Malawi's Ministry of Health and partners launch the third phase of the national NCD response, focusing on often-neglected chronic conditions—such as type 1 diabetes.
04 July 2024 Andreea Enea
At the end of May, Malawi's Ministry of Health (MoH) and other key stakeholders involved in the non-communicable disease (NCD) advocacy, prevention, and care – including WDF – met in the capital city Lilongwe to officially celebrate the launch of the Scaling up the Implementation Capacity for NCDs Prevention and Management Strategy, the third phase of the national NCD response in the country.
Spanning four years, this ambitious nationwide effort prioritises people living with chronic conditions such as type 1 diabetes and will expand access to NCD care at the primary level.
The partnership between the NCD and Mental Health Unit of Malawi's MoH and Partners in Health, a non-profit organisation with extensive experience in NCDs in low- and middle-income countries (LMICs), aims to provide integrated healthcare to underserved communities with limited medical access.
‘The Ministry is grateful to WDF for the historical and cordial working partnership that has driven the country to an improved health system strengthening for NCD and mental health service delivery’, NCD director Dr Jonathan Chiwanda stated on this occasion.
‘This national scale-up is a true testimony of the steady growth of NCD care and it is well aligned with the vision of achieving universal health coverage, improved quality of life, and consequently moving towards reduced morbidity and mortality’.
Dr Jonathan added that these efforts were consistently aligned towards reaching the SDG target 3.4 to reduce premature mortality from NCDs and promote mental health and well-being.
The scale-up, initiated in October 2023, brought relevant partners on board. NCD Alliance Malawi will support the roll-out of a series of national coordination meetings for patient, government, and stakeholder advocacy, while the local NGO Development Communication Trust will play a crucial role in community mobilisation efforts.
With a total budget of 4.7 million EUR, it includes the largest grant ever awarded by WDF to a single project.
‘Up until now, we have supported 12 projects in Malawi, so we are overly thrilled to see how all these efforts have progressed into such a complex programme', shared Mads Loftager Mundt, WDF’s senior programme manager, type 1 diabetes area, who was part of the visit in Malawi. 'It also culminates a decade of collaboration with the Malawi MoH to strengthen diabetes prevention and care’.
The Declaration of Alma-Ata in 1978 called for comprehensive primary healthcare at a global level, but the funding shifted towards disease-specific initiatives, leaving programs addressing NCDs behind. While this approach paid off in low-income African countries, NCDs have increased as the populations have moved to urban settings and adopted sedentary lifestyles.
However, integrating NCD care at the primary level is vital, especially after a global pandemic that has exposed public health vulnerabilities. Primary care is not only the first point of care but also the core of a health system that reaches all patients and ensures early NCD management. Improved policies and plans are urgently needed.
In Malawi, WDF has supported advancements in the national NCD response, such as the inclusion of NCDs in the 2023-2030 Health Sector Strategic Plan III (HSSP III). Since 2008, separate small-scale projects have been developed into a comprehensive partnership framework with MoH and relevant stakeholders aligned with the formation of a national NCD response.
With multisectoral partnerships addressing health inequalities, the new phase seeks to cover the entire spectrum of care, from patient and community levels to hospitals and policymakers.
This scale-up builds upon the outcomes of two previous key projects:
The second phase of support to consolidate and refine the national NCD response, with emphasis on capacity building and quality of care.
A convergence of efforts and investments by WDF and CDiC to integrate and advance type 1 diabetes care by 2025 in eight countries including Malawi.
The progress of expanding NCD responses in LMICs depends on significant investment and international support, as well as on reprioritising NCDs that have been long neglected. One is type 1 diabetes, a severe disease often diagnosed during childhood or adolescence, which requires life-long monitoring and treatment to ensure survival and avoid severe complications.
In a country where most of the population is young and living in resource-limited settings, the prevalence of type 1 and type 2 diabetes is increasing. According to International Diabetes Federation's 2021 estimates, there are 486,000 adults in Malawi living with both type of diabetes, with approximately 58% likely to be undiagnosed and untreated.
The scale-up seeks to bridge this gap by integrating type 1 diabetes care and, at the same time, increase focus on supply chain mechanisms through funding provided in parallel by Novo Nordisk’s Changing Diabetes in Children (CDiC) and other programmes with similar objectives.
WDF is a global partner of Novo Nordisk’s Changing Diabetes in Children (CDiC) programme in eight countries through a separate project funded by a 2021 grant from the Novo Nordisk Foundation. Its goal is to strengthen the integration of type 1 diabetes and reach 12,000 children and adolescents between 2021-2025.
Our colleagues were joined by a Novo Nordisk delegation in meeting the Malawi MoH and key partners to discuss the next steps.
‘We are happy to see that the type 1 diabetes component has now been fully integrated into the national NCD programme’, adds Mads, ‘and we look forward to the implementation research project that was recently approved to better assess the impact of our partnerships'.
Increased care for chronic NCDs is also sustained by the adoption of PEN Plus, a refined model of the World Health Organisation’s Package of Essential NCD Interventions (WHO-PEN) for the decentralisation of primary care.
The close partner collaborations over the past decade have improved the NCD response in Malawi, with a strengthened monitoring and evaluation system, wide coverage of NCD clinics and a continuous expansion of PEN-Plus clinics across the country. PEN-Plus strategies aim for integrated chronic care for people with severe NCDs and has provided a significant support to expand on the NCD care established during previous WDF projects.
'The implementation of PEN-Plus has remarkable value in improving the quality of care for severe conditions at the district level, due to the holistic approach adopted by the healthcare staff', explains Evelyn Chibwe, NCD Technical Advisor for PiH/MoH. 'This leads to better patient outcomes and reduces the financial burden of tertiary care referrals'.
Moreover, Evelyn adds, 'this initiative not only addresses neglected NCDs but also focuses on pediatric NCD care, highlighting the comprehensive nature of the programme'.
Supported by a strong partnership, the phased scale-up of Pen Plus has allowed witnessing the positive impact and the increased awareness of critical health conditions among the population.
'These collaborative efforts and capacity-building measures continue to yield tangible benefits for patients and communities, fostering resilience amidst health system challenges', Evelyn adds.
The scale-up would elevate specialised care to ensure an inclusive and sustainable program. Healthcare professionals will be trained in type 1 diabetes, gestational diabetes, complications, and other chronic conditions, while PEN-Plus clinics will be developed in six new districts (out of 28) and new and strengthened NCD clinics will be established closer to local communities.
Learn about the NCD scale-up here.
Malawi's adoption of digital health solutions, such as the WDF's Diabetes Compass, reflects an outstanding level of integration in its NCD response.
The expansion of digital health, partly driven by the pandemic, has led policymakers to prioritize areas that make healthcare more effective and accessible. Malawi's improved data collection across healthcare sets a favorable environment for embracing such digital solutions.
This project aims to use existing open-source technologies and infrastructure to create helpful digital tools and resources for healthcare professionals managing diabetes and hypertension. The project engages healthcare practitioners, local communities, and community health workers in all the design, development, and implementation stages.
The project has integrated an NCD module within Malawi's national health system (MaHIS) and will soon launch a community screening tool for diabetes and hypertension in six primary care facilities.
By focusing on co-creation and a human-centred approach, we address real-world challenges faced by HCPs and the people they serve’, explains Jacklynne Anyango Ogutu, WDF’s Head of Digital Health Solutions. ‘Our hope is that these digital tools will improve early detection of diabetes and hypertension, support healthcare professionals in making data-driven decisions, and lead to better health outcomes for all.’
Community health workers and health surveillance assistants will utilise these digital health solutions to bring healthcare services closer to the people they serve.
As an essential part of the national scale-up, they receive NCD training and are equipped with a digital community screening tool from the Diabetes Compass project. By conducting household education and screening, referring patients, and providing follow-up, the goal is to reach up to 50,000 patients, ultimately improving health outcomes.
At the community level, the scale-up efforts place a high priority on raising awareness and implementing screening processes for chronic diseases. To meet these goals, our partners are actively involving rural communities.
The programme aims to establish 160 new patient support groups at local diabetes and NCD clinics, and 30 new Radio Listening Clubs (RLCs) to reach the population in remote areas.
RLCs represent a unique community-based initiative led by the Development Communication Trust. The clubs increase awareness and engagement of people with accurate, localised, and gender-responsive prevention, screening, and care information.
Trained volunteers will expand education on gestational diabetes, mental health, and prevention of complications. They will also facilitate basic screenings and referrals, complementing the efforts of the CHWs.
The recordings will be broadcast on national or local radio stations for wider coverage.
For the first time, partners will organise yearly camps for children living with type 1 diabetes covering a wide range of activities involving child education, glucose testing, physical activity, and healthy nutrition. The camps represent a unique opportunity for children to learn about the disease and foster a sense of community, by connecting with counsellors and other children with the same condition.
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More and more governments are developing national NCD programmes as part of the global framework of response to the increasing burden of NCDs through partnerships.
In November 2023, Kenya launched a similar large-scale NCD programme to integrate diabetes and hypertension prevention and control into primary care. The new scale-up phase aligns with Kenya’s decentralised reform and represents the largest WDF-supported project in terms of grant size, thanks to a solid multi-sectoral partnership.
Other ambitious national NCD responses like the one in Kenya and Malawi have also been developed in Tanzania (phase II of the NCD programme) where WDF has been supporting projects since 2003, and in humanitarian settings such as Jordan (Integrated NCD-humanitarian response).