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Introduction

The health area is the catchment area of all health centres that refer to one hospital. The Nathenje health area comprises the catchment area of Nkhoma Hospital and five health centres: Nathenje, Mthentera, Diamphwe, Milamba and Chimbalanga. The catchment population is approximately 150,000 individuals.
 
The health area is a meaningful unit in the health care system because on this level the Government of Malawi develops service level agreements with non profit private providers. It is the level where non profit private providers and government interact. Nkhoma Hospital was the first hospital in Malawi to sign such an agreement with Lilongwe DHO for referral delivery care in 2006. The number of interventions that are covered under the service level agreements grows and should ideally include all interventions of the essential health package as defined by Government of Malawi. Currently most CHAM hospitals provide antenatal care and delivery care under an SLA. The first hospitals signed an agreement for pediatric care this year (Mulanje Hospital, Nkhoma Hospital). Further decentralization of the Government of Malawi may also result in service level agreements between local government and government hospitals.

The Government of Malawi has established health area management teams that are responsible for supervision of health centres and community health care in the health area as well as the ambulance services.The health area committee is a government initiated platform where stakeholders  (government, non government, traditional authority) meet to set priorities and align activities in the health area. In practice the health area committee does not meet on a regular basis due to lack of resources and a limited mandate.  

Nkhoma Hospital has provided technical support to health centres in the health area through the referral and supervision project funded by Norwegian Church Aid (NCA)/ CHAM. Health centres are sometimes constraint in providing good quality care by the health system (lack of human resources,  supervision, poor supply chain). The health system is first and foremost the responsibility of the government. The project had limited structures in place to bring these concerns to the local government level.

The Lilongwe District Health Office and Nkhoma Hospital would like to build capacity on a health area level to improve maternal health. The project aims to inform local government on community felt priorities through PRA and bring together stake holders in the health area committee.  The identified needs will be targeted through a public private partnership between Lilongwe DHO and Nkhoma Hospital. On a health area management and health facility level capacity will be build to implement projects.

Activity 6.1 Develop an Plan of Work between stakeholders

A workshop will be organised to set priorities for the Nathenje Safe Motherhood Project. The workshop will bring together representatives of CCAP Nkhoma Synod, district health office, traditional authority, CHAM and Ministry of Health. The baseline survey will be shared with participants as well as lessons learnt during the site visit to Mangochi Safe Motherhood program. Priorities will be for the Nathenje Safe Motherhood Project. The workshop will result in a plan of work 2009-2011.

Back: Nkhoma Safe Motherhood Program - Overview

Activity 6.2 Form a project management team

The project will led by the Senior Preventive Health Officer of Nkhoma Hospital. The SPHO will be assisted by a full time community health nurse. The SPHO is responsible for all community health activities of the hospital. The position is currently filled by an expatriate public health doctor, dr. de Jonge, on a contract of the Dutch Reformed Church of South Africa. The hospital will employ a malawian public health professional for the position. In line with more recent models of personnel assistance, dr. de Jonge will move to a position of technical assistance to the project management team.

Both Lilongwe District Health Office as well as Nkhoma Hospital will allocate staff time for the implementation of activities. The plan of work will specify which activities will be executed by which organization.

The project management team will be supported by a monitoring and evaluation officer and project accountant for performance and financial reporting. The project secretariat will be accomodated at Nkhoma Hospital. The secretariat will produce three monthly performance reports, which will be shared with the donor, area health committee, CHAM and MoH.

Back: Nkhoma Safe Motherhood Program - Overview