Neonatal mortality remains a critical concern in Malawi, with 24 deaths per 1,000 live births (Malawi Demographic and Health Survey, 2024). Small and sick newborns (SSNBs) including preterm, low birth weight, and critically ill infants account for a substantial proportion of these deaths. Complications from premature births contribute to roughly 36% of all neonatal deaths in Malawi. The care of SSNBs in Malawi is hampered by multiple systemic challenges. While there are effective interventions that could reduce the risk of neonatal mortality, these often require facility-based care and consistent access to adequate breast milk or breast milk alternatives, resources that are not always available due to economic disparities and social challenges.
Save the Children Malawi has received funding from Innovation Norway to pilot Bundle Up! Nutrition for Small and Sick Newborns in Malawi. The project is being implemented at Kamuzu Central Hospital (KCH), a tertiary referral hospital in Lilongwe that manages a high volume of critically ill newborns. As a key referral facility within Malawi’s health system, KCH provides specialized neonatal care but operates under significant resource constraints as revealed by the findings from the project’s needs assessment. The assessment findings shows that nutritional care for SSNBs at KCH relies primarily on breastfeeding, expressed breast milk, and alternative feeding methods such as cup and tube feeding. However, these approaches are limited by inadequate infrastructure, shortages of essential equipment, staffing gaps, inconsistent counselling, weak monitoring systems, and gaps in family-centred care. As a result, feeding practices are often suboptimal, contributing to poor neonatal outcomes.
In response to these challenges, the project aims to explore and procure a bundle of solutions to address gaps in the provision of quality nutritional care for SSNBs. This will be achieved through an Innovation-Friendly Procurement (IFP) approach, which began with a comprehensive needs assessment in September 2025 to identify gaps in current practices, systems, and resources. These findings, further validated and prioritized through a multi-stakeholder workshop in April 2026, will inform the subsequent market dialogue process. This next step, scheduled to commence in June 2026, will engage the private sector and broader innovation ecosystem to identify feasible, low-cost, and scalable solutions tailored to the needs of SSNBs in resource-constrained settings.