Exploring the Funding Challenges Faced by Small NGOs: Perspectives from an Organization with Practical Experience of Working in Rural Malawi

Figures & data

Table 1 Situational Analysis: Indicators Putting Malawi into Context with Other Regional Countries (Latest Data Available)^5,6,8

	South Africa	Botswana	Zambia	Zimbabwe	Mozambique	Malawi
Population estimate^Citation5,Citation8	59,392,000	2,588,000	19,473,000	15,994,000	32,077,000	19,889,000
GDP per capita (current international $)^Citation5	6,776.5	7,737.7	1,487.9	1,267.0	541.5	645.2
Extreme poverty ($2.15/day)(% pop)^Citation5	20.5%	15.4%	61.4%	39.8%	64.6%	70.1%
Life expectancy at birth, total (years)^Citation5	62	61	61	59	59	63
Maternal mortality ratio (per 100,000 live births)^Citation8	127	186	135	357	127	381
Under 5s mortality rate (per 1,000 live births)^Citation8	33	35	58	50	70	42
Neonatal mortality rate (per 1000 live births)^Citation8	11	18	25	25	28	19
Physicians per 1000 people^Citation5	0.8	0.4	0.1	0.2	0.1	0.1
Nurses and midwives per 1000 people^Citation5	5.0	5.5	1.0	2.1	0.5	0.7
People using at least basic sanitation services (% of population)^Citation5	78%	80%	32%	35%	37%	27%
Access to electricity (% pop)^Citation5	89.3%	73.7%	46.7%	49.0%	31.5%	14.2%

Notes: Data from World Bank⁵ and the World Health Organization.⁸ Countries for comparison based on World Bank classifications of upper-middle income countries (South Africa and Botswana), lower middle income countries (Zambia and Zimbabwe) and low income countries (Mozambique and Malawi).⁶

Abbreviations: $, US dollars; %, percent.

Table 2 WMF “Top-to-Toe” Wellbeing Screening examination

Body Site	Examination	Examples of Possible Findings
Whole body	Musculoskeletal examination and General observations Equipment: Tympanic thermometer/ replacement thermometer covers	Spinal/other joint abnormalities Nutritional status Temperature- for acute infective processes
Eyes	Ophthalmoscopy examination Equipment: Ophthalmoscope	Childhood cataracts, trachoma, onchocerciasis (‘river blindness), sequalae of disease processes, such as yellowing (jaundice), pallor (anemia)
Ears	Otoscopy examination Equipment: Otoscope and ear pieces.	Otitis media- with/without effusion, otitis externa
Teeth	General Oral examination Equipment: Tongue depressors, Light source using the above listed equipment	Poor dentition/decay/cavities, gum disease, oral sequalae of infectious diseases
Heart	Cardiac examination Equipment: Stethoscope	Heart murmurs- congenital or acquired through infective disease processes, pericarditis
Lungs	Respiratory Examination Equipment: Stethoscope	Infective/obstructive signs such as reduced air entry, areas of consolidation, fluid.
Abdomen	Abdominal examination No specific equipment required	Malnutrition states including Kwashiorkor, marasmus, organomegaly (liver, spleen) secondary to infective disease such as malaria, hepatitis, etc
Skin and nail	General full body examination of skin and nail/nail bed Equipment: Wood’s lamp (ultraviolet light)	Infective and non-infective conditions including eczematous rashes, dermatitis, sequalae of systemic infective disease, fungal, bacterial and viral infections of skin and nails

Notes: Data from World Medical Fund (WMF).⁴⁹ The “Top-To-Toe” wellbeing screening document was designed for practical use in the field by the WMF medical team (and can be made available to other NGOs by request to WMF).

Table 3 Applying the OECD Evaluation criteria to WMF’s Passport to Health Initiative

OECD Evaluation Criteria	Analysis and Questions for WMF	Additional WMF Considerations
Relevance Is the intervention doing the right thing?^Citation50	How relevant is the intervention to local goals? Have the potential beneficiaries’ needs and priorities been identified? How relevant is the intervention to global goals, such as SDGs? Has the intervention been accepted by target populations?	Disease prevention and health promotion are key in improving health outcomes in low-income areas in order to reduce health inequalities. Program will target remote areas that have little to no access to health resources. The program is in line with SDG – health inequalities. Regional health care professionals and Local elders have been consulted about the community’s health needs and what they would want from the program
Coherence How well does the intervention fit?^Citation50	Is there compatibility with other interventions within the region? Ease of adaptation to external factors and unforeseen events?	Envisioned synergy with WMF mobile health clinic. Baseline infrastructure for Health Education program already previously established with WMF HIV/AIDS Education Program. WMF has been recognized by local government and Malawi Ministry of Health as key to the provision of healthcare to remote and vulnerable populations WMF local/regional goals are closely aligned with global SDG goals.
Effectiveness Is the intervention achieving its objectives?^Citation50	Have the objectives been well defined in order to measure effectiveness? Have intended results/outcomes been achieved? Have unintended effects (positive and negative) been identified? Has continued implementation of intervention been justified?	Determining whether objectives have been met will require robust data collection throughout the evaluation process. This will allow for ease of adaptation when deemed necessary in order to achieve the desired outcomes. Interim results should be analyzed and made available for beneficiary and stakeholder to ensure transparency
Efficiency How well are resources being used?^Citation50	Is the intervention conducted in a timely and economic/resource efficient way? What are the resources including funds, local expertise, natural resources, time, etc. Have more efficient (and effective) methods been identified through alternative interventions?	A solid infrastructure has already been established in target regions. This will ensure that effective utilization of pre-existing resources, and costs will be monitored and reviewed to ensure most cost effective and sustainable processes are adopted. Pre-existing knowledge of local resources will enable WMF to incorporate these resources into project maintenance. Limit reliance on external and non-sustainable resources.
Impact What difference does the intervention make?^Citation50	Has there been adequate interaction and engagement with the WMF Health Education and Top-To-Toe wellbeing screen? To what extent has the intervention generated or is expected to generate significant positive or negative, intended or unintended effects? Have any holistic and enduring changes in systems or norms been achieved? Has the intervention created a change that really matters to local people? What are the observed effects/outputs in comparison to the desired effects?	Anticipated short-term impact trends include early recognition or disease and reduce morbidity due to opportunistic screening via the “Top-To-Toe” well-being examination (ie, the intervention will cause a significant change in the lives of the intended beneficiaries). Anticipated medium-term and long-term trends include uptake of health promotion and disease prevention messages, with long term reduced morbidity and mortality rates, as well as reduced prevalence of common disease and illnesses (ie, the intervention will create enduring changes in norms and systems). Main outcome measures will include rates of mortality and morbidity. Additional outcome measures will include medication use, need for follow- up or admission to hospital, hygiene behaviours pre-health education program. Comparison of outcome measures, such as mortality and morbidity data, with regional/global data held in data banks. Keeping health records and data banks will allow pattern recognition and trends which could potentially dictate subsequent interventions and areas still in need of action. Outcomes to be disseminated to local officials and Malawi Ministry of Health, as well as stakeholders and beneficiaries.
Sustainability Will the benefits last?^Citation50	To what extent will the net benefits of the intervention likely to continue? Are there any factors that might inhibit sustainability such as resources and financing? Is there an exit plan in place?	WMF considers that the key to successful sustainability is empowering locals with the knowledge and skills to ensure long-term continuation of health promotion and disease prevention. WMF is transparent with all expenditure and resource allocation, and regularly reviews budgets and costs to ensure the most viable distribution for long-term sustainability.

Note: Data from OECD 2021.⁵⁰

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