The Global Health Initiative in Malawi
New Approaches and Challenges to Reaching Women and Girls
The Obama administration designated Malawi as a GHI Plus country in June 2010, one of the first eight countries selected to implement the Global Health Initiative’s (GHI) more comprehensive approach to global health and serve as learning labs for other GHI country programs. The GHI team in Malawi has identified the health of women and girls, including HIV and family planning (FP)/reproductive health (RH) services, as critical, promising areas for GHI success. Though still in early stages of implementation, new approaches are emerging in Malawi that leverage resources from the President’s Emergency Plan for AIDS Relief (PEPFAR) to develop greater program synergies for women and girls. Yet Malawi’s weak health system, combined with ever more serious concerns about governance and human rights issues that are undermining donor support, present challenges that may threaten GHI’s ability to achieve sustainable results.
Although over half of U.S. funding to Malawi is focused on HIV/AIDS, Malawi was not one of the original PEPFAR focus countries. The U.S. government has relatively balanced health and development funding in Malawi, which gives the GHI comparatively greater potential for impact than in neighboring countries where U.S. flexibility is limited because funding is effectively tied to PEPFAR. Granted, many questions remain about how GHI will add value, deliver results, and create space for innovative approaches, especially without new money. Nevertheless, GHI has encouraged an attitude of active collaboration within the U.S. government interagency team in Malawi and has introduced new expectations about the importance of program synergies to guide U.S. programs. The value and impact of GHI’s new business model may ultimately be evaluated based on its outcomes for women and girls, given the prominence of the women, girls, and gender equality principle in GHI and the importance of cross-sectoral approaches to address their health and non-health needs.