DoC analysis of Malawi setting out in an open, evidence-based way, the main blockers of progressive change in a country, and the likelihood of these being overcome by countervailing forces, including those external to the national system. The evidence-based approach identifies the most significant changes in the medium and long term. It draws on the experience, knowledge and internal debates of a multidisciplinary team; an extended literature search; and key-informant and focus-group interviews carried out in Malawi in January 2005.