Project Background and Description
At the time of project approval, Malawi had made substantial gains in reducing the prevalence of underweight children. However, chronic undernutrition remained high; 47 percent of Malawi’s children under the age of five exhibited stunted growth (low height for age), exceeding Sub-Saharan Africa’s average of 40 percent. The underlying causes of malnutrition included poverty, nutrition-deficient household behaviors, inadequate food preparation, and care practices.
The government of Malawi’s response to the high rate of chronic malnutrition began in 2004, when it created the Department of Nutrition, HIV and AIDS (DNHA) and implemented a nutrition policy. In 2011, Malawi joined the Scaling Up Nutrition movement to mobilize resources and support for the implementation of the National Nutrition Policy and Strategy Plan 2007–15, which focused on broad-based nutrition interventions implemented at the community level. The Scaling Up Nutrition initiative required coordination with a variety of partners, including the Canadian International Development Agency, the United States Agency for International Development, and Irish Aid.
The Nutrition and HIV/AIDS Project (the project) was approved in 2012 and financed through an International Development Association credit ($32 million) and an International Development Association grant ($26 million). It also received contributions from the following donors: the Canadian International Development Agency ($13 million); the Global Fund, for the country’s HIV Pool to support implementation of the National HIV and AIDS Strategic Plan ($87 million); and the borrower ($10 million). Total estimated project financing was $190 million. The project development objective (PDO) was “to increase access to, and utilization of, selected services known to contribute to the reduction of child stunting, maternal and child anemia, and the prevention of HIV and AIDS in children and sexually active adults” (World Bank 2012b,5).
In 2016, the government asked the World Bank to restructure the project and provide additional financing to address disease outbreaks (Ebola) and acute malnutrition in drought-affected districts. The restructuring aimed to increase coverage of selected nutrition and HIV/AIDS services, and a new disease preparedness component was included in response to the 2014 Ebola outbreak in West Africa. At the time of the outbreak, Malawi had no disease surveillance system, no isolation units, and no specialized equipment for dealing with an outbreak. The project made available emergency financing to implement World Health Organization–recommended measures for Ebola preparedness.