Nemser Bennett, Aung Kyaw, Mushamba Mildred, Chirwa Samuel, Sera Diana, Chikhwaza Owen, Kachale Fannie
UNICEF Headquarters, New York.
University of the Western Cape, South Africa.
Malawi Med J. 2018 Jun;30(2):111-119. doi: 10.4314/mmj.v30i2.11.
During the last 15 years, Malawi has made remarkable progress in reducing child mortality. However, maternal and newborn mortality remains persistently high. To help address these entrenched challenges, the Reproductive, Maternal, Newborn and Child Health (RMNCH) Trust Fund provided short-term catalytic financing of $11.5 million (2013-2016) to support country plans to advance the RMNCH and commodity agenda.
(1) To document how Malawi (ministries, partners, working groups) used evidence to inform decision-making and RMNCH investments, (2) To identify barriers to utilizing information and evidence in the planning and prioritization process at national and sub-national levels, and (3) To assess the utility of the RMNCH Landscape Synthesis, which uses existing information to review life-saving RMNCH commodities and services.
This was a qualitative case study utilizing a Rapid Appraisal (RA) approach, where semi-structured interviews were conducted with staff members from UN agencies, development partners and the Ministry of Health (MoH) at national and district level. The analysis enlists a framework approach for manual qualitative content analysis.
Led by the MoH, the RMNCH Trust Fund grant proposal utilized an evidence-based and equity-focused process for prioritization of investments. Data-informed decision-making permeates similar commodity-focused working groups. However, common health information system (HIS) weaknesses, such as data quality and collection burden, persist and are more prevalent at district-level. The collation of evidence in the RMNCH Landscape Synthesis was a useful and sustainable tool to support planning.
The evidence-based, equity-focused decision-making process for the RMNCH Trust Fund proposal provides an effective model for inter-agency investment prioritization. Strengthening data-informed decision-making will require financial and political commitments to HIS and capacity building for data use, particularly at the district-level. New initiatives (e.g. Health Data Collaborative and QED Network to Improve Quality of Care) provide opportunities to further improve evidence-informed decision-making.
在过去15年里，马拉维在降低儿童死亡率方面取得了显著进展。然而，孕产妇和新生儿死亡率仍然居高不下。为帮助应对这些根深蒂固的挑战，生殖、孕产妇、新生儿和儿童健康（RMNCH）信托基金提供了1150万美元的短期催化资金（2013 - 2016年），以支持该国推进RMNCH和商品议程的计划。
（1）记录马拉维（各部委、合作伙伴、工作组）如何利用证据为决策和RMNCH投资提供信息，（2）确定在国家和次国家层面的规划和优先排序过程中利用信息和证据的障碍，以及（3）评估RMNCH形势综合分析的效用，该分析利用现有信息审查拯救生命的RMNCH商品和服务。
这是一项采用快速评估（RA）方法的定性案例研究，在国家和地区层面与联合国机构、发展伙伴以及卫生部（MoH）的工作人员进行了半结构化访谈。分析采用了手动定性内容分析的框架方法。
在卫生部的领导下，RMNCH信托基金赠款提案采用了基于证据且注重公平的投资优先排序过程。数据驱动的决策贯穿于类似的以商品为重点的工作组。然而，常见的卫生信息系统（HIS）弱点，如数据质量和收集负担，仍然存在，并且在地区层面更为普遍。RMNCH形势综合分析中的证据整理是支持规划的一个有用且可持续的工具。
RMNCH信托基金提案基于证据且注重公平的决策过程为机构间投资优先排序提供了一个有效模式。加强数据驱动的决策将需要对卫生信息系统的财政和政治承诺以及数据使用能力建设，特别是在地区层面。新的举措（如卫生数据协作和提高医疗质量的QED网络）为进一步改善基于证据的决策提供了机会。
