A 'D.I.V.A.' in Malawi: From the Field: M&E Supervision at the Site Level

International aid and development worker – n., a person who focuses on “meeting the needs of people and communities in the developing” often done through seeking to “implement long-term solutions to problems by working with developing countries to help them create the capacity to provide sustainable solution.”

I’ve never thought of myself as an “aid worker.” But by definition, I guess that’s what I am. A glamorous-sounding life of traveling to foreign countries to “do good” is replaced by a difficult and often challenging reality that some of us do because we can’t imagine not being involved. Now of course, working for a non-profit has something to do with it; those I’ve met working for the U.S. government, U.N., or E.U live a considerably different lifestyle than my own. And so began my first real trip away from Lilongwe “in the field”…

Our plan to leave from Lilongwe at 10 AM Sunday morning changed to 2 PM (and then 2:30 PM) just minutes before I was expecting the vehicle, reminding me that patience and flexibility are virtues in public health and development. Three of us and our driver began the few hour journey to the Southern Region district of Balaka, where we would begin our week.

Village we passed on the journey

A homestead

Subsistence farming is the primary economic activity here

You probably can't tell but this is cotton:
one of the biggest exports here!

Town

First thing Monday morning, we visited Phimbi Health Center. We observed the CHWs give the daily health talk (the day’s topic: family planning) and proceeded to watch the pre-test counseling they’ve been trained to provide. We first watched a couple’s counseling session; the pair struck me as no older than mid- to late-20s (although I later noticed that many of the women were teenage mothers). The young man’s football jersey, jeans, and rubber sandals almost allowed me to forget that I was in a rural Malawian village, but I was quickly reminded as I observed the woman’s blackened bare feet and chitenje cloth she wrapped around her body, failing to conceal her pregnant bump. We then watched a newer CHW counsel a group of three women before the blood test was performed by health surveillance assistants (trained by the government to do HIV counseling and testing and administer family planning services due to the shortage of trained healthcare professionals).

Phimbi Village

Health Center

CHW giving talk on family planning

Looking through M&E tools at Phimbi

Over the course of our few days away, we visited five health centers in Balaka and one in Mangochi. We looked through the client registration books and other M&E tools, praising the areas that they did well on and pointing out areas for improvement. Several issues presented themselves throughout our supervisory visits from neglecting to capture all requested data on each client to incorrectly transferring information from the daily register to our logbook we use for our data records. There was also the occasional addition mistake, which could significantly influence our perspective of the program over time.

And then there was the challenge identified by my work partner: the impracticality of managing our current client log at the high-volume sites. A paper logbook track HIV positive women from pregnancy to two years after giving birth, and at sites with hundreds of clients, it is almost impossible to locate a person’s record. I proposed alphabetizing the entries using tabs and possibly switching from the current binding to one where pages can be added as needed. We will see what comes of this proposal.

My colleagues discuss our observations
with the coordinating CHW

Chilipa Health Center

Balaka District Hospital

The experience was much of what I’d been waiting for: visiting several health facilities, traveling to remote villages, interacting with community health workers and overseeing their current work, making recommendations to improve an already impressive program. The highlight for me was encouraging participants at a support group session to demonstrate how to apply a condom.

But it also presented several challenges. We were given a per diem of just over US$100 to get through a week, which encouraged me to live on maize-based nsima, rice, and occasionally deep-fried “chips” and to stay in less-than-desirable accommodations. (Thank goodness my trip to Blantyre reminded me I should always bring my own bed sheets and bug spray). I was constantly aware of my “young, foreign, female” status, as our party of five had only me to represent the XX chromosomes, a reality al too common in aid work in Malawi. And then, we had the added complication of the Malawian fuel shortage; our trip ended three days and five sites early, and we had to leave our driver and vehicle behind.

Add caption

The four plus hour bus ride home...

But overall, the trip was a rewarding experience, a bonding opportunity with my colleagues, and a critical insight toward better understanding the field of global health here.