Despite being one of the poorest countries in the world, Malawi has made considerable progress in key demographic and survival indicators. Life expectancy at birth is 63.7 years and the total fertility rate in 2015/16 was 4.4 children per woman down from 6.2 in 2000. The under-five mortality rate also declined significantly over the same time period, but maternal and neonatal mortality have stagnated. Health system bottlenecks include human resource constraints, supply chain limitations leading to shortfalls of essential medicines and medical commodities, and inadequate infrastructure, all contributing to quality challenges in service delivery, despite increased availability, access, and utilization of key services such as facility delivery. In addition, Malawi’s overall development and its health system are vulnerable to external shocks such as extreme weather events and infectious disease outbreaks.
The GFF Partnership Response
The GFF partnership has supported the government of Malawi to develop an investment case based on the country’s Health Sector Strategic Plan 2017-22 (HSSP-II). Priorities include a focus to enhance governance and accountability, improve coordination, and strengthen access to and quality of primary care towards Universal Health Coverage. The Ministry of Health and Population (MoHP) created a multi-stakeholder task force to develop the country’s investment case that prioritizes key areas for investment for improving outcomes. The GFF is also supporting the government to increase capacity for planning at sub-national level to improve governance, planning, and budget execution for health at district levels. In addition, it supports implementation of a national civil registration system and vital statistics, utilization of health information at the point of care, and strategies for hospital financial autonomy and retainment of health workers, particularly in hard-to-reach areas.
The MoHP is using the investment case to define required district-level budget needs as part of the roll-out of the HSSP-II Operational Plan, which will be used for advocacy for both domestic and external resources. Among the focus areas are the key systems interventions to improve access to quality SRHR services and reduce maternal and neonatal mortality. The related services are provided at a primary level (health posts, dispensaries, health centers, rural hospitals), a secondary level (district and CHAM hospitals), and a tertiary level (central hospitals and one private hospital with specialist services).