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In 2016 WHO launched the priority assistive products list (APL) consisting of 50 products and recommended that using this as a reference, countries should develop their own contextually relevant national APLs. This paper describes the development of Malawi's APL. Two hundred and ninety-six persons with disabilities participated in a rapid Assistive Technology Assessment (rATA) survey. Six focus group discussions (FGDs) with people with various types of disabilities were conducted. The rATA questionnaire and FGDs collected data on assistive products (APs) participants used, APs they needed and the challenges they experienced. Data collection was done in six districts spread across the three regions in Malawi. All age groups were included in the survey. Persons with disabilities aged less than 18 participated but went with their guardians. All persons who participated in this study provided consent. Survey and FGDs results were presented at an APL consensus meeting with policymakers, service providers, disabled peoples' organizations and development partners in the disability sector. Based on the results and further discussions, a consensus was reached on the priority APs for Malawi. More than a third of respondents used wheelchairs (32%), followed by auxiliary crutches (25%), walking sticks (13%), reading glasses (11%), prosthesis (10%), elbow crutches (9%) and orthosis (8%). There is also a high demand for products such as pull-up underwear (incontinence products) (79%), hearing aids (70%), reading glasses (59%) and diapers (63%). After intensive discussions during a consensus meeting, an agreement was reached on the 22 priority APs for Malawi. There is a wide range of APs being used by people with different functional limitations in Malawi. There is also a demand for APs that are not readily available. When developing an APL, the list should include products in use, those in demand, and those recommended by service providers. Following the development of the priority assistive products list (APL) by WHO, member states should develop their own contextually based APL. The development of the APL should be based on research evidence. All key stakeholders including persons with disabilities and other functional limitations, government, and development partners should participate in this process. The APL should be part of the national health system or community services. The Department of Disability and Elderly Affairs in the Ministry of Gender, Community Development, being the Government of Malawi line ministry coordinating disability issues participated actively in this study including inviting participants in the stakeholders' validation workshop. [ABSTRACT FROM AUTHOR]

Previous literature reports that low male partner support is a barrier to women's adherence and retention in HIV care programs. This qualitative study explored the relationships between partners to understand what is meant by male partner support in adherence of HIV-positive women in four healthcare facilities in Southern Malawi. We conducted 8 semi-structured focus group discussions (FGDs) with 73 participants (40 men and 33 women) and 10 in-depth interviews (IDIs) between August 2018 to December 2019. Participants were HIV-positive patients, healthcare workers (HCWs), expert patients (EPs), and couples attending the clinic. All data were digitally recorded, transcribed verbatim, and analysed using a gender-responsive grounded theory approach. This study confirms previous literature, which suggests male partner support is expressed by providing access to transport to the clinic and accompaniment to appointments. However, we found that men can also control access to resources and decision-making. Support is more complex than previous literature reported and, in some cases, gender norms significantly limit women's capacity to engage in care independently of male support since women need male partner permission to access the resources to attend clinics. This paper suggests that restrictive male-partner gender norms limit women's power to engage in care. Most importantly, the gender analysis reveals that what previous literature describes as male partner support can sometimes hide male partner control in permitting access to resources to attend health facilities. For this reason, policies enhancing male support should consider the gender power relationship between partners to avoid reinforcing gender inequality. [ABSTRACT FROM AUTHOR]

Purpose: Banana Bunchy Top Disease (BBTD) was first reported in Malawi in 1997. The major strategy used to deal with BBTD required banana growers to uproot and burn all their bananas and replace them with disease-free imported planting materials. This had limited success only. This paper uses an actor-oriented approach to explain this experience by assessing the different knowledge types and dynamics. Design/methodology/approach: Using a qualitative study design we sampled respondents through snowball and purposive sampling. Focus group discussions and key informant interviews were used to interview 120 farmers in 5 villages, 5 extension experts, 6 crop scientists, 2 banana research scientists and 3 NGOs leaders. Transcripts were analysed using Grounded Theory Methodology. Findings: The results showed that development agents and farmers conceived of, and dealt with, BBTD on the basis of different types of knowledge and dynamics. The battle that arose around this knowledge interface explains why the top-down approach to dealing with BBTD led to resistance from banana growers. These top-down approaches contrast with the widely-used rhetoric of using bottom-up approaches to foster co-innovation. Practical implications: Development actors need to embrace co-innovation principles and move away from merely sticking to the label of bottom up approaches. Theoretical implications: Using participation as a means to achieve predetermined strategies lead to failure and conflict in development programmes while as consulting with, and listening to farmers has potential to increase their cooperation in development programmes. Originality/value: The study informs that while there is so much talk about a shift in extension approaches, not much has changed to embrace co-innovation amongst actors. [ABSTRACT FROM AUTHOR]

Transactional sex has been associated with a high risk of HIV acquisition and unintended pregnancy among young women in urban slums in sub-Saharan Africa. However, few studies have explored the structural drivers of transactional sex from the perspective of both genders in these settings. This paper explores how young men and women understand the factors that lead to transactional sex among their peers, and how deprivation of material resources (housing, food and health care access) and consumerism (a desire for fashionable goods) may instigate transactional sex in the urban slums of Blantyre, Malawi. Data from 5 focus group discussions and 12 in-depth interviews undertaken with a total of 60 young men and women aged 18–23 years old, conducted between December 2012 and May 2013, were analysed using anticipated and grounded codes. Housing and food deprivation influenced decisions to engage in transactional sex for both young men and women. Poor health care access and a desire for fashionable goods (such as the latest hair or clothing styles and cellular phones) influenced the decisions of young women that led to transactional sex. Interventions that engage with deprivations and consumerism are essential to reducing sexual and reproductive health risks in urban slums. [ABSTRACT FROM PUBLISHER]

Antenatal care can act as an excellent tool to improve access to HIV counseling and testing services. This paper investigates an issue that may weaken its potential, namely lack of male involvement. We explored married men's perceptions of HIV in pregnancy and male involvement in antenatal HIV testing and counseling in Southern Malawi through 11 focus group discussions and a cross-sectional survey (n=388). The main findings were that men were largely unaware of available antenatal HIV testing and counseling services, and perceived it overall problematic to attend female-oriented health care. Most men supported provision of antenatal HIV testing. They perceived husbands to participate in the process indirectly through spousal communication, being faithful during pregnancy, and supporting the wife if found HIV-positive. Involvement of husbands was compromised by men's reluctance to learn their HIV status and the threat that HIV poses on marriage. Men stressed the importance of prior spousal agreement of antenatal HIV testing and considered HIV testing without their consent a valid reason for divorce. We suggest that male involvement in antenatal HIV testing requires refocusing of information and health services to include men. To avoid negative social outcomes for women, comprehensive and early involvement of men is essential. [ABSTRACT FROM AUTHOR]

Community health workers (CHWs) play a vital role in facilitating social connectedness, building trust, decrease stigma, and link communities to essential healthcare and social support services. More studies are needed to understand the factors facilitating these interactions among CHWs, clients, and community members. This study examined the CHW role and relationships between CHWs, communities, and health facilities that promote trust, positive relationships, and social connectedness. In 2016, the CHW program in Neno District, Malawi, was transitioned to a household-level assignment of CHWs to provide screening, linkage to care, and psychosocial and chronic disease support from a disease-based program. We employed an exploratory qualitative study with thematic analysis linked to Fredrickson's broaden-and-build theory of positive emotions through focus group discussions (FGDs) and in-depth interviews (IDIs) to understand the impact of the household assignment. We purposively sampled community stakeholders, CHWs, health service providers, and clients (total N = 180) from October 2018 through March 2020. All interviews were audiotaped, transcribed verbatim, translated, coded, and analyzed. Participants reported decreased stigma and discrimination with increased trust and confidence in CHWs with household-level assignment. Positive relationships between CHWs in their households, community members, and health facility staff fostered health knowledge, individual agency, and personal resources for the community members to access health services. Community members' personal resources of increased health knowledge, trust, gratitude, and social support improved social connectedness and subjective wellbeing. Areas to improve positive relationships include CHWs maintaining confidentiality and caring for pregnant women. Our study findings demonstrate that by building solid relationships as a community chosen, well informed, and household-level workforce, CHWs can develop positive relationships with communities and the health-care facility staff through building knowledge, trust, gratitude, and hope. Further work is needed in maintaining CHW confidentiality and new ways to approach culturally sensitive health areas. [ABSTRACT FROM AUTHOR]

How does sustainable agricultural intensification's (SAI) tenet of increased productivity on the same area of land relate to prevailing gender-biased land tenure systems? How can one conceptualize the interactions between intensified land use and control over land, labour, crops and benefits – and how can equitable outcomes be facilitated? These questions (which have not yet received sufficient attention in SAI research) are explored in this study using a qualitative methodology and a gender-transformative approach. Semi-structured interviews and focus group discussions with a total of 248 respondents were conducted in matrilineal and patrilineal intensification contexts in Ghana and Malawi. We develop a conceptual framework that extends Kabeer's institutional analysis to include gender implications of SAI. Selected cases reveal how farmers and key actors link land use intensification to existing land-related institutions with diverse outcomes. We conclude that SAI interventions should adopt gender-transformative approaches. These facilitate equitable outcomes by supporting consensus-based institutional changes and creating positive synergies between multiple scales. [ABSTRACT FROM AUTHOR]

Teenage pregnancy and child marriage continue to rise in Malawi despite the introduction of compulsory Life Skills education in primary schools in 2002. A qualitative approach, employing focus group discussions with participants was used to explore the barriers faced by teachers in delivering sexual and reproductive health education in primary schools in southern districts of Malawi. Pupils, teachers and parents from a total of 10 primary schools, seven in Mangochi and three in Zomba, were invited to participate in focus group discussions on barriers to sexual and reproductive health education. The teaching experience of teachers ranged from one to six years. Pupils were aged between 10 to 19 years while parents had to have a child learning sexual and reproductive health at school to participate. Thematic analysis revealed several barriers to delivering sexual and reproductive health education: over-emphasis on abstinence, an unconducive learning environment, existence of sexual practices linked to becoming of age rites, peer pressure, lack of sexual and reproductive health reinforcement by parents, and inadequate training for teachers. Policymakers and curriculum developers/implementers should create an approach which is inclusive of all stakeholders and able to provide young people with comprehensive sexuality education that is rights based and effective. [ABSTRACT FROM AUTHOR]

An Agricultural Innovation System (AIS) is a collaborative governance (CG) arrangement which brings together several actors in the agriculture sector forming an innovation platform (IP). This study presents findings of CG dynamics obtained from an IP. : A qualitative study used focus group discussions, key informant interviews and desk study to collect data. Establishment of an IP is the first step in the realisation of CG in an AIS. There is a varied range of governance dynamics which affect the functionality of an IP. Actors in an IP choose when and in what circumstances to apply CG, in order to increase their beneficial effect. The differences among actors in terms of their sizes, resources, visions and missions contribute to how the CG works out. : Paying attention to CG dynamics is as important as forming IPs. Failure to address governance dynamics makes actors follow an individualistic, linear approach to extension service delivery under the veil of AIS. There is a need to mainstream CG as a reiterative and not as a sporadic approach on logistical but on substantive matters. This requires a re-orientation and restructuring of extension systems. : Future research should focus on how the collaborative dynamics affect the impacts coming out of the CG regime. Mobilising actors and setting up structures for AIS has become common place yet little attention is paid to understanding the collaborative dynamics affecting their functionality. [ABSTRACT FROM AUTHOR]

Diet and physical activity are crucial to Type 2 diabetes mellitus (T2DM) self-management. However, socio-environmental, and cultural factors can impede lifestyle behaviours, and hence T2DM management. This study aimed to identify barriers, facilitators and support for diet and physical activity among adults with T2DM in Malawi selected from a larger clinical assessment study, conducted in urban and semi-urban public hospitals. Four focus group discussions were conducted, and audio-recorded, transcribed verbatim, coded, then organised and analysed using thematic analysis. Emergent themes included: family, friends, and health worker ties that facilitated both diet and physical activity as socio-support systems. Diabetes peer groups occurred more often in urban than semi-urban areas. Dietary barriers to self-management of T2DM included: cost and access to food; lack of knowledge on what and how much to eat; challenges of separate preparation and purchase of food; dilemmas of what to eat during functions and travel; and conflicting dietary information from different sources. Comorbidities and fear of public ridicule were key perceived barriers to participants being physically active. Therefore, socio-environmental factors should be considered by nutritionists, dietitians, and health workers when developing and providing nutrition and physical activity education to adults with T2DM in Malawi. [ABSTRACT FROM AUTHOR]

The majority of deaths amongst children under 5 years are still due to preventable infectious causes. Emergency care has been identified as a key health system weakness, and referrals are often challenging. We aimed to establish how prepared frontline facilities in Malawi are to implement WHO Emergency Triage Assessment and Treatment (ETAT) guidelines, to support policy and planning decisions. We conducted a concurrent mixed-methods study, including facility audit; healthcare provider survey; focus group discussions (FGD) and semi-structured interviews with facility staff. The study was conducted in two districts in Malawi, Zomba and Mchinji, between January and May 2019. We included all frontline facilities, including dispensaries, primary health centres, rural and community hospitals. Quantitative data were described using proportions, means and linear regression. Qualitative data was analysed using a framework approach. Data were analysed separately and then triangulated into common themes. Forty-seven facilities and 531 healthcare providers were included in the audit and survey; 6 FGDs and 5 interviews were completed. Four common themes emerged: (1) current emergency case management; (2) referral practices; (3) trained staff capacity; (4) opportunities and barriers for ETAT. Triage was conducted in most facilities with various methods described, and 53% reporting all staff are responsible. Referrals were common, but challenging due to issues in transportation. Twelve percent of survey respondents had ETAT training, with clinical officers (41%) reporting this more frequently than other cadres. Training was associated with increased knowledge, independent of cadre. The main barriers to ETAT implementation were the lack of resources, but opportunities to improve quality of care were reported. Malawian frontline facilities are already providing a level of emergency paediatric care, but issues in training, drug supplies and equipment were present. To effectively scale-up ETAT, policies need to include supply chain management, maintenance and strengthening referral communication. [ABSTRACT FROM AUTHOR]

Purpose: St. Gabriel's Hospital (SGH) in Namitete, Malawi, has a Home-Based Palliative Care program of 60 community health workers (CHWs) to support rehabilitation work. Over 5 years, these CHWs received support through annual rehabilitation training programs. The study explores the nature of the CHWs' roles and factors affecting the program's sustainability. Subjects: Participants were home-based palliative care CHWs at SGH (n = 60). Methods: This is a mixed-methods study including qualitative and quantitative data and analysis methods. Data were collected from training surveys, focus group discussion material, field and home-visit observation checklists. Results: Results showed that 59% of the CHWs traveled ≥ 5 km to visit patients. 100% of the 57 patients had participation restrictions. Following trainings, 93.3% of the CHWs felt more prepared. Qualitative analysis revealed four themes: (1) Empowerment and Motivation; (2) Barriers to care; (3) Communication and Network; (4) Scope of practice and Self-Perception of impact. Conclusion: This study illuminated important aspects of the CHWs' work: empowerment through training, burden of travel, and altruism. Future studies could include impact of CHW-to-caregiver training, patient outcome measures following care, and future training needs. Significance: This study provides a unique perspective of the successes, barriers, and motivations of home-based CHWs in Malawi. [ABSTRACT FROM AUTHOR]

Background: Test and Treat has been widely adopted throughout sub-Saharan Africa, whereby all HIV-positive individuals initiate antiretroviral therapy (ART) immediately upon diagnosis and continue for life. However, clients who feel healthy may delay ART initiation, despite being eligible under new treatment guidelines. Objective: We examined health care worker (HCW) perceptions and experiences on how feeling healthy positively or negatively influences treatment initiation among HIV-positive clients in Malawi. Methods: We conducted 12 focus group discussions with 101 HCWs across six health facilities in Central Malawi. Data were analyzed through constant comparison methods using Atlas.ti7.5. Results: Feeling healthy influences perceptions of ART initiation among HIV-positive clients. HCWs described that healthy clients feel that there are few tangible benefits to immediate ART initiation, but numerous risks. Fear of stigma and unwanted disclosure, disruption of daily activities, fear of side effects, and limited knowledge about the benefits of early initiation were perceived by HCWs to deter healthy clients from initiating ART. Conclusion: Feeling healthy may exacerbate barriers to ART initiation. Strategies to reach healthy clients are needed, such as chronic care models, differentiated models of care that minimize disruptions to daily activities, and community sensitization on the benefits of early initiation. [ABSTRACT FROM AUTHOR]

Socio-cultural beliefs and practices surrounding menses influence women's sexual and reproductive health behaviors and decision-making. We analyzed menstrual experiences within the context of the MTN-020/ASPIRE clinical trial during which women were asked to use a monthly vaginal ring for HIV prevention. The qualitative component of the trial was conducted during February 2013-June 2015, included interviews and focus group discussions with 214 women aged 18–42, in Malawi, Zimbabwe, Uganda, and South Africa. Emotions of shame, embarrassment and disgust relating to menses emerged. Menstruation was referred to using euphemistic terms or language about dirtiness. Women were uncomfortable touching their own menstrual blood when removing vaginal rings and felt embarrassed about study staff seeing blood on returned rings. Despite reassurances, women felt ashamed performing study procedures while menstruating, leading to missed study visits. Women's aversion to menstrual blood was linked to narratives about avoiding sex during menses and beliefs about its potential harms. Women associated men's disgust pertaining to menstrual blood with men's willingness to use condoms for sex only during menses, highlighting another way through which socio-cultural beliefs and practices around menstruation affect HIV protective behaviours. These findings provide novel insight into menstrual shame among women in these four countries. [ABSTRACT FROM AUTHOR]

Poverty has widespread impacts on health. In dealing with resource scarcity, individuals' thoughts are narrowed to address immediate resource limitations, thus crowding out other information, a phenomenon called the scarcity mindset. To assess for indication of a scarcity mindset in sexual and reproductive decision making in rural Malawi, a setting with extreme resource scarcity, we collected qualitative data in the form of eight focus group discussions and 28 semi-structured, in-depth interviews with women and men of varying ages and marital status. Participants, who were of low socioeconomic status, described constant tradeoffs that they made to secure their daily needs. They articulated both the challenges of supporting many children and the need to bear many children to guarantee their own future support. While participants described wealthy people as being concerned with preserving resources (often through the practice of limiting childbearing), they described poor people as working to increase their probability of success against an uncertain economic future (without due consideration of contraceptive behaviours). We found qualitative evidence that a scarcity mindset may influence reproductive decision making among women and men in rural Malawi and may preclude the use of contraception in low-resource settings. [ABSTRACT FROM AUTHOR]

Timber out-grower schemes have proved to be one of the most profitable enterprises for rural households. No wonder, several analysts and researchers regard them as an alternative model to avoid problems of displacement and create 'win-win' outcomes for both rural communities and private investors in forestry. However, understanding farmers' knowledge, attitudes and perceptions towards tree out-grower schemes plays a key role in farmers' adoption of the interventions. This study examined these farmers' attributes towards out-grower schemes in selected districts of Malawi. Data were collected from 300 farmers who were randomly selected between September and October 2017 through semi-structured interviews and focus group discussions. The results revealed that 82% of the respondents participated in timber out-grower schemes, piloted by WVI and ICRAF. Based on a median score of 4.75 (IQR 4–5), respondents were strongly agreed on their knowledge on timber out-grower schemes as a basis for adopting the intervention. Using the cumulative Cube-root frequency method of stratification, the results revealed that more than half (51%) of the respondents belonged to the high category, and thus had high knowledge of timber out-grower schemes, whereas 32% and 17% had very high and medium levels of knowledge, respectively. The study also revealed that 79.3% of the respondents had a positive attitude towards out-grower schemes. Pearson correlation analysis revealed a positive, significant relationship between marital status (r = 0.081), household size (r = 0.062), education (r = 0.051) and knowledge of the respondents on timber out-grower schemes. A significant positive relationship was also observed between marital status (r = 0.156), household size (0.178), education (0.002), ethnic group (0.151) and attitudes of the respondents towards timber out-grower schemes. However, a negative relationship between knowledge and attitude was revealed (r = −0.534). The study therefore concludes that socio-economic factors, such as gender, education, ethnic group and household size, should be considered in upscaling timber out-grower schemes in Malawi. [ABSTRACT FROM AUTHOR]

Aim:The aim of the study is to contribute to a more holistic evidence based on lower limb fracture management in low-income settings, by exploring the perspectives of those actually experiencing and administering skeletal traction in Malawi. Methods:The study took place at Queen Elizabeth Central Hospital in Blantyre and Kamuzu Central Hospital in Lilongwe, the two largest public hospitals of Malawi. Qualitative data were collected by participant observation, individual interviews with eight patients, two orthopedic surgeons, one physiotherapist, and two focus group discussions with multidisciplinary teams. Results:Patients experienced physical and psychological pain from the prolonged traction treatment in bed. Anxiety, indignity and emotional distress in the ward environment were commonly observed. Patients emphasized the negative impact on their families and the significant economic consequences due to prolonged hospitalization. Health care providers identified the major obstacles for quality treatment due to the lack of staff, equipment, specialized knowledge and skills. Rehabilitation services were nearly absent, thus little effort was made to maintain function and enhance recovery during and after long-term bed confinement. Conclusion:The use of long-term skeletal traction has a devastating impact on the patients and families, and causes major frustrations to health workers involved with fracture management in a low-resource setting. Implications for RehabilitationAs stated by various health care providers, there is a need to improve trauma care, strengthen rehabilitation services and educate more rehabilitation staff so they can take up the different roles and functions required in treatment and rehabilitation after injuries and other debilitating conditions.In the current situation, sufficient pain relief for patients is required. This should go hand in hand with the empowerment of patients so as to fulfill their rights to quality health services. For health care providers, multidisciplinary teamwork, enhanced specialized education and skills, improved access to adequate equipment and developing standardized procedures appear essential in order to improve fracture management.With injuries representing a growing portion of the global burden of disease, and in the changing demographic panorama with aging populations in Africa and the world at large, injury prevention, trauma care- and rehabilitation need a stronger focus in public health globally. [ABSTRACT FROM PUBLISHER]

Social forces shape people's reproductive health in many ways. We examined people's knowledge about reproductive health using focus group data collected from 93 participants in rural districts of Malawi. Participants' perspectives were contextualized by explaining the socioeconomic, cultural, and gender factors that determine reproductive health for rural Malawians. Strategies to improve reproductive health care in environments lacking in health infrastructure, staff, and economic resources are then provided. We call for a reproductive health agenda to target preventive care by providing information about anatomy and biology, communicating information in culturally competent ways, and educating men and women over the life course. [ABSTRACT FROM AUTHOR]

There is a growing body of evidence on the correlation between improving access to water, sanitation and hygiene (WASH) in schools and positive health and educational outcomes for students. Similar evidence on the impact of school WASH facilities on health, enrolment and absence for children with disabilities is not available. The limited data have revealed that children with disabilities are burdened by poor WASH in schools access, and even prevented from attending school due to inaccessible WASH facilities. We conducted two case studies of policy and provision of school WASH services for children with disabilities in Uganda and Malawi. We found a robust policy environment in Uganda and Malawi with policies and guidelines in place for WASH in schools for children with disabilities. However, provision of services and facilities are low and focused primarily on sanitation. [ABSTRACT FROM AUTHOR]

Historically, African women have been viewed through a colonizing and Eurocentric lens emphasizing poverty, oppression, and suffering. A postcolonial, feminist approach to our two qualitative studies with human immunodeficiency virus (HIV)-infected women in Malawi and Kenya led us to depart from this discourse, highlighting women's capacity. Through this article, not only is a forum created for African women's voices to be heard as subaltern knowledge leading to transformational change, but also health care providers are made aware, through women's words, of how they might capitalize on grassroots women's movements, particularly in resource-poor communities, to implement effective HIV prevention and treatment strategies. [ABSTRACT FROM AUTHOR]

Although some cultural practices have been identified as a determinant of HIV transmission, research investigating how specific practices affect HIV risk is lacking. In Malawi, initiation rites, in which young people attend ceremonies around the time of puberty, have received little attention. In this qualitative study, we explored whether communities in southern Malawi perceive initiation rites to be an HIV risk factor for girls. Twelve focus group discussions were held with adolescents and adults in a rural community of Thyolo district and a peri-urban community of Mangochi district. Community members observed that certain aspects of traditional initiation rites propel girls into sexual roles expected of adulthood, without facilitating their adaption to the emerging landscape of HIV, thereby increasing HIV risk. HIV prevention programming needs to address the role of initiation rites in adolescent girls' vulnerability to HIV and help young girls navigate the conflicting messages they receive from a wide range of channels about expected sexual behavior. [ABSTRACT FROM AUTHOR]

Research into the effects of global health initiatives (GHIs) on health systems has largely left out the viewpoints and contributions of civil society. This study details civil society's perspective regarding the effects of two GHIs, the US President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), on country health systems and the added value of civil society interacting with GHIs to strengthen health systems. The study employed qualitative data collection methods using semi-structured interviews administered during focus groups and key informant interviews. A range of health system stakeholders were interviewed in Kenya, Malawi, Uganda and Zambia. Data were coded and analysed for themes and sub-themes. In total, 2910 civil society participants provided information individually or in focus groups. Respondents reported that GHIs have contributed to dramatic health benefits within and outside of a disease-specific focus, including health systems strengthening efforts. However, opportunities for synergy between GHIs and health systems have been missed, and GHIs have not worked sufficiently to close capacity gaps of grassroots civil society organisations. Despite some governance innovations, civil society's opportunities to participate meaningfully in GHI priority setting efforts are limited. Recommendations are included on how to best use GHIs to strengthen health systems by partnering with civil society. [ABSTRACT FROM AUTHOR]

Cash transfer programs throughout the world were designed within a Social Protection framework to alleviate poverty in the short term and to interrupt the long-term intergenerational cycle of poverty. In this study, we examine the potential of the Malawi Social Cash Transfer Scheme (SCTS) to interrupt the intergenerational cycle of poverty in ultra-poor and labor-constrained households in Malawi. Using qualitative data from 16 focus groups with 163 children, we map the voices of children to various dimensions in a framework of intergenerational poverty. The framework identifies financial, material, environmental, human, social, cultural and political capital as important inputs for older generations to transfer to younger ones in order to avoid lifelong poverty. We found that focus-group participants reported dramatic and widespread changes in their lives resulting from the cash transfer in nearly all of the framework's dimensions. Participants reported that the cash allowed them to gain access to goods and materials, including food, healthcare, school supplies, clothing, blankets, housing and livestock. Respondents described changes in their lives, such as providing less labor for the household, allocating more time to schooling, enjoying adequate and high-quality foods, accessing healthcare and purchasing medicine. They also described better mental health, with new hopes and dreams for the future. These changes have the potential to interrupt the intergenerational cycle of poverty. Nevertheless, despite these widespread and positive benefits to children, whether the SCTS will become part of the national policy, and the scheme's long-term sustainability, is still uncertain. [ABSTRACT FROM AUTHOR]