Maternal mortality rates in Malawi are among the highest in the world claiming over 5,800 women at childbirth or pregnancy related illnesses. A major factor in the high maternal mortality rate is delayed or no access to quality health services at birth. Relevant underlying factors, among others, are poverty and lack of money to pay for transport to the health facility for delivery (demand-side), and low quality of maternal health care provided in the health facility (supply-side).

The programme, funded by the Government of Germany, through KfW and the Government of Norway is supporting the Government of Malawi in achieving the MDGs, particularly MDGs 4 & 5 using results-based financing mechanisms to improve maternal and newborn health. Options has been contracted by the German Development Bank, KfW to design and manage this three-year programme.

Options is working closely with its partner BroadBranch Associates, and drawing on international and local expertise to build capacity of the Ministry of Health and Reproductive Health Unit in implementing results-based financing approaches. The programme is in its design phase and has three principal components:

• Immediate investments in minor infrastructure and equipment for participating facilities to bring them up to a minimum operating level to participate in the project
• Supply-side component: provide financial rewards to facility-based teams at both district level and below and district health management teams
  
• Demand-side component: a conditional cash transfer to women delivering in an approved health facility.

To date, activities have comprised the development and implementation of a detailed baseline survey tool covering some 30 facilities (both CEmOC and BEmOC), analysis of results to inform the selection of participating facilities and to set baseline indicator levels for financial incentives and to serve as the baseline for project’s own internal monitoring and evaluation. The programme team has also worked on the detailed design of the cash transfer (funds flows, fraud control mechanisms, etc.) and agreeing on the detailed design for the incentive structure (selection of indicators for rewards, agreement on payment schedules, contracting mechanisms and so on).

The programme is working in four districts: Ntcheu, Mchinji, Dedza in East Central Zone and Balaka in South Eastern zone of Malawi. Participating facilities will be drawn largely from the public sector with a small number of Christian Health Association of Malawi facilities as appropriate.