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(IYCF) issues, Targeted Nutrition
Programmes, CMAM Stakeholders
Committee, etc.
This move to the OPC enabled the
MoH to focus its attention on implementation
of programmes, while helping to
strengthen the policy environment for
nutrition. An example of this is the clearly
defined role of nutrition in the Malawi
Growth and Development Strategy
(MGDS). The MDGS is an overarching
operational medium-term strategy for
Malawi designed to attain the nation’s
Vision 2020. The MGDS has six pillars.
The 6th Pillar is ‘Prevention and
Management of Nutrition Disorders, HIV
and AIDS’. This pillar has three focal areas
namely:
I. HIV and AIDS: the goal is to prevent
further spread of HIV and AIDS and
mitigate its impact on the socioeconomic
and psychological status of
the general public.
II. Nutrition: the goal is to ensure nutritional
well being of all Malawians.
III. Interaction between HIV/AIDS and
nutrition: the goal is to improve the
nutritional status and support services
for people living with HIV/AIDS
(PLHIV) for improved quality and
duration of life.
Furthermore, nutrition has a separate line
item within the budgets of the DIPs.
Challenges remain when trying to translate
policies into action, mostly due to the
number of urgent health priorities that the
country is trying to deal with and the
limited resources for this. However,
Malawi is currently on target to meet
Millennium Development Goal (MDG) 4,
which if successful will be a major
achievement.
Due to strong leadership within
government, nutrition is now being packaged
as a cross-cutting issue in the same
way as accounting. So while there is a
general Ministry of Finance, there are also
accountants located in each of the
ministries to assist with the finance of
each Ministry. For example, the Ministry
of Transport has its own accountants. The
same idea is being applied to nutrition. It
is planned that each of the ministries will
have a nutrition section based within it,
which can ensure that that nutrition issues
remain firmly on the agenda of each
Ministry.
Another example of a successful advocacy
tool utilised in Malawi has been the
production of a ‘MP’s kit’ in 2008. The
MP’s tool kit was developed to help
parliamentarians guide actions. It included
explanations of the magnitude of malnutrition
problems, the consequences, why
nutrition matters for national and
economic development, their role as MPs,
and what they could do to promote nutrition.
This advocacy has been very effective,
with MPs recently resisting the budget cuts
that were suggested for nutrition.
Local production of RUTF
In most countries, all RUTF is centrally
procured by UNICEF. However it is
encouraging that MoH in Malawi recently
started procurement of RUTF from its
own budget to supplement the supplies
procured by UNICEF and the Clinton
Health Access Initiative (CHAI).
Due to the high cost of imported RUTF
and the long process of transportation
from France, two organisations have setup
local production facilities that
currently provide all the RUTF needs for
Malawi. In Blantyre, Project Peanut Butter
(PPB) was established during 2005. This
production facility started from a small
facility in a local hospital, developing into
a large enterprise that has a current
production capacity of 120 metric tons per
month. In Lilongwe, Valid Nutrition (VN)
also started from humble beginnings in a
small factory, which has grown to become
a major production facility capable of
producing 160 metric tons per month.
There are a number of challenges associated
with local production of RUTF,
particularly with the importation of
certain raw materials (powdered milk and
the mineral vitamin complex). Problems
also arise with aflatoxin contamination of
the groundnuts (peanuts) used for the
RUTF. Sufficient testing equipment is only
available in Europe, which can mean long
delays between production and test
results.
Valid Nutrition are also committed to
developing new formulations of RUTF
using recipes intended to bring the cost of
production down, whilst maintaining the
curative integrity of the product.
Formulations specifically for nutritional
rehabilitation of persons with HIV have
also been developed and tested in Malawi.
Progress on scaling up and
integrating CMAM
National scale-up
Establishment of the CAS (previously
known as the CTC Advisory Service) in
2006 helped considerably with the rapid
country-wide scale-up of CMAM. The
CAS is currently staffed by members of
Concern Worldwide, with its role to
provide technical support for the MOH to
scale-up CMAM activities. There is particular
emphasis on the standardisation of
implementation activities, assistance with
development of strategic plans, training
and operational plans, mentoring and
monitoring and evaluation (M&E) of
MoH-led CMAM services.
All 28 districts of Malawi are implementing
CMAM as of May 2010.
However, the percentage of health facilities
offering CMAM varies across districts,
with some districts providing CMAM
services in all hospitals and health centres,
while others operate only a few CMAM
sites. One of the main reasons for the
disparities in site coverage is the necessary
gradual nature of the scale up
process. The Ministry wants quality service
delivery such that it cannot authorise
rapid scale up when the performance of
an existing site is poor. Meanwhile, other
districts benefited from NGO support and
supervision, capacity building and provision
of supplies.
Figure 2: CMAM scale up trends
No. of CMAM sites
450
400
350
300
250
200
150
100
50
0
100
90
80
70
60
50
40
30
20
10
0
236
116
100
72 73 81
32 32
8 8
20
2004 2005 2006 2007 2008 2009 2010
year
No. OTP sites No. NRUs (reported) No. SFP sites
17.9
12.6
11.7 9.0
11.6
6.7 6.2
2.7 1.4 1.7 2.9 2.4 4.9 5.1
2004 2005 2006 2007 2008 2009 2010
year
Cure rate >75% Death rate