Template_Assignment 7(a)
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Section 1: Introduction
Provide a brief (250-word maximum)
introduction to your overall plan and strategy for your proposed program. Discuss economic, political, and social issues that contribute to or limit the current situation. Include a history of the burden of disease (including improvements) and a discussion of current issues including internal obstacles and external obligations the Global Fund Assignment #6a – Draft Final Proposal
Country: Malawi
Disease Focus: HIV/AIDs
Reminder: document all citations using the APA citation style! APA Style Guide
Please do not write your name since the peer review is anonymous.
Malawi is a democratic country that has experienced various political transitions since gaining independence in 1964. Despite undergoing significant economic and structural changes to keep its economy growing, Malawi ranks as one of the world's poorest countries. The nation's economy leans heavily on agriculture, making Malawi particularly
sensitive to external factors, like weather changes, that can quickly disrupt its growth and stability. The country is committed to health services through public health policies and partnerships with international organizations to combat HIV/AIDS. The government's efforts are evident in its National HIV/AIDS Strategic Plan, which aims to reduce the impact of HIV/AIDS on the population. The first case of HIV/AIDS was identified in 1985. The epidemic escalated quickly, particularly in urban centers like Blantyre, where HIV prevalence among pregnant women rose sharply in the late 1980s and 1990s. The adult prevalence rate stands at 15% (Mwale, 2002), with significant mortality due to AIDS-related diseases. Socioeconomic structures are weak as the disease affects many between the ages of 15 and 49, leading to increased business costs and overburdened healthcare facilities. Internal obstacles include the limited healthcare infrastructure, unable to cope with the high number of AIDS patients, and the loss of the workforce. External obligations include adhering to international health guidelines and securing funding from global organizations to combat the crisis. Malawi faces the challenge of integrating community-level support with national and international resources to create sustainable solutions for the HIV/AIDS epidemic.
Department of Global Health
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Section 2: Goals and Logic Model
Revisit the goals and logic model plan that you developed in Assignment #3. If you’ve made changes, explain and justify those changes. Then write a brief narrative (250-350 In Assignment #3, Malawi has a prevalence rate of HIV of 7.7% among the population aged 15-49, with 93% of those needing antiretroviral therapy receiving it. This was a favorable comparison to the regional average of 83% in 2022. Revisiting these goals in the context of the current proposal, we find the need to reinforce and expand on these initiatives due to the ongoing burden of the disease. The proposal will outline a plan to reduce HIV prevalence among adolescents and young adults, increase the number of physicians per 100K in Malawi, and improve ART adherence rates among HIV-positive individuals. It will emphasize the need for sustainable healthcare improvements and a multi-sectoral approach that includes not only medical treatment but also social support and education to prevent new infections and support those living with HIV/AIDS. Logic Model for Global Fund Program in Malawi
targeting HIV/AIDs
Inputs
(Consider Staff, Stuff,
Space, and Systems)
Activities
Outcomes
Goal 1: Reduce HIV prevalence among adolescents and young adults
Staff:
Health educators, sexual health experts, and peer educators.
Stuff:
Educational materials on HIV prevention, contraceptives, and safe sex practices.
Space:
Classrooms and community centers for workshops and discussion groups.
Systems:
Training programs for educators, distribution systems
for educational materials, and a peer support Activity 1: Develop and distribute educational materials on HIV prevention
and safe sex practices in schools.
Outcome 1: Increases understanding of HIV transmission and prevention among adolescents and young adults.
Activity 2: Train educators to deliver effective sexual health education.
Outcome 2: Enhances skills among educators to effectively teach sexual health.
Activity 3: Organize peer-led workshops
and discussion groups on HIV prevention.
Outcome 3: Increases peer engagement and support in HIV prevention and act as a support group.
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network.
Goal 2: Increase the number of physicians per 100K in Malawi.
Staff:
Medical faculty, experienced
physicians for mentorship, and administrative staff for scholarship programs.
Stuff:
Scholarships,
financial aid packages, and educational resources for medical training.
Space:
Medical schools, training facilities, and spaces for mentorship programs.
Systems:
Application and selection processes for scholarships, mentorship program
structures, and partnerships with international medical schools.
Activity 1: Offer scholarships and financial aid to students pursuing medical degrees.
Outcome 1: Increases enrollment and graduation of medical students.
Activity 2: Develop mentorship and training programs with experienced physicians.
Outcome 2: Increases professional development and skills of new physicians.
Activity 3: Collaborate with international medical schools for exchange programs and advanced training.
Outcome 3: Strengthens international collaboration and expertise in the medical field.
Goal 3: Improve ART adherence rates among HIV-positive individuals.
Staff:
Counselors, community health workers, and IT specialists for the reminder system.
Stuff:
ART medications, counseling Activity 1: Provide counseling and support groups for individuals on ART.
Outcome 1: Additional emotional and psychological support for HIV-positive individuals.
Activity 2: Train more community health workers to conduct home visits and provide adherence support.
Outcome 2: Improves patient management and follow-up care.
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materials, and technology for the reminder system (phones, software).
Space:
Counseling centers, community centers for group meetings, and patients' homes for visits.
Systems:
Training for community health workers, a system for tracking and reminding medication adherence, and support groups coordination.
Activity 3: Create a reminder system for
medication adherence through text messages or phone calls.
Outcome 3: Increases adherence to medication among patients.
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Section 3: Policies and Programs (250-300 words)
Please discuss existing policies and programs from the government in your selected country for your disease focus. How do these government policies and programs interact with your proposed activities?
Section 4: Community engagement and other cross cutting issues (min 150 words for each issue)
The Malawian government has implemented policies that have been largely successful in rural and remote settings, which provide free HIV services, rapid
ART initiation, and PMTCT services. The government's public health approach has facilitated wide-scale delivery of ART since 2004 and improved access to PMTCT through the "Option B+" policy since 2011 (Dasgupta, 2016) . The policy aims to reduce HIV prevalence among adolescents and young adults through education, increase the number of physicians, and improve ART adherence rates, which aligns with the goals. Developing educational materials, training health educators, and organizing peer-led workshops can leverage existing policies emphasizing rapid treatment initiation, free services, and education on HIV prevention. Offering scholarships and financial
aid to medical students aligns with the government's initiatives to strengthen
the healthcare workforce capable of delivering HIV services (Dasgupta, 2016)
. Focusing on counseling and support groups complements government practices exceeding policy guidelines, like home-based care and community support groups.
There are areas where the proposed activities address gaps in policy implementation. Despite the policy for active dialogue for adherence monitoring, providers often rely on pill counts. The proposed activities aim to create a reminder system for medication adherence, which could improve active engagement with patients, potentially addressing this gap. The government's progressive policies have set a foundation that the activities can build upon, enhancing the effectiveness of HIV management in Malawi.
Engagement of beneficiaries of the program
(e.g., people with or at risk of HIV/AIDS, TB, malaria). This section is asking not about how your program will benefit the people but how the beneficiaries could be involved. Focus on how beneficiaries could be involved in the program at all stages, from planning to implementation to monitoring and evaluation. Ex: Community advisory boards as an integrated element of program management, how do you obtain information about the responsiveness of your program from the beneficiaries? A community-based participatory approach can be employed to engage beneficiaries in the program. Beneficiaries, such as individuals living with or at risk for HIV/AIDS, can be involved through Community Advisory Boards that partake in all stages of the Department of Global Health
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program. These boards can be pivotal during planning, providing insights into the community's unique needs. During implementation, beneficiaries can offer valuable feedback on service delivery and effectiveness. For monitoring and evaluation, patient-
reported outcomes can be collected through surveys, interviews, or focus groups.
Additionally, involving beneficiaries in the interpretation of data ensures that the program
remains responsive to their needs. Establishing a continuous feedback loop will inform iterative improvements to the program. This empowers beneficiaries and fosters ownership, enhancing the program's effectiveness and sustainability.
Community participation:
Focus on how diverse formal and informal leaders, institutions and organizations could be involved in the program. Community participation in HIV/AIDS programs in Malawi should actively involve diverse formal and informal leaders, institutions, and organizations, including government health departments, local NGOs, faith-based organizations, traditional leaders, and healthcare facilities. Leaders from various sectors can contribute to the program's design, providing that activities are appropriately targeted. For example, local NGOs familiar with community dynamics can help identify critical populations and tailor
interventions to meet their needs. Faith-based organizations often have extensive community reach and can be instrumental in disseminating educational materials and reducing the stigma associated with HIV/AIDS. Institutions such as schools and colleges can integrate HIV/AIDS education into their curriculums, while healthcare facilities can participate by providing space and staff for testing and counseling services.
Collaboration with these stakeholders at all stages, from planning to monitoring and evaluation, guarantees a more comprehensive reach and promotes sustainability by rooting the program in the community it serves. Such partnerships also facilitate a multi-
sectoral response to the epidemic, which is critical given the complexity of HIV/AIDS as a public health issue. Regular stakeholder meetings, joint training sessions, and shared monitoring and evaluation frameworks can further enhance the effectiveness and responsiveness of the program.
Gender equality issues
Addressing gender equality in Malawi requires acknowledging and combining the specific needs and experiences of women and men, boys and girls, into the program. The gendered aspects of HIV/AIDS can be addressed by assuring women's participation in leadership roles within program implementation and decision-making processes. By involving women's groups and networks in the planning stages, identifying and addressing gender-specific barriers to accessing HIV/AIDS services will be more accurate. Additionally, educational campaigns should challenge gender norms that contribute to the spread of HIV and limit the ability of females to seek care and support. Males should also be engaged in these programs to encourage gender relations and their involvement in prevention and treatment efforts. Furthermore, the program must include Department of Global Health
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Section 5: Potential Opposition (min 200 words)
Discuss and explain obstacles (other than funding) and who, how, and why some individuals or organizations could oppose the proposed activities. How would you address these limitations? measures to protect and empower vulnerable groups, such as women and girls, who are often at a higher risk of HIV due to gender-based violence and economic dependence. This includes economic empowerment initiatives and targeted outreach to ensure that HIV/AIDS services are accessible to them. Monitoring and evaluation mechanisms must disaggregate data by gender to assess the differential impact of HIV/AIDS on men and women. Social equality issues
Social equality in Malawi is closely linked to gender equality and economic opportunities
for women and girls, as these factors directly influence health outcomes. The latest gender assessment for Malawi indicates that inequalities in human endowments, economic opportunities, and ownership and control of assets contribute to gender-based violence, which in turn affects women's health, including their vulnerability to HIV/AIDS
(World Bank Group, 2022). Addressing social equality in the context of HIV/AIDS in Malawi would involve ensuring that women and girls have equal opportunities for education and economic resources, which would empower them to make informed decisions about their sexual health and reduce their risk of HIV infection. It would also require engagement with men and boys to challenge and change harmful gender norms that contribute to women's vulnerability to HIV/AIDS. By implementing these strategies, Malawi can work towards a more socially equal society where all individuals, regardless of gender, could live healthy lives free from the threat of HIV/AIDS.
Human resources development
There is a goal to increase the number of physicians per 100K in Malawi, which is crucial
for improving the healthcare system's capacity to manage HIV/AIDS effectively. Strategies include offering scholarships and financial aid to medical students, developing mentorship programs with experienced physicians, and collaborating with international medical schools for exchange programs and advanced training. Efforts aim to increase medical students' enrollment and graduation, improve new physicians' professional development and skills, and strengthen international collaboration and expertise in the medical field.
Incorporating human resource development strategies into the broader context of HIV/AIDS management in Malawi will be essential for achieving improved health outcomes for those living with HIV/AIDS and for preventing new infections. This approach aligns with the overall strategy of enhancing Malawi's capacity to address the HIV/AIDS epidemic through improved service delivery, education, and community engagement.
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Section 6: Concluding remarks (250 words max)
Describe the consequences if this program is not implemented. Please provide a
compelling argument and bring-in numerical estimates or data that you identified in the development of the proposal.
Obstacles to the proposed activities could include cultural resistance, limited infrastructure, and potential opposition from individuals or organizations resistant to change or those with differing beliefs about HIV/AIDS management and prevention. For example, cultural beliefs might lead to resistance against sexual health education or the use of contraceptives, which are necessary components of HIV prevention. Local leaders or religious institutions may oppose certain activities if they conflict with traditional values or beliefs. Trust can be built by engaging with community leaders and stakeholders to guarantee that programs are culturally sensitive and respect local norms. It might involve adapting educational materials to align with cultural beliefs while conveying critical health information or engaging religious leaders as allies to advocate for the program's benefits.
Infrastructure challenges, such as the lack of adequate healthcare facilities or transportation in rural areas, can hinder the effectiveness of HIV/AIDS programs. Collaborating with local governments and international partners to invest in infrastructure
development could be a long-term solution. To build awareness and support for the program's goals, strategies for overcoming these obstacles must include extensive community engagement, education, and advocacy campaigns. This would involve clear communication of the program's benefits to the community and the nation's health and economic well-being. Dialogue and negotiation with opposition groups would also be essential to finding common ground and ensuring the program's successful implementation.
The consequences of not implementing the proposed HIV/AIDS program in Malawi could be threatening. The current state shows a reduction in HIV-attributable adult mortality since the introduction of ART and an improvement in the number of adults retained in care one year after starting ART. However, there is significant attrition across the HIV diagnosis-to-treatment cascade, which continues to result in excess deaths (Dasgupta, 2016). Without implementation, Malawi risks reversing its gains in
reducing the HIV epidemic's impact. The Option B+ policy led to a 49% increase in ART coverage among HIV-infected pregnant women within 18 months, yet without continued support and expansion, default rates could remain high, potentially increasing mother-to-child transmission rates and impacting women's health more broadly (Dasgupta, 2016).
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Section 7: References
Include a list of references with AT LEAST THREE peer -reviewed articles, formatted in APA style.
Furthermore, the program's absence could mean missed opportunities for better monitoring of treatment failures through viral load testing, as recommended by the 2014 Malawi Guidelines for the Clinical Management of HIV. This could contribute to increased drug resistance rates and higher mortality, especially among vulnerable groups like pregnant and breastfeeding women, who are already at a higher risk of defaulting on treatment. Failing to implement the program could lead to an increase in
HIV/AIDS-related morbidity and mortality, potentially overwhelming the healthcare system and erasing the progress made in the past decade.
1.
Mwale B. (2002). HIV/AIDS in Malawi.
Malawi medical journal : the journal of Medical Association of Malawi
,
14
(2), 2–3.
2.
Dasgupta, A. N., Wringe, A., Crampin, A. C., Chisambo, C., Koole, O., Makombe, S., Sungani, C., Todd, J., & Church, K. (2016). HIV policy and implementation: a national policy review and an implementation case study of a rural area of northern Malawi.
AIDS care
,
28
(9), 1097–1109. https://doi.org/10.1080/09540121.2016.1168913
3.
World Bank Group. (2022, June 8). Breaking the cycle of reduced economic opportunities for Malawi’s women and girls
. World Bank. https://www.worldbank.org/en/country/malawi/publication/breaking-the-cycle-of-
reduced-economic-opportunities-for-malawi-s-women-and-girls 4.
Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants: Recommendations for a Public Health Approach: 2010 Version. Geneva: World Health Organization; 2010. PMID: 26180894.
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