Investing in poor children in Malawi provides more value for money, UNICEF report finds

More investments needed for children in Malawi

07 December 2017
Girls taking part in activities at a Children's Corner in Mzimba
UNICEF Malawi/2018/Govati Nyirenda
Girls taking part in activities at a Children's Corner in Mzimba

LILONGWE, 12 July 2017 – A new UNICEF analysis has affirmed that investing in the health and survival of the most deprived children and communities provides more value for money, saving almost twice as many lives for every dollar spent as equivalent investments in less deprived groups. The global report highlights Malawi alongside Afghanistan and Bangladesh, as one of the countries with high rates of under-five mortality where focus on the most deprived has made a difference for children.

Narrowing the Gaps: The power of investing in the poorest children presents compelling new evidence that backs up an unconventional prediction UNICEF made in 2010: the higher cost of reaching the poorest children with life-saving, high-impact health interventions would be outweighed by greater results.

“Over the past 10 years we have seen an increase in funding for children’s health and survival programmes by government and development partners,” said UNICEF Malawi Representative Johannes Wedenig. “This has helped Malawi reduce child and invest in basic health care at community level. As a result, Malawi is one of the few countries in the world that managed to attain Millennium Development Goal 4 on reducing child mortality.”

In 1990, almost one in four children in Malawi were dying before reaching the age of five. However, the focus on the most deprived has made a difference for children and between 1990 and 2015, under-five mortality decreased by 50 percent.

Malawi’s approach to bringing down under-five mortality focused on improving equitable coverage of high-impact interventions to tackle the major causes of child death. These include pneumonia, diarrhoea and malaria, expanding vaccination programmes, promoting the use of insecticide treated bed nets, and scaling up efforts to prevent child undernutrition.

Malawi also expanded community-based approaches, deploying 11,000 health extension workers to set up village clinics in 4,300 hard-to-reach locations, and organizing child health days across the country twice a year to promote public awareness about health issues. The Malawi government also took an integrated approach to child health, focusing on both prevention and treatment to address the major causes of child deaths.

Drawing on new data from the 51 countries where around 80 per cent of all newborn and under-five deaths occur, the study shows that improvements in coverage of life-saving interventions among poor groups helped decrease child mortality in these countries nearly three times faster than among non-poor groups.

The study selected six key health interventions as indicators to assess access to high-impact maternal, newborn and child health interventions: the use of insecticide-treated bed nets, early initiation of breastfeeding, antenatal care, full vaccination, the presence of a skilled birth attendant during delivery, and seeking care for children with diarrhea, fever or pneumonia.

Specifically, the study found that:


  • Access to high-impact health and nutrition interventions has improved most rapidly among poor groups in recent years, leading to substantial improvements in equity.
  • During the period studied, absolute reductions in under-five mortality rates associated with these changes in coverage were nearly three times faster among poor groups than non-poor groups.
  • Since birth rates were higher among the poor than the non-poor, the reduction in the under-five mortality rate in poor communities translated into 4.2 times more lives saved for every million people.
  • While the per capita investment needed to improve coverage among the poor is greater than that required to reach the non-poor, these investments save almost twice as many lives per US $1 million invested as equivalent investments in the non-poor.


The findings come at a critical time, the Government with support from development partners such as UNICEF continue working towards achieving the Sustainable Development Goals, which set a target of ending all preventable deaths among newborns and children under the age of five by 2030. Investing in children’s health and survival can also support the achievement of other global development goals, such as ending poverty.

“Investing in the poorest children in Malawi is not only right in principle, it is also right in practice, saving more lives from the money spent,” said Wedenig. “This is critical news for governments working to end all preventable child deaths at a time when every dollar counts – a healthy child has a better chance of learning more in school and earning more as an adult.”

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