- AREAS OF PROGRAMMING AND ACTIVITIES IMPLEMENTED BY MHEN
MHEN’s core function is conducting evidence based advocacy on health. This advocacy is based on identified health issues at national, district and community levels. Currently the network is conducting advocacy on the following,
- Advocacy on adequate resourcing of the health sector
- Advocacy on prioritizing preventive health services and promoting high impact health service interventions such as immunization.
- Advocacy for provision of hardship allowance to all health care workers working in hard to reach / hard to staff areas.
- Advocacy on minimising/stopping drug stock outs in Malawi especially the rural communities.
- Advocacy on the advantages of strengthening health systems especially at district and community levels such as at health facility level. This concentrates on advantages of strengthening health centre and hospital advisory committees and other committees that have linkages to this committee such as the village health committees and area level committees.
- Health rights education to both service providers and beneficiaries.
- Advocacy on solving or minimizing general health governance and health service delivery challenges that are be identified by various stakeholders.
- Advocacy on valuing health care workers as a necessary resource (recruiting, remunerating, motivating and retaining health care workers).
- HEALTH BUDGET WORK
MHEN conducts analysis of the national health sector budget estimates soon after the presentation of the estimates in parliament by the Minister of Finance. The report informs debate by Members of Parliament during the budget sitting in addition to informing monitoring by the civil society, MPs and other stakeholders. The network also provides financial and technical assistance to selected district health offices on the development of district health budgets (district implementation plans) that are responsive to the needs of all people including gender groups. To effectively undertake budget advocacy work, MHEN does the following:
- Trains selected district health teams to monitor implementation of the health sector budget at district level and or to track their district implementation plan and disseminate the findings.
- Supports selected district health offices and network members to train community leaders and community members on the process of budgeting for health service and their role in the health budget development and implementation.
- Builds capacity of community structures, leaders and members on how to conduct advocacy on solving identified health budget issues.
- Supports community structures, leaders and members for them to effectively conduct advocacy on solving identified health budget issues.HEALTH SYSTEMS STRENGHTHENING
The network supports its network members and district health offices to strengthen health systems especially the hospital advisory committees, community based health care groups (e.g. mother care groups)and their linkages. In this initiative, the Network identifies gaps in health service provision, pilots interventions that may address the gaps and conducts advocacy on the findings of the piloted interventions.
To conduct evidence based advocacy MHEN conducts research on various health issues. The network also pilots specific health interventions and make recommendations to government and other stakeholders. Traditionally the network conducts service delivery satisfaction surveys that look at satisfaction with service by service beneficiaries and providers. This is done at national level, selected districts and community levels. The information collected informs planning of health interventions by various stake holders.
- NETWORKING AND COLLABORATION
Human Resource for Health (HRH) Coalition
The network is a member of the HRH platform that is spearheaded by various non-state actors who advocate for strategies to retain health care workers and strategies to increase the pool of the health care workers. The coalition also conducts studies on implementation of sustainable interventions to improve health care motivation.
Civil Society Organizations (CSO) Platform on Immunization and Health Systems Strengthening
The Malawi Health Equity Network (MHEN) is coordinating the CSO Platform on Immunization and Health Systems Strengthening, with support from Gavi, the Vaccine Alliance. The initiative seeks to contribute to strengthening the capacity of integrated health systems to deliver immunization by resolving health systems constraints, increasing the level of equity in access to services and strengthening civil society engagement in the health sector. Gavi and partners came up with the initiative having recognized that many actors are involved in immunization work, and although civil society organizations are often a major player in service delivery, they often lack a platform for meaningful engagement in policy dialogue. As such, one of the GAVI Board’s four strategic goals for 2011-2015 is to “Contribute to strengthening the capacity of integrated health systems to deliver immunization by resolving health systems constraints, increasing the level of equity in access to services and strengthening civil society engagement in the health sector.”
To date the following processes have taken place:
- Through the Health Sector Working Group (HSWG) where the Platform has a seat. The HSWG is the equivalent of Health Sector Coordinating Committee (HSCC) in other countries.
- Through the Expanded Program on Immunization (EPI) Sub-Technical Working Group (TWG) where the Platform has a seat. The EPI Sub-TWG is a Sub-TWG under the Essential Health Package TWG of the Ministry of Health in Malawi and is equivalent to the Inter-agency Coordinating Committee (ICC) in other countries.
A report entitled “Civil Society Engagement in the Global Financing Facility: Analysis and Recommendations” (9th February 2016), described the Malawi CSO Platform as follows:
“MHEN is a CSO health coalition, supported by the Gavi CSO Constituency Platforms Project, which has shown tremendous success in advocacy and accountability, and as a trusted partner in helping to expand the reach of the government’s immunization program, for example reaching hard to reach communities with immunization, training, and demand generation activities. MHEN brings together local CSOs and INGOs to organize, align priorities, and serve as a focal point for the government to engage with civil society. MHEN has a seat on Malawi’s multi-stakeholder Health Sector Working Group, and the EPI (expanded program on immunization) sub-technical working group. Through its national steering committee, regional committees, and district focal persons, MHEN facilitates information sharing from the community to the national level and vice versa; it also has served as the recipient of Gavi Health Systems Strengthening (HSS) funds, which it then distributes to CSO members in the form of sub-grants, and provides oversight. The Gavi CSO Constituency Project has been critical for strengthening the capacity of MHEN to serve as an effective network of CSOs with the skills to engage in key government and multi-stakeholder platforms, representing the voice of civil society. Among MHEN’s advocacy successes was a significant budget increase for health in
2014, including $2.1M in earmarked funds for immunization; MHEN had worked with parliament to provide data about budget shortfalls, and first-hand stories about the negative impact on children’s access to critical health services at the community level (pg. 21-22)
Gender Responsive Budgeting Forum
The Gender Responsive Budgeting Forum (GRBF) draws membership from the Malawi Health Equity Network (MHEN), the Malawi Economic Justice Network (MEJN), the Civil Society Education Coalition (CSEC) and Civil Society Agricultural Network (CISANET). The forum seeks to bring together Civil Society Organizations (CSOs) that play a key role in advocating for gender responsive budgeting (GRB) in Malawi. The Network provides a platform for the members to share information, experiences and practices on gender responsive budgeting.
The GRB forum intends to ensure that the national budget (multi-sectoral budget of health, education, agriculture and transport) is gender responsive and meets sectoral demands. Such knowledge is envisaged to inform the forum’s lobby and advocacy initiatives in the four sectors with respect to GRB. Publication of the analyses ensures that stakeholders gain increased knowledge and understanding of the gendered nature of the four sectors’ budgets and how to engage various stakeholders including parliamentarians and planners on the need for a gender sensitive health budget so that the country makes progress in the health sector as well as in addressing MDGs 3 and 5 and SDG 3.
As part of advocacy MHEN conducts campaigns based on identified issues. Some of the issues are persistent drug stock outs and inadequate health workers. For example and with support from the Joint Oxfam Program in Malawi, MHEN successfully implemented the “Access to Medicines/Medicines for All Campaign (including the SMS Pill Check from 2009 to 2011).
- KEY ACHIEVEMENTS AND RECOGNITION
The Network is recognized nationally as a key partner in the health sector in Malawi and a channel for voicing out concerns of the poor and voiceless. For example, MHEN’s Executive Director was part of the team of influential civil society leaders put together by Oxfam America to lobby the US Government on continued aid to resource-constrained countries such as Malawi. When conducting advocacy MHEN starts with contact and dialogue, as opposed to antagonism and militancy. Other key achievements/marks of recognition are as follows:
- In the Health Sector Strategic Plan (HSSP), MHEN is recognized as the source of information on client satisfaction (i.e. the lead civil society institution in conducting Service Delivery Satisfaction Surveys (SDSS))
- MHEN (previously) represented civil society organizations in Malawi on Global Fund’s Country Coordinating Mechanism (CCM) in Malawi
- MHEN has a seat on the Health Sector Working Group (HSWG), which is the country’s coordinating mechanism for all GAVI funded programs/projects in Malawi, and the highest decision making structure in the health sector in Malawi
- MHEN has seats on technical working groups within the Ministry of Health, including the EPI Sub-technical Working Group (operating under the Essential Health Package Technical Working Group)
- Through is budget advocacy work, MHEN has influenced health budget sector allocation including influencing allocation for training of health care workers and overall health budget allocation increase of MK7.4 billion for the 2014-2015 fiscal year.
The Network collaborates and networks with sister networks such as Malawi Economic Justice Network (MEJN), Civil Society EDUCTATION Coalition (CSEC), the National Organization of Nurses and Midwives (NONM), Civil Society Agricultural Network (CISANET), among others in addition to various faith based organizations. This is done through coordination and networking meetings, implementation of joint activities, and information sharing both locally and internationally.
 This paper was developed with support and guidance from RESULTS Educational Fund. Susannah Hurd (Global Health Visions), Rachel Wilson (Catalysts for Change), and Aubrey Cody (Global Health Visions) were the primary authors.