Pillar 1: Early Childhood
To ensure every child in Malawi is given the best chance to survive and thrive, UNICEF takes a comprehensive approach to supporting young children in their first 1,000 days of life
Evidence shows the first years of a child’s life set the stage for all future growth and development. In the earliest years of life, especially from pregnancy to two years old, babies and children need nutrition, protection, and stimulation for healthy brain development. Yet too many children are still missing out on the “eat, play and love” they need for their brains to mature properly. Put simply, we do not care for children’s brains the way we care for their bodies.
But despite the need for nutrition and care, many children in Malawi face challenges as their parents or guardians do not have the opportunity or adequate knowledge and skills to develop positive and responsive parenting skills. During the first 1,000 days of life, which are crucial to child development, Malawian children often experience poor health care, inadequate nutrition, little early stimulation and learning, and the absence of a protective environment. The challenges increase when children are also affected by HIV/AIDS and humanitarian disasters. Negative social norms, cultural beliefs, gender socialization and power dynamics at the household and community level have also hindered the acquisition of knowledge and skills and adoption of improved positive and responsive parenting practices and behaviors over time.
Underlying Constraints to Improved ECD in Malawi-
- Despite a slower rate of reduction in the prevalence of stunting (0.5 per cent reduction over the last 25 years), the past ten years Malawi made significant reduction in stunting rates to 37%. However high population growth has led to an increase in the absolute number of stunted under-five children in Malawi.
- The prevalence of wasting also reduced from 6% to 2.7% and vitamin A deficiency from 22% to 4% between 2010 and 2015/16.
- The prevalence of stunting among children in Malawi increases with a child’s age and the key underlying factors vary at each age group.
- Limited access to responsive parenting education and counselling, early stimulation, and early learning contributes to poor education outcomes in Malawi.
- Early marriages and adolescent pregnancies in Malawi increase gender inequalities and expose many newborns and infants to multiple risks, including stunting.
- Malawian children have low access to water, good sanitation, and hygiene services, which are essential for optimal child growth and development.
- Existence of social norms and cultural beliefs that hinder the adoption of positive parenting and responsive feeding and adoption of improved MIYCN practices.
- Protecting young children from poverty, hunger, food insecurity, and stress is one of the most cost-effective investments in human development.
Opportunities for Improving Child Development in Malawi-
- Malawi has policies and institutional frameworks in place for implementing cost-effective interventions essential for optimal growth and development of young children. Malawi was one of the initial countries to join the global Scaling Up Nutrition movement in 2011 and developed a National Nutrition Policy 2012–2016, which has been revised and extended to cover 2017–2021. Similarly, revised ECD policy was launched late in 2018 provide the guidance on integrated ECD interventions.
- Existence of platforms for implementing nutrition, reproductive, maternal, and adolescent health, early stimulation, and early learning interventions already exist in Malawi.
- Improving ECD outcomes includes critical investments in human capital that can contribute to reducing poverty and increasing economic growth and shared prosperity in Malawi. Early childhood care and experiences, especially in the first 1,000 days of life, have a profound impact on brain and cognitive development, including longer-term effects on learning, skills gain, and ultimately income.
- Donor interest has been establishing in ECD since new release of scientific evidence on new ECD approach as well as advocacy efforts for an integrated approach towards ECD. Also, worth mentioning about Malawi is one of the 26 countries worldwide that receives financial and technical support from the Global Financing Facility (GFF) Trust Fund, currently approved Investing in Early Years project for next five years.
- The CBCCs have been established with active community participation and contribution, following support and guidelines provided by the Ministry of Gender Child Disability and Social Welfare (MoGCDSW). Children ages 36-59 months are expected to attend preschool before joining the formal primary education. However, the quality of services provided through the CBCCs is generally not up to standard.
ECD refers to the physical, cognitive, linguistic and socio-emotional development of a child from pregnancy through the first two years of life. The right interventions at the right time can boost a child’s development and increases their chances of leading a healthy, productive life. For babies born into deprivation, intervening early, when the brain is rapidly developing, can reverse harm and help build resilience.
UNICEF is supporting the expansion of Integrated ECD services through various platforms including Community Based Child care Centers, Community Care groups, and Health Facilities. . UNICEF is also working with the government to improve policies and learning frameworks. One of these is the Care for Child Development Framework which was developed by UNICEF and the World Health Organization. It guides health workers and other counsellors as they help families build stronger relationships with their children and confront problems they face at home. The framework also highlights the links between ECD and other development areas including health, nutrition, early childcare, learning and development services.
Although large gains have been realized in reducing stunting, UNICEF remains concerned that 37 per cent of children below the age of five years are stunted. In addition, the prevalence of exclusive breast feeding has declined to 61% in 2015/16 from 72% in 2010. This is compounded by a sharp rise in the proportion (92%) of children aged 6–23 months whose diets fail to reach the minimum acceptable quality, up from 81% in 2010. Malnutrition is a leading cause of infant and child mortality in Malawi and acute malnutrition is a major risk factor for child mortality. Furthermore, anaemia is still a concern as it affects 28% of preschool children (22% have iron deficiency), while zinc deficiency is prevalent in 60% of the children
Under 2019 to 2023 country programme, UNICEF will continue to support interventions to improve ECD and include it as part of the lifecycle approach, which targets key stages of a child’s development.
UNICEF’s efforts to combat stunting aim to reduce the condition in Malawi from 37 per cent to 30 per cent by 2023, by focusing on children aged zero to 23 months and pregnant women. UNICEF is working in collaboration with the Government of Malawi in the implementation of the Scaling Up Nutrition (SUN) global movement and the First 1,000 Days initiative, adolescent nutrition and ECD interventions using a multisectoral approach. Additionally, UNICEF is also stepping up efforts to improve the quality of diets for children by promoting exclusive breastfeeding for the first six months of a child’s life, and continued breastfeeding until children are two years old. UNICEF is also promoting adequate complementary feeding by highlighting integrated homestead farming, improved utilization of diversified diets through food preservation, processing and meal preparation. UNICEF is also supporting the improvement of complementary feeding for children through home fortification using micronutrient powders. In addition, maternal nutrition interventions are carried out and include improving quality of diets and promoting antenatal care. Central to these approaches are evidence-based C4D approaches which support good nutrition practices and behaviours. UNICEF continues to engage and empower various stakeholders and groups from national, district, community and household levels to encourage the adoption of various maternal, infant, and young child nutrition (MIYCN) practices and behaviours. Using community, media and service delivery platforms, UNICEF is also actively creating demand for nutrition services and facilitating adoption of various nutrition practices and behaviours, and promoting health-seeking behaviour through community behaviour tracking mechanism. Through C4D interventions, UNICEF is also actively mobilizing, engaging and empowering adolescents to use good nutrition practices. In addition, UNICEF is supporting the government’s provision of weekly iron and folic acid supplements, and annual deworming tablets to adolescent girls aged 10-19 years, to prevent anaemia and low birth weight babies. The prevalence of anaemia in this age group is high at 35.3 per cent. To counter this challenge UNICEF and the government aim to build iron and folic acid stores among adolescent girls as they transition into adulthood.
UNICEF’s efforts to address wasting are aligned to the global action plan (GAP) on wasting which is a framework for action to accelerate progress in preventing and managing child wasting. The immediate drivers of undernutrition in Malawi include frequent childhood illnesses (diarrhea, malaria, pneumonia, HIV), poor maternal health and nutrition, inadequate quality of infant and young child diets, poor water, hygiene and sanitation, and insufficient childcare and health seeking practices.
UNICEF continues to facilitate the integration of early detection and treatment of child wasting into routine primary and community health services. In order to achieve early identification of children with acute malnutrition, trained community health workers and care group promoters regularly measure the mid-upper arm circumference (MUAC) of children and examine them for bilateral pitting oedema. Checking up on children who suffered from SAM and have been discharge from treatment is essential to ensure compliance, assess response to treatment and avoid relapse. UNICEF is also strengthening capacity of caregivers to be able to assess the nutrition status of their children using simple tools like MUAC tapes and refer those identified to be wasted for further assessments at the nearest health facilities.
Community awareness of acute malnutrition as a public health issue and work to educate people on how to prevent wasting are enhanced through C4D and strengthening linkages with the health, food and social protection systems.
UNICEF is also supporting the Ministry of Health to integrate nutrition supplies into the national health supply chain management system. Currently, RUTF (fortified peanut butter pastes rich in vitamins and energy), F75 and F100 (therapeutic milk) are on the essential medical supplies list and are integrated within the national health supply chain management system. UNICEF continues to procure nutritious foods, vaccines, and essential medicine supplies on behalf of the government while advocating for the government to increase its procurement of these essential commodities. Advocacy has led to a 380 per cent increase in the government budget for immunization services from 263 million Malawian kwacha in 2018-19 to 1 billion kwacha in 2019-2020. The Central Medical Stores Trust (CMST) is responsible for storage of therapeutic food supplies at the national level and distribution to health facilities. At the same time the pharmacy department is responsible for storage and dispensing therapeutic food stocks to end users in the same way they manage medicines. In addition, supplies are now monitored using the Ministry of Health Open Logistics Management Information Systems online platform. Increased accountability in the management of nutrition supplies has helped integrate them into the national supply chain management system. UNICEF is also strengthening end-user monitoring to ensure supplies are used for the intended purposes.
Ensuring every child has access to essential health services and a clean environment, UNICEF continues to invest in maternal and child healthcare, WASH, HIV, community resilience and capacity building among healthcare workers. Strengthening community structures by providing a platform for key stakeholders and resources to convene at the grassroots level is key to success. By leveraging community platforms, UNICEF continues to support village health workers and provide clinics for children under five years with new vaccines for diseases such as malaria and substitute for vitamin A deficiency. These efforts have helped halved the rates of children who have not been immunized. More than 8,700 children have also commencing early treatment for severe bacterial infections such as meningitis. UNICEF is also committed to ensuring improved maternal and newborn care as more than 90 per cent of deliveries are now conducted by skilled birth attendants. Access to HIV testing services for early diagnosis and treatment within eight weeks of birth has also increased.
UNICEF ensures health facilities maintain proper hygiene practices and that clean water is available for staff and patients. UNICEF’s WASH sector provides solar-powered water schemes for maternity centres, which served more than 20,000 users in 2018. More than 20 water schemes serving healthcare facilities were also constructed for the government. UNICEF continues to support Malawi during humanitarian emergencies. For example, Malawi experienced widespread floods, displacement of people and disruption of regular health programmes after Cyclone Idai struck in early 2019. Due to sustained efforts by UNICEF and other partners, no widespread cholera outbreak was recorded after the cyclone despite the fact it affected 14-cholera prone areas. Only 26 cases of cholera and one death were recorded compared to more than 3,500 cases and 93 deaths recorded between 2015-18.
In addition, UNICEF has adopted innovative approaches such as drone technology to supply essential commodities to inaccessible areas. For instance, UNICEF created a humanitarian drone corridor during Cyclone Idai to dispense supplies. Drone technology could also be used to combat the current COVID-19 outbreak. In collaboration with academia using climate-seasonality modelling in predicting diseases such as cholera and malaria.
To ensure every child who undertakes ECD is tracked and supported, UNICEF, UNDP and the Government of Malawi made significant progress in registering more than 300,000 under 5 children in 2019, an increase of 180 per cent from 2018. UNICEF also created multidisciplinary taskforces to carry out a “whole-of-child” approach to interventions for children aged up to 5 years, as well as supporting learning for pre-school children in community-based child care centres.