Jess Kuehne, Health Advocacy Officer at RESULTS UK, reflects on her experience in Malawi and how UK aid is being put to use in one of the world’s poorest countries.

A few weeks ago RESULTS UK led a parliamentary delegation to Malawi, one of the poorest countries in the world. Its low rankings in terms of development indicators are particularly stark when you take into account that, unlike many of the other poorest countries on the continent, it has not been affected by conflict. In terms of the Human Development Index, Malawi currently ranks 171 out of 187.

Being one of the poorest countries with a weak economy has meant that Malawi is heavily dependent on donor aid to address some of its main health challenges. During our trip we had the opportunity to witness how UK aid is being utilised on the ground and how it is being translated into results that affect the lives of thousands of people.

There are two stories to tell about child health in Malawi: one is a story of success, the other exemplifies the continuing challenges Malawi still faces.

Malawi has made great inroads in terms of reducing under-five mortality rates among children. It has been at the forefront of tackling childhood illnesses and is currently on track to meet Millennium Development Goal 4 of reducing child mortality by two thirds by 2015 from 1990 levels. The UK Department for International Development has been supporting efforts to improve child health in Malawi.

DSCN4799We visited three levels of primary healthcare in Salima, Malawi – one district hospital, one health centre and a monthly outreach clinic led by community health workers called Health Surveillance Assistants (HSAs). HSAs are recruited from the communities they serve and receive much shorter training than professional health workers – thereby saving resources and quickly increasing the health workforce in a country dealing with a chronic shortage of health workers.

DSC_0370HSAs carry out the majority of vaccination provided to children in rural areas and have been credited with eliminating or significantly reducing diseases such as measles, polio, diptheria, pertusis, smallpox and tetanus. In a village just outside of Salima we watched streams of women lining up to have their babies immunised and receive lifelong protection against some of the top infectious disease killers of children.

In addition to vaccination services, the monthly outreach clinic also set up a scale under a tree where parents could bring their babies to be weighed and measured. Each child has its own health passport, which HSAs used to track their height and weight. It was exciting to see health services being brought to communities that otherwise have no access to healthcare.


This is where the story turns and exposes some of the extreme challenges Malawi continues to face in terms of child health. I watched a distressed mother approach one of the health workers and explain how her nearly five-year old child, who looked no bigger than a two-year old, was able to see but not hear. The child was stunted, and the mother was desperate for help. The health worker referred her to the nearest health centre, but this case demonstrates the significant problem of child under-nutrition.

Almost half (47 percent) of Malawian children under the age of five are stunted, meaning they have low height for age and are chronically malnourished. Stunting can cause serious and irreversible mental disabilities, which have long term consequences. Under-nutrition affects a child’s brain development, resulting in reduced potential and lower earnings in adult life. These figures are drastic and will have a serious impact on the country’s future economy which is already in a precarious state today.

Despite these shocking facts, hope is on the horizon as Malawi is slowly taking steps to improve nutrition. In March 2011 Malawi committed to join the SUN – Scaling Up Nutrition – movement that will support nutrition interventions and monitor their impact. These efforts are laudable but will take time to implement and its effects won’t be seen for another generation. The Government has said they will triple their annual expenditure allocated to nutrition by 2020 and will build nutrition into other areas such as health, education, gender and agriculture.

As Malawi strives to improve child nutrition, it is important that the UK continues to support these efforts to ensure Malawian children are given the opportunity to live healthy lives.

The views and opinions expressed herein are those of the author and do not necessarily reflect the views of the RESULTS UK.