Maternal newborn context
Malawi is a low income country that faces numerous health system challenges, including unevenly distributed and poorly resourced health facilities, a lack of trained health workers and a high birth rate. The neonatal mortality rate is 22 per 1000 live births. In addition to this, Malawi has the highest preterm birth rate in the world, estimated at 18% of live births. Despite these challenges, Malawi has made significant efforts to implement initiatives in response to the problems of both maternal and newborn morbidity and mortality. This includes exemplary efforts to institutionalise high impact interventions for small and sick newborns, most notably, their focus on facility based kangaroo mother care (KMC), resuscitation training for health workers though the Helping Babies Breathe (HBB) initiative and development of newborn care protocols. As Malawi develops their monitoring strategy for their national Newborn Action Plan, increasing attention has been paid to facility level data and data on small and sick newborns.
Health information system context
Malawi has also made significant progress in strengthening its national health information system. In 2013, the Central Monitoring and Evaluation Division (CMED) of the MOH rolled out the district health information system 2 (DHIS2) platform nationally. By 2014 all districts were reporting data for the main HMIS monthly reports, including data on maternity, delivery and newborn care (KMC, HBB, etc). While reporting rates are generally high (>90%) for the standard forms supported by CMED, there are notable gaps in reporting, particularly among the high volume central hospitals, which often do not report. However, as of 2015, CMED and partners have been working to address these reporting gaps and reporting rates by central hospitals are improving. HMIS are an ideal platform to develop as they are relatively inexpensive (compared with health facility assessments), and are largely driven by national decision makers meaning there is real potential to streamline and improve the existing data and its quality. Other relevant efforts underway include the development of a national KMC register and monthly report that was finalized and rolled out in 2015 and initiation of a newborn register and development of patient charts for care of small and sick newborns. Further investments are being made to standardize indicators, reporting formats and dashboards to encourage quality checks and use of the data by program staff.