At a glance
For over 23 years, CDC has collaborated in Malawi with local and international partners to strengthen health systems. The office works to prevent, detect and respond to diseases. Efforts include building healthcare workforce capacity, strengthening laboratory systems, and increasing the capacity of surveillance and health information systems. CDC also implements high-impact HIV and tuberculosis programs through the President's Emergency Plan for AIDS Relief and supports malaria control activities under the U.S. President's Malaria Initiative.
Overview
CDC established an office in Malawi in 2001. CDC Malawi works closely with the Ministry of Health (MOH) and partner organizations to address the following public health areas:
- Global health security
- HIV
- Tuberculosis (TB)
- Malaria
- Immunization
Global health security
Strategic focus
CDC's technical support strengthens public health systems to prevent, detect, and respond to emerging infectious diseases. CDC focuses on real-time disease surveillance, laboratory systems and diagnostics, workforce development, and emergency management.
Laboratory systems strengthening
CDC supports the Public Health Institute of Malawi (PHIM) to develop the capacity to prepare for and respond to emerging diseases. PHIM's reference laboratories are producing specimen genotyping and proficiency panels for TB, HIV, Syphilis, and Hepatitis B tests. These efforts help to sustain the national quality assurance program.
CDC also supports a four-tiered approach (central, district, facility, and community) to strengthening laboratory capacity testing for HIV diagnostic and treatment monitoring, COVID-19, and TB. This work includes implementing continuous quality improvement for both conventional and point-of-care testing laboratories. All 28 districts in Malawi participate in this initiative.
Health information systems
CDC supports the implementation of the largest electronic medical record system in Malawi. CDC collaborated with the MOH to deploy and support infrastructure improvements. CDC's support also covers systems integration efforts to promote data visibility and use.
Workforce development
CDC partnered with the PHIM to establish the Field Epidemiology Training Program (FETP) in 2016. FETP trains field epidemiologists at community, subnational, and national levels to strengthen their capacity in disease and public health surveillance as well as outbreak investigation and response. Malawi's FETP program supports the frontline and intermediate levels of training.
Emergency response
Cholera
Malawi experienced the deadliest cholera outbreak in the country's history from 2022-2023, with over 59,000 cases and 1,770 deaths reported. CDC Malawi supported the cholera outbreak response by providing technical expertise and supporting emergency operations centers. CDC leveraged HIV, TB and COVID-19 funds to support the investigation and response. CDC also supported UNICEF in water, sanitation, and hygiene activities.
Polio
After 30 years without a poliovirus case, the Government of Malawi declared an outbreak in 2022 following confirmation of Wild Poliovirus Type 1. Since then, the country has reported four vaccine-derived poliovirus type 1 cases and a confirmed vaccine-derived poliovirus type 2 outbreak from an environmental surveillance sample.
Flaccid paralysis
CDC supported the implementation of enhanced acute flaccid paralysis surveillance by FETP graduates to improve active case search visits and the detection of poliovirus cases.
COVID-19
CDC's COVID-19 response activities included:
- Setting up diagnostic capacity at the national reference laboratory.
- Implementing COVID-19 response activities in five high-burden districts
- Establishing a COVID-19 sentinel surveillance system in five health facilities and two land points of entry.
- Providing support with community-based and facility-based surveys.
Key achievements
- More than 200 public health workers have graduated from Malawi's FETP since 2016.
- As of March 2024, 248 health workers completed frontline FETP over 20 cohorts, and 22 health workers completed the intermediate FETP over two cohorts from 2022.
- Participants helped the MOH to investigate the most recent cholera outbreak.
- As of March 2024, 248 health workers completed frontline FETP over 20 cohorts, and 22 health workers completed the intermediate FETP over two cohorts from 2022.
- Supported the national Public Health Emergency Operating Centre to coordinate emergency response activities.
- Over 760 facilities now have an electronic medical record system.
HIV and TB
Strategic focus
As a key implementer of the President’s Emergency Plan for AIDS Relief, CDC works with Malawi to build a sustainable national HIV response program to accelerate progress towards the UNAIDS global goals. CDC collaborates with implementing partners to build public health capacity and infrastructure, and strengthen surveillance and health information systems. CDC activities include:
- HIV testing services and antiretroviral therapy
- Pre-exposure and post-exposure prophylaxis
- Voluntary medical male circumcision
- Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS) program
- TB-preventive treatment
- Building public health capacity and infrastructure
- Key population estimates and behavioral surveillance
Key achievements
- Nine CDC-supported molecular laboratories achieved HIV viral load testing (ISO 15189) accreditation.
- Continuous activities including trainings and proficiency tests have improved the quality of HIV rapid testing services.
- CDC supports an integrated sample transportation system covering 790 facilities across all districts.
Immunization
Strategic focus
CDC provides technical and programmatic expertise to eradicate, eliminate or control vaccine-preventable diseases through immunizations. CDC works with international and local partners to strengthen immunization systems and provide evidence-based technical knowledge to expand routine vaccine delivery. This work helps prevent cases of infectious diseases like polio and measles.
CDC continues to support field activities in response to polio outbreaks in Malawi. This includes:
- Vaccination campaign planning
- Program monitoring
- Acute flaccid paralysis surveillance
- Outbreak investigations
- Community outreach
- Research
- Data management
CDC has also extended support towards field operations for COVID-19 campaigns aimed at bolstering population immunity.
Additionally, CDC has provided technical assistance for the Periodic Intensification of Routine Immunization (PIRI) initiative. PIRI aims to ensure that children receive essential immunizations.
Malaria
Strategic focus
Malaria is endemic in Malawi. Through the U.S. President's Malaria Initiative (PMI), CDC assigned a resident advisor to support malaria prevention and control activities in Malawi. PMI provides:
- Insecticide-treated nets
- Diagnostics and malaria case management
- Malaria prevention during pregnancy
PMI Malawi supports the National Malaria Control Program to conduct entomological monitoring and operational research to guide malaria program decisions. Recent and ongoing studies include:
- Evaluation of the effectiveness of first-line antimalarials.
- Assessments on expanding community case management for malaria from children under 5 to all ages.
- Evaluation of indoor residual spray and insecticide treated nets for malaria prevention.
- Assessments of the efficacy of an alternative medication for intermittent preventive treatment in pregnancy and of a new delivery method to increase its uptake.
Key achievements
- CDC-supported tracking found more insects in Malawi are resistant to pyrethroid insecticides.
- This led to strategic changes in the purchase of bed nets treated with insecticide.
- This led to strategic changes in the purchase of bed nets treated with insecticide.
- CDC developed a data platform (M-Dive) to target interventions in high-risk malaria districts.
- CDC's support through PMI has helped deliver:
- Over 18 million mosquito nets.
- Almost 73 million rapid diagnostic tests.
- More than 65 million fast acting malaria medicines.
- Over 16 million preventive treatments in pregnant women.
- Over 18 million mosquito nets.
Success story spotlight
SIYAKHA Program: Vocational Training Helps Curtail Risk of HIV in Malawi
In Malawi, adolescent girls and young women between 10-24 years old experience a troubling reality—they are twice as likely as their male counterparts to have HIV and nearly four times as likely to contract it. A myriad of interconnected social, behavioral, and structural factors, exacerbated by economic instability, contribute to this harsh reality. Recognizing the urgent need for focused, tailored action, CDC jumped in to bridge the gap through PEPFAR.
In collaboration with Jhpiego, CDC implemented the DREAMS program in Blantyre district from 2020 to 2023. Within this initiative, a pivotal component known as SIYAKHA emerged, which focuses specifically on young women between 18-24 years old. SIYAKHA sought to decrease participants' risk of HIV by training them in essential skills (e.g., leadership, financial literacy, social skills) so they can secure employment or become entrepreneurs across industries like electrical installation, hotel operations, tailoring, plumbing, cosmetology, and welding.
After concluding in March 2023, the impact of SIYAKHA was clear—175 young women's lives were positively impacted, with 38 finding employment in institutions and 75 receiving essential support to start their own businesses.