A majority of maternal deaths occur in Sub-Saharan Africa, and nearly all are preventable with good quality healthcare. Both Malawi and Zambia are fully committed to improve maternal and neonatal health outcomes, but are not making adequate progress.

This new programme of work will build upon the collaboration formed by the NIHR DIPLOMATIC research group.


Our aim is to improve maternal and neonatal health outcomes in Malawi and Zambia, by strengthening the quality of maternity care.


Senior leadership of the group are all based in Malawi and Zambia. They will partner with other leading international researchers and methodologists, but a decision has been made to shift the locus of control to Malawi.

Research plan

The aim will be delivered through 4 themes:

 Theme 1. Data driving improvement

 High quality maternal and neonatal health data is key for quality improvement. We will provide real-time digital reporting of maternal deaths, near-miss cases, and quality of care data, accessible via online dashboards. This will be used to identify critical improvement needs and measure progress.

We will link facility and community Demographic Health Surveillance System sites to understand the gaps in facility data.

 Theme 2. Placing users at the centre of change

 We will use qualitative methods to understand the experience of users, in particular adolescents and women with mental health problems. Their narratives will identify how services can better support their needs and inform priority setting.

We will optimise a brief tool to measure maternity users’ experience and evaluate its use in practice.

 Theme 3. Prioritisation and co-design


Many of the required changes to improve maternal health are identified at a facility level, yet the root causes span the whole system. We will conduct an annual maternal health needs prioritisation meeting, identifying and championing issues for sector wide focus.

To target prioritised needs we will train managers and providers in intervention design using the Behaviour Change Wheel methodology and support them in the co-design process. 

Theme 4. Implementing and evaluating change

Sites across Malawi and Zambia will implement carefully designed behaviour change interventions and robustly evaluate the implementation process.

The first intervention has been prioritised. This will evaluate a package of “Enhanced Antenatal Care”, seeking to improve compliance with evidence based antenatal care.

We found identification of sexually transmitted infections is poor during antenatal care. We will address how services can be changed to improve this.

Behavioural change interventions will be developed by site teams and field tested in their facility. The most effective of these pilots will be selected for a multi-site roll-out and evaluation.

 Community Engagement and Involvement (CEI)

This is embedded across the work, with strong elements of user engagement and co-design throughout. A specific maternal and neonatal health CEI group will be established in Malawi and Zambia, and provided training.

 Capacity building

Plans include 3 PhD studentships and support for integrated MSc student projects. Ongoing research skills, policy engagement and management training will be provided at all levels of the team.

 Communicating for impact

In addition to high quality scientific outputs we are superbly positioned to communicate the work and maximise impact. We will support this with “policy and impact committees” and policy briefs.




Our AIM is to improve the maternal and neonatal health outcomes in Malawi and Zambia, by improving the quality of maternity care.

This will be achieved through a coordinated programme of work (Figure 1.). We will strengthen facility and community data systems and make this information accessible to decision-makers (Theme 1). We will ensure that users’ experiences and voices, especially those from normally marginalised groups, are centred in this process (Theme 2). This information will be assimilated and a prioritisation process with a broad range of stakeholders will focus actions on the areas of greatest need, and together we will co-design interventions to respond to these needs (Theme 3). We will then implement and robustly evaluate interventions that have been developed including locally led pilot projects, and multi-country studies (Theme 4).

This research is funded by the NIHR using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government.

Lusaka Apex Medical University Online Research Repository

Lusaka Apex Medical University Repository is an open access computerized assortment for the scholarly work of, staff, Students and others which contains student projects, recorded materials, theses and dissertations, journal articles,. It builds the perceivability of LAMU’s research; assist with contacting a worldwide audience and starts the course of carefully safeguarding the University’s scholarly output.