ONSE Health Activity Overview

The program began on November 15, 2016, and is set to conclude on November 15, 2021. Management Sciences for Health (MSH) serves as the prime implementing partner, while Banja La Mtsogolo (BLM), Dimagi, Overseas Strategic Consulting, Ltd. (OSC), and VillageReach are subawardees. The Malawi Ministry of Health and Population is the major counterpart organization. The ONSE Health Activity focuses on 16 districts in Malawi, including Balaka, Chikwawa, Chitipa, Dowa, Karonga, Kasungu, Lilongwe, Machinga, Mangochi, Mchinji, Mulanje, Nkhatabay, Nkhotakota, Ntcheu, Salima, and Zomba. The program's clinical services component includes renovation of health facilities and equipment provision. In Chikwawa, the renovation and construction works at Chapananga Health Center postnatal and maternity blocks, as well as waste disposal facilities, were completed on December 14th. A new borehole was drilled, and a water reticulation system was installed to improve water supply to the health center. Integrated Family Health Outreach Clinics (IFHOCs) are another key component of the program. Through December 14, ONSE supported 167 IFHOCs in all 16 ONSE districts, reaching a total of 41,908 beneficiaries. The most commonly cited reasons for cancellations included lack of fuel or reliable transport, impassable roads, and funerals within communities. ONSE works closely with MoHP counterparts to support fuel and transport to ensure IFHOCs occur regularly. Maternal and newborn health is a critical focus area for the ONSE Health Activity. Intrapartum care is a key component, with ONSE supporting emergency obstetric and newborn care (EmONC) supportive supervision for 32 providers from 11 facilities in Karonga, Kasungu, and Nkhotakota. The supervision aimed to assess performance on EmONC functionality and support capacity building for performing all signal functions. Many of the improvements can be attributed to the deployment of registered Nurse Midwives in facilities who are able to perform all signal functions, the provision of KIWI vacuum extractors that are easy to use, and ongoing mentorship on signal function performance across all facilities. In Zomba, ONSE supported the MoHP to conduct MNH mentorship at the cluster level for 10 health facilities and 22 providers. The activity aimed to improve providers' skills, knowledge, and attitude in the management of life-threatening obstetric conditions. Participants were mentored on adherence to partograph when monitoring patients, Helping Babies Breathe (HBB), Kangaroo Mother Care (KMC) using the Family Led Care Model, management of postpartum hemorrhage (PPH), pre-eclampsia and eclampsia, and methods for improving data capture in various registers. ONSE will conduct follow-up supervision in Q2 to assess performance improvement. In Chitipa and Salima, ONSE supported MoHP district health offices to conduct facility-based mentorship on Non-Pneumatic Anti-shock Garment (NASG), Helping Mothers Survive (HMS), and active management of the third stage of labor (AMTSL) through drills and return demonstrations for 27 midwives and clinicians from 9 facilities. This mentorship aimed to impart lifesaving skills for managing obstetric emergencies, thereby preventing maternal deaths. At the end of the mentorship, all participants were proficient on using the NASG for managing bleeding complications and improved their skills in providing general management for patients with hemorrhage. In Lilongwe, ONSE supported neonatal case reviews with a focus on partograph adherence. The case reviews were based on the neonatal death audit report for October 2018, which revealed that 55% of the neonatal deaths that occurred at Bwaila Hospital from August to October 2018 were attributed to health worker competency factors. A total of 47 healthcare workers participated in the case reviews, which aimed to improve their skills and knowledge in managing neonatal care.