Structural Factors Affecting Mother–Baby Pairs to Access HIV Services in Malawi: A Case of Balaka District

Mother–baby pairs’ ability to efficiently obtain HIV care in Malawi and around the world is impacted by structural elements in the societies, institutions, and systems. In the Balaka district, HIV Diagnostic Assistants (HDAs) play a significant role in providing mother–baby pairs with facility-based HIV services, while Health Surveillance Assistants (HSAs) work with other governmental and nongovernmental partners to inform the community about the facility’s HIV services. HSAs offer HIV services at outreach clinics and keep track of pregnant women and their infants to connect them to facility-based care. In our project, the Tingathe program provided HDAs as full-time clinic-based human resources to provide HIV services in 14 facilities of Balaka District. The HDAs reorganized the workflow to reach as many people as possible, allowing mother–baby pairs to access the services 6 days a week, synchronizing the appointment dates for the mothers and their babies, and making sure that all babies born to HIV positive women are administered an HIV test. As a result, all babies who were HIV-exposed now have easier access to HIV services. In addition, policy-level initiatives like a financial service-level agreement between the Malawian government and nonpublic health institutions, allowed mothers and infants to receive HIV and other services from these facilities without paying a fee.