Malawi

Background

Reflecting the global demographic trend, young people in Malawi make up a significant proportion of the population. Those ages 10 to 24 now comprise one-third of Malawians, and for more than a decade the Government of Malawi has focused on addressing their health needs. Since 2007, the government has worked with local and international partners to implement and scale up a minimum package of youth-friendly health services in an effort to make them accessible, appropriate and affordable for the growing population segment. The minimum package of services responds to the broad range of health problems, including sexual and reproductive health problems—such as unwanted pregnancies, sexually transmitted infections, and HIV/AIDS—young people disproportionately encounter.

Despite these efforts, young people still face challenges to accessing comprehensive health and sexual and reproductive health services. These barriers not only impede young people from exercising their rights to health services and protection, and to decide when and how many children they have, but also keep the country from reducing its high fertility rate, increasing its low contraceptive prevalence rate, and addressing the social and economic implications of a rapidly growing population. The Government of Malawi therefore decided to carry out a comprehensive assessment of youth-friendly health services in the country.

Evaluation of Youth-Friendly Health Services

E2A provided technical assistance to the government’s assessment, specifically by evaluating the proportion of youth around service delivery points in ten of Malawi’s districts who have accessed youth-friendly health services and the extent to which services have been performed in accordance with government standards. The involvement of youth at different stages of program implementation was also examined. Results of E2A’s evaluation will likely inform strategies to improve the implementation and uptake of youth-friendly health services in Malawi.

E2A applied a mixture of quantitative and qualitative data collection instruments at the community and health facility levels. The qualitative component focused on gaining deeper understanding of the facilitators and barriers to the uptake of youth-friendly health services in Malawi, while the quantitative components focused on the coverage of youth-friendly health services, uptake of those services, adherence to standards, and satisfaction with services provided. E2A gathered data through focus group discussions with youth, parents, and community leaders, as well as interviews with clients, service providers, peer educators, community-based distribution agents, district health officers, NGO staff, health facility managers, and district youth-friendly health service coordinators. Additionally, E2A conducted a community survey of young people, ages 10 to 24, to determine coverage of services and reviewed health service statistics. Findings from the evaluation are published in this comprehensive report and four-page evaluation summary.