Malawi is institutionalizing quality of care in all its programmes and the delivery of essential health packages at all levels of health care within the Health Sector Strategic Plan III 2023-2030. With support from the World Health Organization WHO, 29 districts institutionalized quality of care using WHO adapted quality-of-care network technical resources, an upgrade from the existing 9 learning districts.

The WHO encourages member states to adopt a whole-system approach to improve healthcare quality and patient safety for achieving universal health coverage and SDG 3 targets with a focus on effectiveness, safety, and people-centeredness. 

Malawi has since reported reduced maternal and new-born deaths. According to the 2024 Malawi Demographic Health Survey, trends in Malawi’s maternal mortality ratio have been reducing since 2015/16 to 2024 from 439 to 224 maternal deaths per 100,000 live births. A decrease in neonatal from 27 to 24 neonatal deaths/1000 live births, reducing child mortality., A decrease in total fertility rate from 4.3 to 3.7, and reduced need for family planning from 19% to 13% in 2024. By 2030, all countries should reduce the maternal mortality ratio to less than 70 per 100,000 live births, reduce neonatal mortality to as low as 12 per 1000 live births, and under-5 mortality to at least as low as 25 per 1000 live births. 

The capacity built among health workers in the application of quality-of-care principles and dimensions, and measurement has evidenced positive experiences using the Leadership Action Learning and Accountability and Measurement (LALA+) framework. WHO progressed its technical guidance on the integration of quality of care in all Ministry of Health programmes. This included the introduction of the stepwise quality improvement using a health systems approach. This support led to higher participation of different Ministry of Health directorates in quality-of-care assessments and higher star ratings for targeted health facilities.

The use of three mentorship models district, zonal, and national strengthened the capacity of mentors at all levels to deliver integrated quality of care and support Maternal and Perinatal Death Surveillance and Response (MPDSR). This led to improved functionality of quality-of-care structures, including quality improvement support teams, work improvement teams, and MPDSR committees. As a result, maternal and perinatal death notifications and audits increased.

Through point-of-care training, coaching, and mentorship, 70 trained zonal and district mentors reached 1,234 health workers across 180 health facilities in 18 districts. Of these, 46% were female, including nurses, clinicians, data clerks, and Health Surveillance Assistants. Health workers strengthened their knowledge and skills in addressing the leading causes of maternal and newborn deaths, including patient, community, health system, and administrative factors, and implemented effective quality improvement projects. Over 85% of mentees rated their mentors as “very good” or “excellent” in quality-of-care knowledge and skills.

A zonal mentor from the Southwest zone noted that the mentorship and capacity-building efforts deepened understanding of evidence-based maternal and newborn health practices, strengthened knowledge of quality improvement methodologies, ICD-11, and EPI integration, and improved skills in clinical mentoring. It also increased confidence in managing complex cases and reinforced a strong sense of responsibility to deliver high-quality care.

WHO support expanded collaborative learning from 9 to 18 districts, with each session involving about 40 health workers, including repeated learning cycles in six UN Joint Programme districts. This approach strengthened peer-to-peer and expert support in designing and implementing maternal and newborn quality improvement projects, in collaboration with District Health Management Teams, and fostered a stronger culture of quality and data use in health facilities.

A health worker from Chikwawa District Hospital highlighted that the training provided new knowledge on quality improvement and practical approaches that would be shared with colleagues upon returning to the facility.

WHO continues to support Malawi in building capacity to measure progress and outcomes in reducing maternal and neonatal mortality and morbidity. Its technical guidance remains central to institutionalizing quality of care at all levels of the health system and tracking progress toward Universal Health Coverage and SDG 3 targets.

Together, these efforts are translating into more responsive services, stronger accountability, and better outcomes for mothers and newborns. What began as mentorship and training is now shaping a culture of continuous improvement—where data is used, skills are applied, and lives are saved. As Malawi continues to strengthen quality of care across all levels of the health system, the impact is clear: more mothers survive, more newborns thrive, and the country moves closer to achieving Universal Health Coverage and its SDG 3 commitments.