Evaluation of A.I.D. child survival programs : Malawi case study

The study assesses the Malawi program in five areas: (1) the effectiveness of interventions in water supply and sanitation, health education, child spacing, maternal and child health services, immunization, and malaria, HIV/AIDS, and diarrheal disease control; (2) economic efficiency; (3) financial and institutional sustainability; (4) long-term impacts; and (5) the program's relevance to specific conditions in Malawi. The following general conclusions emerged. (1) Female illiteracy is a critical obstacle to child survival. (2) The shortage of trained health personnel severely limits the quality and quantity of child survival services. (3) Child survival services have benefitted from being integrated within the broader national health portfolio. (4) The presence of many donors creates a management burden for the Malawi Government. At the same time, donor support for child survival is unpredictable. (5) In Malawi, malaria is the major barrier to further declines in infant and child mortality. HIV/AIDS is another major threat; with nearly 10% of the population infected by the virus, infant mortality could increase by as much as 50% over the next 10 years. (6) Interest in controlling diarrheal diseases has declined among both donors and the Ministry of Health. (7) Child survival investments are economically justified. (8) Sustainability is the most important objective of A.I.D.'s child survival programs, but the most difficult to attain. (9) Institution building and integrated health programs can be effective approaches to assisting national child survival programs. (10) Poor measurement of results weakens child survival programs. Appendices provide more detailed analyses of program sustainability and effectiveness, along with child mortality and morbidity data.