Cost Benefit Analysis of Improving Neonatal and Maternal Health Outcomes in Malawi - Technical Report

Malawi has been one of the few low-income countries to achieve the Millennium Development Goal (MDG) for child survival. The country is rightly considered a global success story in this area, given its wealth and resource constraints. Malawi has reduced under-5 mortality by two-thirds between 1990 and 2015 from 234 deaths to 63 deaths per 1000 live births in 2015–16. This has been achieved by a series of community level interventions to address the major causes of child death and includes vaccinations drives, bed nets, supplementary nutrition programs, diarrhea and malaria treatment and prevention and treatment of HIV. The rate has now further reduced to 50 deaths per 1000 live births representing a 78% decrease over a 28-year period. This achievement is proof of the country’s high-level policy commitment to child health, and support for strengthening health workforce capacity, and expanded maternal and newborn care. However, while child mortality has decreased substantially for all age groups above age 1, the rate of decline of neonatal mortality has been slower even though rates of facility births are increasing. While child mortality declined by more than 5% annually from 2000, neonatal mortality declined less rapidly (3.3% per year) from 50 in 1990 to 22 deaths per 1000 births in 2018. In 2017, neonatal disorders represented the second highest source of disability adjusted life years (DALYs) after HIV / AIDS. Malawi also faces a challenge with maternal mortality, with the country recording among the highest maternal mortality rates in the world. What is evident therefore is that in the broad area of maternal, neonatal and child health, Malawi has performed well in the area of child health but needs to address maternal and neonatal health as a high priority. To achieve this, investments in interventions to improve reproductive, maternal and newborn health are crucial.