MALAWI REPORT 2003
1. Institutional Framework and Set-Up of FBOs
o The National Strategic Framework in recognition of the work that
FBOs are carrying out on HIV/AIDS in Malawi placed them as core
implementing agencies working directly with communities. Efforts
have been made to strengthen partnerships among religious
organizations with regard to planning, implementation, monitoring,
evaluation and resource mobilization.
o There is an office responsible for religious affairs in the Office of the
President and Cabinet.
o In addition, religious groups have formed umbrella organizations
including Episcopal Conference of Malawi (ECM), Moslem
Association of Malawi (MAM), Malawi Council of Churches (MCC),
Christian Health Association of Malawi (CHAM) and Charismatic
and Pentecostal Association of Malawi (Chapel), under which the
majority of FBOs operate. These umbrella organizations support
collective coordination and collaborative efforts including planning.
o a State Faith Community Task Force was formed to enhance
collaboration between Government and FBOs in Malawi.
o As a follow-up to the November 2001 WCC HIV/AIDS Conference
in Nairobi, a churches conference took place in November 2002
where all churches and their umbrella organizations came together
to break the silence and address the challenges of HIV/AIDS. This
conference was a result of the cooperation of the three major
church mother bodies of MCC, ECM and EAM in collaboration with
the Norwegian Church Aid.
2.0 SPREAD OF FBOs IN MALAWI, GOVERNANCE AND HUMAN AND
FINANCIAL SYSTEMS CAPACITY.
The mushrooming of FBOs in all parts of Malawi cannot be
. Faith leaders and their organisations are well respected and
therefore command a strong following.
In addition religious organisations , individually and together
have a deep geographical penetration. This presents great
advantages to intensifying interventions and to increasing the
reach and impact of these interventions.
Many FBOs have recognized governing structures. However,
many do not open up to external professional membership of
their governing bodies while others still remain very
conservative with bureaucratic structures. This has dented the
face of the FBOs as many remain very closed to open up
particularly to books of accounts.
The human and management systems capacity have been
affected much by unavailability of qualified personnel in these
institutions. However, it is seen as a common tradition in most
FBOs recruiting unqualified personnel and in some cases based
on ‘relationships and trust’ which has compromised quality of
work being provided. As an example of one of the FBOs human
resource capacity, CHAM’s current capacity of selected
professional health workers from its 159 members is as presented
PROFESSIONAL HEALTH WORKERS IN CHAM
Cadre Recommended Actual %
Medical Officers 36 15 41.6%
Clinical Officers 102 69 67.6%
Medical Assistants 271 80 29.5%
Nurses 1995 856 42.9%
Dental Tech/Assistants 152 10 6.6%
Laboratory Tech/Assistants 152 51 33.6%
Pharmacy Tech/Assistants 276 19 6.9%
Patient Attendants 234 413 176%
The overall picture of the staffing situation in CHAM has 7664
recommended posts of which only 4746 (61.9%) posts are filled.
Amongst the professional cadres, only 33% of the recommended
posts of the approved establishment are filled.
Several reasons are contributing to this situation which among others
Many FBOs are very rural based therefore difficult to attract
Qualified personnel particularly health workers are scarce on the
Competitive packages – other NGOs of which some are faith-
based are providing very high perks.
The problem of HIV/AIDS: attrition resulting from HIV/AIDS related
deaths is very high at the moment.
Current outputs from all health training institutions do not match
the demand for personnel in the health sector.
1.1 INSTITUTIONAL SET UP OF FBOs
Some FBO’s have structures for implementation of HIV/AIDS where
coordinators/ supervisors are in place but this applies to only a few. In
most of the FBOs, structures are just being put in place.
In October 1999, a wide array of stakeholders in Malawi developed the
National Strategic Framework on HIV/AIDS: 2000 – 2004 (NSF),
outlining the national response to the epidemic. National AIDS
Commission (NAC) has been tasked to coordinate the national response
including provision of policy and leadership on the issue.
Strategies and Policies to guide activities of HIV/AIDS activties are
found within some organizations e.g. World Relief Malawi, AHS,
Anglican Diocese of Northern Malawi, LISAP Project (Livingstonia
Synod) among others. Other FBOs still do not have policies/strategies
to guide them in the endeavor to fight against HIV/AIDS.
3.0 MAJOR ACTIVITIES PURSUED BY THE CHURCHES
In responding to the epidemic Faith Communities have addressed
both prevention and impact mitigation. The study has strengthened
the knowledge that FBOs are working in many areas of HIV/AIDS, trying
to stop its spread among the children of God, but also dealing with the
effects for the infected and affected persons.
5.2.1 EDUCATION AND TRAINING
Prevention interventions have included information campaigns, but
these have not been adequate in part because of judgemental
approaches to interventions and in part as a result of emphasis on
Almost all FBOs considered training of the providers of HIV/AIDS
services as important. Target groups were also included in different
training sessions of all the sub themes to equip them with knowledge,
skills and positive attitudes when handling HIV/AIDS issues. The number
of training sessions for each institution depended on availability of funds,
which determined availability of the other resources.
All FBOs considered the importance of the clergy/sheiks and included
them in the trainings they have conducted.
Due to inadequate funds, some institutions trained only a few.
From the findings, we realize that FBOs would like to conduct
more training sessions but due to inadequate funds, some
institutions trained only a few. Many FBOs expressed the need for
more consistent and encompassing training programmes, with
more emphasis on the outputs.
Faith communities would be more effective if they at the same time
revised their theological positions on issues of sex and sexuality.
Groups of people in all FBOs are engaged in disseminating
HIV/AIDS messages to people in their areas regardless of religious
affiliation. Some FBOs involve target groups in planning
programmes as this helps with ownership of the activities. The
advocacy groups are gender based in all FBOs.
FBOs have been called upon to collectively respond to the HIV/AIDS
situation in Malawi. They acknowledge the need that all are present,
actively participate in and coordinate with regional and national efforts,
donor community and government in the fight against HIV/AIDS.The
advocacy work is also important inside the FBOs.
The Clergy/Sheiks still need to be oriented and re-oriented on
HIV/AIDS issues, values and ethics and create awareness against
stigmatization using the pulpit and other channels and teach
people and children to break the silence on issues of sex and
sexuality, prejudice and fear of HIV/AIDS. Many say that the issue
of stigimatization and condemnation is still high among some
Despite that some FBOs are unclear about advocacy, there are others
who are active in FBO work.
5.2.3 ORPHAN CARE:
Most FBOs are providing care to orphans. All orphans in an area
regardless of the cause of death of their parents are supported. This is
to remove stigma and discrimination of those whose parents died from
HIV/AIDS for example the Muslim Association of Malawi (MAM) has
orphanage centers but the names were changed to Islamic Welfare
Centers because the former was regarded discriminatory.
Volunteers are providing care to orphans in centers where orphans are
being kept. Most FBOs have trained foster families and orphans are
being kept in the homes with other members of the families. All the
support food, clothes, educational materials including fees is given while
Some programs in some FBOs are targeting the orphan families in crisis
(OFIC) families headed by children, grandparent and sick single parent.
The programs aim at identifying and supporting families on emergency
basis to improve their livelihood and rehabilitate their families in a secure
and sustainable manner.
Due to abuse of orphans and the magnitude of the problem, many work
through institutions even though they would have preferred a community
5.2.4 HOME BASED CARE
The aim of this program is to provide care and support to people living
with HIV/AIDS, carers and orphans. Almost all FBOs have HBC
programs in their areas targeting the infected, other chronically ill
patients, and the affected – guardians and vulnerable children.
Volunteers –most women and a few men work hand in hand to take
care of the sick people. They provide simple treatment, feed them,
train guardians and ensure hygiene of body and environment.
They also share the word of God to encourage positive living.
Constraints and Challenges
Increasing numbers of patients and orphans requiring Home
Inadequate resources – funds, materials transport for follow-up
Reduced numbers of male volunteers.
Increasing numbers of volunteers drop outs due to lack of
Some institutions have mentioned issue of dropouts because
people are not able to fend for themselves while they are providing
voluntary services to the chronically ill.
Increased numbers of HIV/AIDS patients and orphans if VCT is not
intensified. There will be many more people getting infected. The
PLWAs also need a lot of counseling so that they do no infect other
people and avoid becoming pregnant. This will reduce the number of
babies born with HIV/AIDS. Therefore, if every FBO intensifies VCT
services and efficiently care for PLWAs, new infections will be
reduced. Resources to effectively provide HBC to HIV/AIDS
patients are not adequate because they come from development
partners and some from NAC. FBOs are not linked with others, as
a result some FBOs have more than others. FBOs have to plan
how they will fend for themselves in future. The numbers of male
volunteers are small in many FBOs. There seems to be fewer
advocacies that HBC is everyone’s role.
5.2.5 VOLUNTARY COUNSELING AND TESTING (VCT)
Most FBOs carry out counseling services while only a few do the
testing as well. The testing has not yet been taken to the
communities. So far only one NGO outside the health facilities does
testing otherwise testing is still very much clinic based making it
unaccessible to the majority. Trained men, women and youths are
used for counseling. Some FBOs have used VCT as a behavior
change intervention tool, targeting males, females, orphans and
youths e.g. The Salvation Army. Some schools are using
headmasters, headmistresses and teachers to counsel the students
and other teachers.
The counselors are advised not to scare people with HIV/AIDS
messages. Those tested are followed up so that those who tested
negative are encouraged to remain negative by being living responsible
while those who tested positive are advised to have positive attitude and
are advised how nutrition and a healthy lifestyle can assist to prolong
5.2.6 SCREENING OF BLOOD
Blood is properly screened for the virus before transfusion. In
most of CHAM hospitals blood is screened using trained personnel.
The effort is sometimes being hindered because of inadequate
reagents and use of untrained laboratory personnel.
This is a program that is coming up to prevent further spread of disease
between mother and child. A few FBOs are providing the service of
which are five out of 159 CHAM facilities with assistance from
UNICEF. The mothers also receive as prophylaxis isonyazide and
bactrim. HIV positive mothers are encouraged to only breastfeed
for the first 6 months to reduce the risk of transmission of the
virus. This is a result of research in South Africa.
CHAM is planning to extend this service beyond the five facilities
currently providing the service.
Mother to child transmission of HIV virus is a growing problem in
Malawi that requires serious and urgent attention.
5.2.8 INFORMATION, EDUCATION AND COMMUNICATION
Almost all FBOs print and distribute IEC materials consisting of leaflets,
brochures, comics and booklets on HIV/AIDS to everyone regardless of
religious affiliation and sex. Examples are World Life Ministries
International, Evangelical Lutheran Church etc.
HIV/AIDS messages are also disseminated during religious meetings,
preaching sessions targeting males, females and youths. Most FBOs
have drama and singing groups in place who take HIV/AIDS messages
to all communities in their catchment area.
It is pleasing to note that many FBOs are printing and distributing
HIV/AIDS IEC materials. It is however, not known if the materials
are of acceptable standards.
The Faith communities have over the years conducted behaviour
change communication activities especially for the youth. Again
these efforts are affected by lack of adequate resources. But most
important, teaching responsibility tends to be limited to the
members of the clergy and those in leadership positions, excluding
the general membership in most cases. In addition, some Faith
communities do not have the leaders who should project the
appropriate models of moral behaviour.
5.2.9 TREATMENT INCLUDING ARV THERAPY
Opportunistic infections and sexually transmitted infections are treated
promptly and each prolongs life. Community health workers have been
trained on how they can treat these infections. Churches/Mosques
often promote the contribution that traditional medicine and
wisdom can offer as a therapeutic resource. The 7 dioceses of the
Episcopal Conference of Malawi is an example of using herbal
medicines treatment. Some facilities under FBOs provide
Prophylaxis treatment of INH and Cotrimoxazole to HIV positive
mothers with their babies. In 5 CHAM facilities, they also receive
Collaboration is occurring in some facilities where the FBO is working in
close cooperation with Ministry of Health and Population (MOHP) and
MSF in treating HIV/AIDS patients. An example is Bilal Clinic in
Chiradzulu under MAM.
Some FBOs have reported using community health workers in treating
Opportunistic Infections (Ols) and Sexually Transmitted Infections
(STIs). What is not known is the competence of these people to handle
It is not known if they have been given any treatment guidelines for
treating the Ois and STIs and if they are regularly supervised by the
FBOs. The Episcopal Conference of Malawi is using herbal medicine
treatment on PLWAs. However, there is need to expand what the
Episcopal Conference of Malawi is doing to other FBOs.
ARV therapy still remains a distant hope for the majority poor
Malawians. ARV therapy is still very much Government controlled
and provided at a high fee of $28/month in two central hospitals
and only one CHAM unit.
5.2.10 ABC FOR SAFE SEX PRACTICES
All FBOs are addressing this issue to prevent further spread of
HIV/AIDS. They encourage abstinence in a more relevant and practical
way among youths and the importance of the “why wait” stand. The
issue of promoting use of condoms is still difficult for the FBOs. Faith
communities maintain a strong non-permissive position
counterbalanced against the more ethical and rational-scientific
position of the government. Most feel that by promoting the condoms,
they encourage promiscuity. There is also a reluctance to give
information about condoms. All the FBOs talk about condoms,
meaning the male condom. The female one is out of question. FBOs
leaders in Malawi have started to open up the discussion, realizing
that it contains a long row of ethical dilemmas that cannot easily be
overlooked. They have asked for arenas to discuss the issue of
condoms in a more holistic and gender sensitive way. Many FBO
leaders realize that their parishioners ask for guidance about condoms
from other NGOs.
Adults are encouraged to have one partner and to be faithful with each
Some FBO’s promote the use of condoms inside marriage and in cases
FBOs recognize and salute those people who have come out to share
their personal counts as PLWAs. There is need to provide PLWAs with
a safe and conducive environment where they can continue to share
their fears, agonies, pain and emotions.
In HIV/AIDS, it is not only the condition that hurts most, but also the
stigma and possibility of discrimination and rejection, misunderstanding
and loss of trust.
Some FBOs have programs for PLWAs. Most active members are
those living with HIV/AIDS. They hold meetings to share
experiences, training each other in drama and counseling
techniques. They also encourage those who are HIV positive to live
positively. Some FBOs have Relief and Development programs e.g.
Word Live Ministries International under the ICOCA project, which
has 500 beneficiaries. They give each one of them 25Kg Maize per
month and 5Kg beans/month. Maize and legumes have been grown to
distribute to beneficiaries.
It is unison among the FBOs that PLWAs must not be discriminated
against; they as everyone else must be loved, shown compassion
and be supported in a holistic way physically. Spiritually, they
must be given comforting word of God. Clergy/Sheiks are
encouraged not to preach stigma to PLWAs but to use PLWAs in all
activities of the church. It is acknowledged that there are still many
elements of stigmatization of PLWAs inside the FBOs.
5.2.12 YOUTH ACTIVITIES
Young people are the most vulnerable to the HIV/AIDS epidemic. About
46% of all new adult infections occur in youths aged 15-24. Of these, 66
% are young women. Peer pressure, certain cultural practices and
limited access to information about sexual and reproductive health risk
them to HIV/AIDS.
Most FBOs have programs for youths. They encourage them to
form anti-Aids clubs. Youth out of school train members and
teachers on anti-Aids clubs. They provide recreational materials to
They share HIV/AIDS information during youth meetings,
campouts, rallies, and retreats. The main focus is on behavior
change. An example could be the SDA church that reaches several
thousand youths every year through drama and radio plays.
Some youths are trained to share with others HIV/AIDS messages, train
peer educators in life skills, and supervise educators in drama. They
encourage each other on abstinence. This most outreaching
programmes are found within the members of EAM.
However, it has been observed that the issue of youth has not been fully
addressed in the questionnaires. There is a general lack of adequate
programs directed towards this most important group of
Malawians, our window of hope.
In Malawi, men make most decisions and women are viewed to be
inferior and hold lower status in society. This is enforced and
worse in the FBOs.
Some FBOs have started involving both men and women in activities of
the church and community. In orphan and home based care, groups of
men and women work together. Some FBOs have aimed at having
equal numbers of males and females in groups and have moved away
from specific women’s programs. Some FBOs have allocated specific
activities to specific departments of the church in order to empower
everybody. Some FBOs have girl’s brigades with special activities.
HIV/AIDS messages and activities are shared with them.
Gender mainstreaming assists to have activities of HIV/AIDS to the
grassroots and should be expanded. It is a long way for the FBOs to
have a gender sensitive approach in their programs. Most of them
seem to have no idea of what the term gender means.
5.2.14 PROGRAMS TARGETING WOMEN
Women and the girl child are more vulnerable of getting infected by the
HIV virus and other sexually transmitted infections owing to their
positions in society. Some FBOs have programs targeting women and
the girl child.
There are Women Ministry departments where among other things,
HIV/AIDS issues are discussed. Training and empowerment is
done where women are involved in incoming generating activities.
Also they discuss empowerment to fight the disease and to
empower the girl child to say No to casual sex.
This work will only succeed if men are sensitized in the same way
and start to take care of their young boys and girls and guide them
5.2.15 ADDRESSING HARMFUL CULTURAL TRADITIONS AND
Some harmful cultural traditions and practices have lead to the spread of
HIV/AIDS amongst people especially women and youths e.g. Chokolo,
kuchotsa fumbi and fisi. Some FBOs are working with traditional
leaders to take a leading role in finding alternative harmless rituals
at initiation ceremonies for youths to reduce spread of HIV/AIDS.
The practice of herbal cleansing is becoming popular in some
areas as opposed to sexual cleansing. Many FBOs are working with
traditional leaders and some materials targeting traditional
authorities are being developed. Workshops have been held with
traditional leaders, healers, elderly men and women on HIV/AIDS.
FBOs are active in the fight against HIV/AIDS and are implementing
a number of HIV/AIDS programmes at common level. However, they
are still grappling with challenges such as:
High turnover of Counselors and Volunteers
Inadequate technical staff such as clinicians, nurses and
Lack of specialized personnel with skills in behaviour
Capacity in operational research, rights based approaches to
HIV/AIDS programming, mainstreaming gender in HIV/AIDS
programmes, planning, management, monitoring and
evaluation of HIV/AIDS programmes is also limited
Coordination of HIV/AIDS training and capacity building of
local training institutions is critical for sustainable capacity
Harmful cultural practices which are health hazards e.g.
wasting dead bodies.
Poor information management system at all levels and poor
information sharing. Documentation of activities and use of
research information I for planning and decision making is
still very poor in Malawi
Poor collaboration with some international organizations who
often bypass umbrella organizations resulting in duplication
and work overload for member units.
Donor conditionalities. Some development partners are not
interested in certain HIV/AIDS interventions e.g.
Inadequate resources at implementation level
Poor infection prevention practices at health facilities and
Compartmentalization of activities of the health facilities
which makes sharing of resources difficult.
Inadequate youth friendly activities and services.
KEY CONSTRAINTS TO IMPLEMENTATION OF HIV/AIDS
Considerable overt resistance still exists with regard to
certain methods of HIV prevention and reproductive health
Absence of an effective national coordination mechanism
for collaborating with FBOs as a group.
Limited participation of men in FBO activities, such as care
and support activities.
Limited resources allocated to FBOs (especially by
international partners) commensurate with their scope of
FBOs frequently do not have the human resource and
technical capacity required to meet the complexity and
challenges of implementing HIV/AIDS activities.
While FBOs have increased support for PLWHAs, changes
in language and behaviour which cause despair and
negative attitudes remain a challenge.
Lack of understanding of mainstreaming gender and rights
7.0 A SWOT ANALYSIS OF FBOs IN MALAWI
Strengths Weaknesses Opportunities Threats
Dedicated/committed Lack of qualified Community Donor fatigue.
staff. personnel. participation Labour market
Church has Recruitment of . very small for
strongest roots, unqualified staff. Spirit of qualified
linkages and longest Programmes not volunteeris personnel.
existing community totally linked and m in Competition
with formal integrated with surrounding caused by
management and each other. communitie international
governance Competition s. FBOs inflicted
structures. amongst FBOs. Political will. upon local FBOs.
Strong programme Conservative/rigid Government High attrition of
implementation governance interest to staff resulting
background. structures. support from HIV/AIDS,
Holistic care. Difficult to FBOs in greener
National wide disclose financial HIV/AIDS pastures.
coverage. resources. activities. Natural
Deep geographical Lack of use of IT Donor disasters,
coverage to help M & E and interest and drought.
Well respected and accountability. trust in Unstable micro
command a large Donor FBOs. and macro
following dependency/ Peaceful economic
Better quality of care Lack of local working environment.
Willingness to care resources. environment Unfriendly
for the suffering with Poor salary . external/foreign
compassion structure. policies.
8.0 LESSONS/BEST PRACTICES
Participation of communities, particularly local leaders is vital
at all levels of the project cycle.
Consultation and collaboration must have no limit (with all
Involving PLWA in IEC activities helps to reduce fear stigma
and discrimination in addition to those involved.
Persons living with HIV/AIDS have been involved in AIDS
service organizations as staff persons, volunteers and board
members. In some localities, HIV-positive persons have set up
their own organizations. At the national level, networks of
persons living with HIV/AIDS have been established in many
countries. Such networks also exist at regional and global
levels. As well, persons living with HIV/AIDS have participated
in ever increasing numbers in international conferences,
thanks to scholarship programs and other special funding
mechanisms that other organizations are providing.
10.0 AREAS OF POSSIBLE COLLABORATION BETWEEN FBOs AND
VARIOUS FUNDING AGENCIES
FBO and the funding partners should work as partners in the
execution of all activities including HIV/AIDS. FBOs should not be
parasitic but work in such a manner of mutual trust with the funding
agencies for the benefit of those disadvantaged.
As the adage says, ‘ Do not walk behind me for I will not
see you, do not walk in front of me for I will not follow you,
but let us walk side by side’ –
thus funding partners and the FBOs have to look at each other as
equal partners working to achieve a common goal. Some of the areas
the two could work together include:
Join hands in breaking the silence that still surrounds the
epidemic and removing all forms of discrimination.
Financial/technical assistance to support the implementation
of identified programmes.
Networking to ensure both FBOs and the donor agencies are
linked to important areas for the benefit of both parties.
Information sharing to ensure transparency, avoid duplication
of activities and for successful implementation of activities.
Capacity Building of the FBOs to ensure sustainability of
Development of skills in the design and implementation of
programs, including means for mobilizing and accounting for
Advocacy and lobbying particularly focusing at policies that
will make us ‘as partners’ achieve our objectives.
Promoting establishment of HIV/AIDS testing facilities and
encouraging youth and adults to test.
Mainstreaming HIV/AIDS, Gender, Human rights into all
development programs while at same time creating more
effective mechanisms for mobilizing essential resources.
Engaging in on-going collaboration and consultation with
other stakeholders such as Government, and recognizing the
good efforts that each is making in the fight against the
Revising some of the theological positions which seem to
curtail effectiveness for example on matters of sex and
sexuality, gender, PLWAs and understanding the HIV/AIDS
Facilitate availability and provision of free ARVs to the
majority who cannot afford so that productive life of the
infected and affected is prolonged.
The review shows that a variety of HIV/AIDS activities take place in the
FBOs at the grass root level, especially in the area of care and support.
But there is a general lack of consistent strategies, of consistent training,
of a human rights approach and gender mainstreaming of activities.
Lack of funds is listed as the main constraint and does also lead to
inconsistency in capacity building.
In all answers we see a will by FBO to do and assist more if funds were
available. It is obvious that the attitude towards infected and affected changes
and is constantly changing, but especially church leaders in HIV/AIDS should be
The FBOs ask to no longer be looked upon as a group of narrow minders,
condemning people but as important partners for Government of Malawi in
the fight against HIV/AIDS.
One could say that there are two milestones that all the FBOs set as the
Availability of funds
Consistent capacity building
With these in place, the work against HIV/AIDS would be immensely
Key Recommendations and Milestone for the Next Two Years
There is need to strengthen the position and role of the
State Faith Community Task Force as a coordinating
structure for FBO HIV/AIDS activities.
Intensify advocacy aimed at encouraging FBOs to fully
maximize their comparative advantage in the fight against
HIV/AIDS without compromising approaches by other
partners (e.g. issues related to condoms and reproductive
There is need to re-prioritize mobilization to support
HIV/AIDS activities by faith based organizations.
There is need to facilitate human resource and technical
support for faith based organizations (i.e. project planning
and management and ensure that they equally benefit from
the various funding initiatives such as the Global fund on
AIDS, TB and malaria.