District Health System Strengthening and Quality Improvement for Service Delivery in Malawi

District Health System Strengthening and Quality Improvement for Service Delivery in Malawi


The District Health System Strengthening and Quality Improvement for Service Delivery (DHSS) project (2012-2018) supported the Government of Malawi in implementing the National Strategic Plan for HIV and AIDS in line with the Country Operational Plan. The DHSS leveraged PEPFAR resources and supported the implementation of the Health Sector Strategic Plan through its work in the Nkhata Bay, Likoma, Blantyre, Chiradzulu, Thyolo, Mwanza, and Neno districts.

Funded by the US Centers for Disease Control and Prevention (CDC), the project contributed to a healthy and prosperous nation free from HIV and AIDS. The main objective of the DHSS was to improve quality, access, and coverage of priority HIV-related health services in priority sites in the seven districts by identifying 90% of people living with HIV (PLHIV); initiating and retaining on antiretroviral therapy (ART) 90% of PLHIV identified; and achieving 90% viral suppression for ART patients.

The National Evaluation of the Prevention of Mother-to-Child Transmission (PMTCT) Program was also a part of the DHSS and evaluated the effectiveness and impact of Malawi’s PMTCT program by measuring transmission rates in HIV-exposed infants at 54 study sites. The study examined mother-to-child transmission rates and HIV-free survival rates among approximately 3,400 HIV-exposed infants whose mothers are on ART. The study followed up with participants over a period of 24 months or until weaning. The study also compared the use of PMTCT services, including uptake of antenatal testing and ART, and mother-to-child transmission rates between adolescent and young mothers and their babies and examined factors related to disclosure between partners.

In Malawi, an innovative strategy called index case testing is helping more people learn their HIV status by supporting HIV-positive clients in identifying family members and partners who may be at risk of infection and inviting them to be tested. With funding from PEPFAR through the US Centers for Disease Control and Prevention, MSH implemented this strategy in Malawi, reaching more than 20,000 family members served through 90 health facilities across the country. This video shares the story of the Justin family, who benefited from this initiative.
Under PEPFAR-funded projects, MSH teams have been employing index case testing as one strategy to reach the UNAIDS 90-90-90 targets. In index case testing, a person with confirmed HIV infection (an index case) is asked to contact family members (children, spouse, sexual partners, siblings, and parents) to invite them to be tested for HIV. Watch this webinar to learn more through three case studies from Ethiopia, Angola, and Malawi.

Donors & Partners


Centers for Disease Control and Prevention

The United States President’s Emergency Plan for AIDS Relief

Children’s Investment Fund Foundation


Malawi Ministry of Health

Dignitas International

Malawi AIDS Counseling and Resource Organization

The Hunger Project

Word Alive Churches

Malawi Girl Guides Association

Riders for Health

Joint Clinical Research Center

University of North Carolina Project-Malawi

Blantyre Malaria Project

Malawi Prison Health Services

Ekwendeni College of Nursing

Malawi College of Health Sciences

Mulanje Mission College of Nursing and Midwifery

St. Joseph College of Nursing

Malamulu College of Health Sciences