We are excited to announce our 4th 2023 Spring Grant Recipient!
Thanks to our generous Legacy Giving Circle donor community, African Mothers Health Initiative is receiving a $19,200 grant towards supporting families to improve survival of vulnerable infants and children.
Initiative Location: Lilongwe, Malawi
Initiative Cause Areas: Food Insecurity; Healthcare; Women Empowerment Programs
UN Sustainable Development Goals: 03 Good Health & Well-Being
Initiative Description: African Mothers Health Initiative (AMHI) is requesting an investment of $19,200 from the Legacy Collective Giving Circle to expand our income generation program and cash stipends for vulnerable families, which will deepen the impact of our core work providing home-based nursing care to vulnerable babies in Malawi. Our work is directly aligned with the UN Sustainable Development Goal 3.2 to end preventable deaths of newborns and children under 5 years of age.
Systemic Issue: High Risk Infants and the Impact of Poverty
Despite improvements over the past decade, infant mortality rates remain high in Malawi (42 deaths per 1000 births). Most of these deaths (74%) occur within the first year. Notably, the risk of dying in early childhood falls disproportionately on high-risk infants, which include orphans, multiples (twins and triplets) and infants without access to breast milk (e.g. infants with mothers who are critically ill). The majority of these infants are healthy at birth but due to an environment of severe poverty and lack of resources, they often die within their first weeks or months of life. By reducing the deaths among the highest risk groups, we aim to impact the overall infant mortality rate. Death among these high risk infants is a widespread issue throughout Malawi, but is not currently being addressed by other organizations.
Our Innovation: Integrated, Continuous Care
In a resource poor environment, high touch individualized care is generally not considered due to presumed associated costs. African Mothers Health Initiative’s integrated approach targets the infants most at risk of dying, provides high quality individualized care, and has resulted in a sustained measurable impact while staying within a modest budget. Since our founding in 2008, we have partnered with experienced nurses in Malawi to provide home-based healthcare to almost 1700 babies and over 550 mothers. During the past 3 years alone, we admitted over 400 babies at high risk of mortality: 60% of these were babies whose mothers died after childbirth; 23% were multiple births (twins or triplets); and 15% were reported low birth weight.
As a result of our work, 96% of the infants in our program survive early childhood, compared to a 20-50% survival rate for similarly high risk infants in the region. Our program is distinguished by:
Continuous Support- Over their critical first year of life, infants receive monthly home visits by an experienced nurse from our sister organization Chimwemwe mu’bereki, and then a visit every two months after the age of 1 to ensure their continued normal growth and development. Postpartum women receive up to six home visits by a nurse and are discharged from the program only once they have regained their health.
Family care- Babies who survive their mother’s death face the greatest risk of mortality. In general, an infant’s well-being is closely linked to the well-being of the mother. For this reason, we provide individualized nursing care in the context of family and community. While other organizations may attempt to address severe health problems of infants living within communities facing deep poverty by moving babies into orphanages or temporary crisis nurseries, we understand that, with adequate support and resources, vulnerable babies thrive when they remain within the loving arms of their family unit.
Our integrated, continuous care approach includes the following components:
Health Assessments and Education- During the home visits, nurses conduct a health assessment of the baby including vital signs, growth, nutrition, and developmental milestones. They conduct an assessment of the home, including whether the basic needs of the baby and other children are being met, noting whether the environment is hygienic, and if there is a mosquito net in use. Nurses then work to mobilize community members based on the needs of the family as determined during the assessments. At each visit nurses spend time educating and counseling family members on the health and care of the baby as well as on related danger signs.
Nutritional Support- Nurses supply a flask to hold clean water, a feeding cup (bottles are strictly avoided due to the high risk of bacterial contamination related to inadequate cleaning), and three to seven tins of formula. Nurses carefully instruct guardians on the reconstitution and administration of formula. At subsequent visits nurses assess the hygiene of the feeding utensils for the baby, the source and/or preparation of water, and observe the guardian prepare the formula and feed the baby. The majority of our babies receive formula due to necessity. As an organization, we value breastfeeding, and for mothers who are lactating, we educate them on the importance of breastfeeding (even when supplementation is necessary) and provide breastfeeding support. For HIV positive mothers who are unable to exclusively breastfeed, we provide counsel about switching babies to formula due to the increased risk of HIV mother-to-baby transmission when mix feeding. Once babies reach 6 months, we provide some enriched porridge and educate families on creating healthy diets using local foods.
Income Generation- For some women enrolled in our program we provide a small investment – approximately $10 – for income generation. Women have used this money to start a small grocery, create a business making and selling local donuts, charcoal, etc. This additional income helps cover a few basic needs and mitigates the impact of poverty, which adversely affects their ability to lead healthy lives, ultimately resulting in increased chances of mortality for themselves and their children. This modest investment means that program benefits do not end with discharge.
A Critical Initiative: Expanding Income Generation and Cash Stipend for Sustainable Change
Over the past 15 years that we have been doing this work, we have had a sustained measurable impact. We have ensured that vulnerable infants have survived early childhood and supported women in their recoveries from extremely difficult births. But we want to do better. All the families enrolled in our program live in extreme poverty. All the households we visit are affected by severe food instability. The care we provide is focused on the most vulnerable members within the home, but often the entire family is struggling to meet basic needs and ultimately whatever affects the family affects our beneficiary. For example, when babies start eating solids, if there is no food in the home they often begin to suffer from malnutrition. We’re seeking to partner with the Legacy Giving Circle on an initiative to expand our core services to improve our enrolled families’ economic stability and ensure that the positive impact of our program extends beyond the period of enrollment.
This critical initiative is two-fold:
- Expand the income generating program to include all mothers/guardians caring for vulnerable infants and increase the investment amount to $20 equivalent per household.
- Offer cash stipends.to each household at the time of our visit in the amount of $5. Domestic and international research has shown that putting cash into the hands of the caretakers results in improved child health and development. We trust that the caretaker in a family (grandmother, mother, auntie, friend, father) understands the needs of the home far better than we might. We know that within the hands of caretakers, $5 will have the largest impact possible within the home.
- $5,000 Income generation expansion ($20 for 250 households)
- $10,200 Cash Stipends for Households. ($5 per household visit for 12 months)
- $1,200 Focus Groups (at six months and one year), includes: facilitator, translation & transcription service, transportation and lunch for participants
- $300 photographer
- $2,500 Data Manager
- $19,200 TOTAL REQUEST
AMHI will cover the cost of nurses, driver, fuel, vehicles, and administrative oversight.
Initiative Impact: Initiative Implementation, Monitoring and Evaluation We have an average of 220 individuals enrolled in our program at any one time and our nurses currently make an average of 170 visits every month. We anticipate that the expansion phase supported by Legacy Giving Circle will run over a 12 month period. Disbursement of cash stipends would begin as soon as funds are available.
Nurses utilize an electronic data information system to record details from every visit. Data collected include: the health and development of the child, the number of meals eaten in the household, the inclusion of protein in meals, any recent hospitalizations, general health status of other children in the home, items received (i.e. formula and porridge). This electronic system will be used to track individual disbursements in real time. Data points will be analyzed at four month intervals and compared with data sets predating the Initiative.
With regard to the one time income generation investment of $20 per household: Nurses typically begin planning for the disbursement with clients several months in advance, asking and documenting the following: what business ideas does the client have? Is there a need or desire for this business in their community? What items do they need to purchase in order to set up the business? How will they market the business? Who will help run the business (e.g. if she is farming, or needs to take a child to the hospital)? We will allow between 3-6 visits for this planning phase. Once both the nurse and the client are satisfied with their plan, the one time investment will be disbursed. Infants are enrolled in our program for a minimum of 12 months, so the nurse will continue to visit the home and be able to document the progress of the household business over a minimum of 6 months.
At the end of one year we will hold a focus group to evaluate the impact of the monthly cash stipend. A second focus group will be held with a group of beneficiaries three to six months after receiving their income generating investment.
Initiative Anticipated Impact and Outcomes
In prior focus groups conducted with mothers and guardians of discharged beneficiaries we identified various themes. All of the guardians/mothers of infants expressed gratitude for the survival and health of their children. Many guardians requested that we expand our services to continue beyond two years. Several women who received the income generating investment spoke about how the money earned improved their lives by covering the cost of items such as soap and clothing.
The current Initiative with Legacy Giving Circle is a direct response to these comments and themes. We anticipate that the cash stipend initiative will result in a general improvement in infant health as well as the health of other vulnerable family members within enrolled households. We anticipate that this difference will be evident within four months of the launch date.
We anticipate a more varied, but overall positive impact of the income generating initiative. Our hope is that this will indeed help extend the benefits experienced by those enrolled in our program beyond the period of enrollment and temper impact of seasonal food instability and household poverty.
Specifically we hope to see that family members are eating three meals daily and that at least two of these meals contain protein; to have fewer enrolled infants with periods during which weight plateaus or drops; to decrease hospitalizations among enrolled infants. We hope to see basic items such as soap always present in homes.
Initiative Sustainability: AMHI is a trusted organization with a strong track record. Using the services of an actuary we have calculated that we spend under $1,500 to avert one death. Our sister organization in Malawi (Chimwemwe mu’bereki), which implements the program, is well known within the District of Lilongwe – where we operate – by communities, health facilities personnel, and District health administrators. We value high quality and evidence based care. Our efficient use of resources and our strong outcomes have helped us recruit and sustain donors, which is how we have sustained our work over the past 15 years. This new investment by Legacy Giving Circle will provide us with an opportunity to deepen and prolong the impact of our work with vulnerable infants and their families. The data and reports that we will have at the conclusion of this Grant will strengthen the evidence base for the work we do and in turn help us advocate for future investments in the families caring for vulnerable infants.
AMHI operates with the core knowledge that all life is precious and that the greatest positive impact is made when we work in partnership with those we serve.