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The child in the family

Malawi: Community Integrated Management of Childhood Illnesses (C-IMCI)

© UNICEF/1993/ Andrew
UNICEF cooperation supports programmes in primary health care aimed at reducing child malnutrition and diarrohoeal disease; increasing household food security, especially for single mother families; and improving water, sanitation and hygiene.

In recent years Malawi has made important strides in protecting the rights of children in spite of daunting economic and social challenges.

 In 2003 a major landmark of UNICEF’s cooperation with the Government of Malawi was the implementation of a registration system for all children born on or after January 1st, 2000; as well as for orphans and children who have become heads of households as a consequence of the loss of their adult family members to HIV/AIDS.

Given the devastating impact of HIV/AIDS on families and particularly young children, an important area of UNICEF Malawi’s work has been Early Child Care and Support to Families affected by HIV/AIDS. A key aspect of this programming effort is the Community based Child Care project.

The overall objective of the project is to reduce infant mortality through the approach of Community Integrated Management of Childhood Illnesses (C-IMCI). Additionally, families are supported so that they can provide physical, psychological and material support for holistic and healthy development of their children.

Strategies employed to achieve these objectives include capacity building at district and community levels. At the community level the main vehicle for capacity development involves use of an innovative Community Dialogue Tool that is based on participatory methodology.

The Community Dialogue Tool is the mechanism that engages families in the community for ensuring the rights and well-being of their children. The Community Dialogue Tool is a both a problem-based adult learning methodology, and a negotiation tool. There are four tenets of the Community Dialogue Tool, all of which are grounded in and compatible with the principles of human rights:

  • consider current practices, requiring much learning and listening for a service provider
  • respect the interests and goals of the families and community members in terms of well-being of their children
  • have a range of options through dialogue and choose the best for improved well being of children
  • a commitment to action, usually in the form of an action plan

While the project initially aimed at early childcare, particularly the prevention and treatment of childhood illnesses at the household and community levels, the participatory methodology made the family members realize the needs to address the underlying causes of childhood illnesses and especially the significance of proper child care practices and access to basic social support.

The results so far have been impressive. The C-IMCI has been expanded from five to nine districts, covering 1,179 villages in 2003; it has also been included in the national Essential Health Package as a strategy to reduce poverty and promote health. A multisectoral National Steering Committee for C-IMCI has been established to provide policy guidance.

An early childhood development survey was conducted in 2002-2003. Findings show positive changes and improvement in family care practices, particularly in the role of fathers in child rearing. Community leaders and care givers have been trained in the Community Dialogue method. They have also been trained on care seeking behaviours as well as in the basic principles of the Convention of the Rights of the Child (CRC).

Apart from the community-based childcare centers, the program has strengthened the capacity of families affected by HIV/AIDS through home based care and income generating activities. Training of parent committee members are some of the many activities that are current carried out under the C-IMCI umbrella and support programs for families affected by HIV/AIDS that also includes:

  • Training in small-scale business management
  • provision of start up loans through partners for income-generating activities
  • establishment of children’s centers to provide psycho-social and recreational support to vulnerable children
  • training of home based care volunteers
  • development of home based care kits
  • training of volunteers in psychosocial counselling
  • orientation on property dispossession issues

The Malawi case is an example of multisectoral programming addressing a critical range of child and family well-being issues working in partnership with families and communities. It is also an example of multi-level advocacy and capacity building at the level of families, communities, and the state policy.

The Malawi case illustrates the power and multiplying effect of human rights-based development interventions, when families are engaged as equal partners and contributors to the well-being of their children and protection of their rights.


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