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Evaluation database

Evaluation report

2014 Malawi: Catalytic Initiative Evaluation of ICCM

Author: Tanya Doherty, Karen Daniels, Debra Jackson, David Sanders, Donela Besada

Executive summary

With the aim to continuously improve transparency and use of evaluation, UNICEF Evaluation Office manages the "Global Evaluation Reports Oversight System". Within this system, an external independent company reviews and rates all evaluation reports. Please ensure that you check the quality of this evaluation report, whether it is “Outstanding, Best practice”, “Highly Satisfactory”, “Mostly Satisfactory” or “Unsatisfactory” before using it. You will find the link to the quality rating below, labelled as ‘Part 2’ of the report.


The IHSS programme was established in 2007 with funding from the Canadian Government in 10 Districts. Selected high impact interventions to reduce child mortality were strengthened at the facility and  also through task-shifting for essential maternal and child oriented health care services to community health workers known as Health Surveillance Assistants  (HSAs) who run village clinics in hard to reach areas and also provide  promotive  health care to community and household levels.


The project aimed at strengthening the Malawi health system’s capacity to reduce maternal and child mortality. The evaluation therefore aimed at:

- Assessing the impact of the IHSS program on the coverage of the selected high impact interventions
- Informing program and policy decisions in Malawi and internationally.


Quantitative, qualitative and economic evaluation methods were utilised. Data sources for the coverage and LiST analyses included the Malawi Demographic and Health Survey (DHS) 2000, the Malawi Multiple Indicator Cluster Survey (MICS) 2006, the DHS 2010 and the 2012/13 Lot Quality Assurance Survey (LQAS). In depth interviews with health workers and care givers were used to gather qualitative information.

Findings and Conclusions:

Almost half (1796) of the HSAs trained in iCCM were trained with CI funds and deployed to the 10 CI districts. It was also found that the community appreciated the iCCM as an effective intervention while HSAs recognise and value the role that they play in reducing maternal and child mortality. However, supervision and availability of HSAs in the village clinics due to other competing priorities and lack of accommodation were   seen be inadequate.


-Improve coordination to avoid duplication  and also partner bypass or undermining of the existing routine systems
-Consider gender equity/balance by including more female  HSAs in hard to reach in order to handle sensitive issues like the new born
-Need for government  to reconsider the recruitment process so that it becomes really decentralised and that people are recruited from their areas to reduce attrition
Need for viable sustainability plans  by emerging the strategy into the routine government planning  and funding mechanisms

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