religious leaders, and service providers could voice their concerns and hesitancies about the vaccine and other health services. The CSC helped to identify major concerns around the vaccine and aided stakeholders in creating locally-driven solutions to combat vaccine hesitancy and misinformation.
Building on these early experiences, from May to June 2021, CARE further implemented a pilot project designed to support efficient and equitable COVID-19 vaccine roll-out in three locations in Malawi: Kandeu and Chigodi health facility catchment populations in Ntcheu district and the New Hope Clinic health facility catchment population in Ngolowindo in Salima district. In all three locations, key stakeholders included groups of women, men, youth, community leaders (chiefs and religious), district health management teams, and health personnel (including health surveillance staff, health facility staff in-charge, and the health center management committee). CARE Malawi’s CSC team led the implementation of the pilot with support from CARE USA and digital support from Kwantu. Read More...

Support for Service Delivery Integration- Services (SSDI-Services) Endline

SSDI-Services was the flagship project for USAID/Malawi’s health office. The project was implemented from November 8, 2011 to March 7, 2017 under a cooperative agreement, valued at USD 89 million. Active project implementation occurred over a 4.5-year period from April 2012 to December 2016, with the preceding and following months focused on startup and closeout activities respectively.

SSDI-Services provided financial and technical assistance to the Malawian Ministry of Health (MoH) to deliver, refine, and scale up high-impact interventions contained in the Essential Health Package (EHP). The EHP includes globally proven and cost-effective interventions to address key causes of illness and death in Malawi. SSDI-Services implemented interventions under the following program areas: maternal, newborn, and child health (MNCH); family planning (FP); malaria; nutrition; HIV/AIDS; and sanitation and hygiene.

SSDI-Services was implemented by a consortium comprising Jhpiego as lead, CARE, Plan International, and Save the Children. The project focused on increasing access to, and strengthening the delivery of, EHP services both at the health facility and in the community. It leveraged the work of both SSDI-Communication and SSDI-Systems to improve health-seeking behavior and the quality of health services by addressing the informational needs of both service providers and their clients. It also addressed systems issues that may hinder the provision of high-quality Read More...

Lessons Learnt from CARE’s Shelter Responses to Cyclone Idai in Malawi, Mozambique and Zimbabwe

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Malawi VSLA Survey for COVID-19 September 2020

CARE is working with women in savings groups to better understand their needs in COVID-19 and how they are already leading and adapting to cope with the crisis. This is the first of 3 planned rounds of data collection to better understand how women's needs are evolving during the crisis. The findings in this survey are informing CARE's programming for VSLAs in Malawi and globally. Read More...

MALAWI COVID-19 RAPID GENDER ANALYSIS

Coronavirus disease (COVID-19), an infectious disease caused by a newly discovered coronavirus has had a devastating impact globally. While WHO declared COVID-19 as a world pandemic on 30th January 2020, Malawi declared a state of disaster on 20th March 2020 and this was followed with some restrictions including closure of schools. While countries in Southern Africa have imposed lockdowns and other restrictions, as of 7th May Malawi was yet to go on lockdown, which was stopped through a court decision. Malawi is in an election period for fresh presidential elections and with the campaign period officially opened, observance of COVID-19 safety and preventive measures will be a challenge.

Global research findings have shown that COVID-19 has significant social and economic impact on people, especially those living in poverty-stricken countries. Malawi is at more risk due to other significant health challenges that would exacerbate the severity of COVID-19, such as high levels of malnutrition, malaria, anemia, HIV/AIDS, and tuberculosis.

For women and girls, the impacts can be much higher due to their social responsibilities as primary caregivers, coupled with childcare and nutrition and farm work. Further a majority of health care workers are female (especially nurses). In Malawi, the nursing profession is dominated by female nurses of which 91.5% are professional and 84.7% are associates . With the Covid 19 response, there is also an increased risk of exposure to the infection for health care workers, particularly if health care services are not provided with adequate Personal Protection Equipment (PPE).
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Gender Implications of Cash Transfers in Malawi

The government of Malawi operates a national safety net program targeting the poorest 10% of the population with unconditional cash transfers and the next poorest 15% with conditional cash transfers through a Cash for Work (CfW) program and vouchers for subsidized agricultural inputs. In 2019 the Government, with support from development partners, has started implementation of an ultra-poor graduation program in nine districts which support ultra-poor households with livelihood grants and complementary services. This safety net is designed to quickly scale to more people or to provide more money to existing participants in case of emergencies.
CARE Malawi set out to identify the gendered implications of this cash programming and how participants’ experiences of cash transfers affected gender equality. To do so, CARE used a combination of literature review and primary data collection with stakeholder consultations, key informant interviews, and focus group discussions (FGDs) at national, district, and community levels. Because of the large-scale cash response to Cyclone Idai in 2019—largely operated through international nongovernmental organizations (NGOs)—the study also compared gendered impacts of the government program and NGO humanitarian response. Read More...

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