As we are getting close to 2015, and the deadline for the Millennium Development Goals (MDGs) set by the United Nations, many countries in sub-Saharan Africa struggle with persisting high rates of childhood mortality. For many sub-Saharan countries, it is not likely that the under-five mortality rate will be reduced by two thirds between 1990 and 2015, as is the target of MDG4. Within this context, the case of Malawi is particularly impressive. Malawi is a country situated in the southeast Africa, with one of the highest mortality rates among children under five years of age in the world. At the same time, Malawi has experienced a substantial reduction in under-five mortality rate since the onset of the MDGs, and has already achieved MDG4. The aim of this study is exploring how and why Malawi has had relative success in their efforts of reducing childhood mortality. The focus of this thesis lies with the Government of Malawi and how the Government, through their political commitment, policy formulation, programs and interventions works towards achieving MDG4. Emphasis is put on building a health system capable of delivering basic health services to the broad population. Malawi´s health system strategies are analysed, and challenges for further progress are discussed. This is a literature study. Sources were identified using official websites (i.e. United Nations and World Bank), Google search (for Malawi policy documents) and non-systematic search in Pubmed/McMaster Plus for articles and updated material on childhood mortality in Malawi.