Formative research to identify and characterize the most vulnerable and unreached to understand the determinants of essential health and nutrition service coverage among the most marginalized groups of children under five across three districts of Malawi.
In a bid to improve health and nutrition outcomes for the most vulnerable children in Malawi, the Center of Innovation for Public Health and Emergency Response (CIPHER) and Nutrition International conducted a formative research study across three districts—Mangochi, Mchinji, and Mzimba. The study aimed to identify and characterize the most unreached children under five, understand the barriers to essential health and nutrition service coverage, and explore systemic changes needed to improve outreach programs.
Objectives of the Research
The study focused on three key objectives:
Characterizing Vulnerabilities – Identifying geographic and sociodemographic factors contributing to low coverage of essential health and nutrition services among children under five.
Assessing Opportunities and Barriers – Evaluating existing outreach programs to determine gaps and opportunities for improved service delivery.
Identifying Systemic Determinants – Analyzing structural and systemic challenges within health, social, and governance systems that hinder effective service provision.
Key Findings
- Geographic and Sociodemographic Vulnerabilities
The research revealed that children in hard-to-reach areas, including remote rural communities and informal settlements, face significant barriers in accessing health and nutrition services. Factors such as:
- Distance to health facilities
- Poor road infrastructure
- Low household income and food insecurity
- Low maternal education levels
contributed to disparities in service uptake. Additionally, cultural beliefs and gender norms influenced care-seeking behaviors, with some communities relying more on traditional healers than formal healthcare providers.
- Barriers and Opportunities in Outreach Programs
While Malawi has several community-based health initiatives, the study identified gaps in:
- Community Health Worker (CHW) capacity and coverage – Some areas had insufficient CHWs to meet demand.
- Supply chain challenges – Stockouts of essential nutrition supplements (e.g., Vitamin A, therapeutic foods) were common.
- Low awareness – Many caregivers were unaware of the importance of routine nutrition services.
However, the research also highlighted opportunities for improvement, such as:
- Strengthening community engagement through local leaders and influencers.
- Leveraging mobile health (mHealth) technologies for better follow-up and education.
- Integrating nutrition services with other health programs (e.g., immunization campaigns).
- Systemic Determinants Requiring Change
The study emphasized the need for multi-sectoral collaboration to address systemic issues, including:
- Policy and funding gaps – Ensuring sustained investment in nutrition programs.
- Health system strengthening – Improving supply chains, training for health workers, and data monitoring.
- Social protection programs – Linking nutrition interventions with poverty alleviation efforts.
Recommendations for Action
Based on the findings, CIPHER and Nutrition International proposed several actionable steps:
- Targeted outreach programs for remote and marginalized communities.
- Enhanced training and support for CHWs to improve service delivery.
- Community sensitization campaigns to increase demand for nutrition services.
- Advocacy for policy reforms to address systemic barriers.
This formative research provides critical insights into the challenges faced by Malawi’s most vulnerable children and offers a roadmap for improving health and nutrition service coverage. By addressing geographic, sociodemographic, and systemic barriers, stakeholders can design more effective interventions to ensure no child is left behind. CIPHER and Nutrition International remain committed to working with the Malawian government, local partners, and communities to implement these recommendations and drive sustainable change in child health and nutrition.