Malawi

Q: Strategic purchasing

The Ministry of Health’s Essential Health Package prioritizes conditions such as diabetes and hypertension for primary and secondary care, but limited readiness and financing constraints have impeded full implementation. The National Health Financing Strategy (2023–2030) emphasizes strengthening public–private partnerships (PPPs) as a mechanism to improve service delivery at public health facilities.

Malawi faces the twin challenge of continuing poverty reduction and an evolving health burden. The country remains low-income and is pursuing economic reforms to sustain growth. At the same time, Malawi is managing both infectious diseases and a rising burden of noncommunicable diseases (NCDs). NCDs accounted for roughly 43% of adult deaths in 2019, up substantially from a decade earlier—an indication of changing population health needs and growing demand for chronic care.

Over the past decade Malawi has strengthened its NCD policy environment. The government launched a National Health Financing Strategy (2023–2030) that maps pathways to universal health coverage (UHC) by expanding domestic revenue, improving pooling and strategic purchasing, and exploring a national health insurance mechanism.

In August 2023 Malawi ratified the WHO Framework Convention on Tobacco Control (FCTC), signalling a commitment to use fiscal and regulatory measures to reduce tobacco consumption and to mobilize sustainable financing for health.

The Cost of NCDs in Malawi

In 2019, Malawi received the UN Interagency Task Force Award for its demonstrated commitment and efforts in preventing and controlling NCDs.

Health financing for NCDs: Progress in Malawi

Malawi has made significant progress in positioning noncommunicable diseases (NCDs) at the center of its health policy agenda. The National Health Financing Strategy (2023–2030) sets out a clear path toward universal health coverage, emphasizing the expansion of domestic revenue, the introduction of a national health insurance scheme to ease out-of-pocket costs for low-income households, and the strengthening of public-private partnerships (PPPs) to enhance service delivery.

In 2024, the Ministry of Health launched the Scaling Up the Implementation Capacity for NCD Prevention and Management Strategy (Phase III)—a four-year national initiative designed to expand access to NCD care at the primary level. Building on earlier phases of Malawi’s NCD response, this effort prioritizes people living with chronic conditions, particularly those in underserved rural communities.

The country’s ratification of the WHO Framework Convention on Tobacco Control (FCTC) further widens fiscal and regulatory opportunities, including the potential for stronger tobacco taxation, to both reduce risk exposure and mobilize additional health financing.

Domestic resource mobilization is central to Malawi’s progress toward sustainable health financing. Although donor funding continues to provide more than half of the total health budget, the government is taking steps to expand its domestic revenue base and strengthen financial sustainability. The National Health Financing Strategy (2023–2030) outlines pathways for increasing domestic revenue— including plans to establish a National Health Fund—and recognizes tobacco taxation as an innovative financing mechanism to both reduce health risks and generate additional funds for the health sector.

Despite these advances, funding specifically dedicated to NCDs remains very limited—only 0.1% of total programmatic health funding in 2015–2016. Addressing this imbalance will require not only higher budget allocations but also better integration of NCD priorities within broader health and fiscal planning processes.

Malawi currently provides public health services free at the point of care; however, there is no national public health insurance system. As a result, households still face out-of-pocket costs—including transport, medicines and devices, and informal payments—which can limit access to care and contribute to financial hardship. Private insurance covers only a small share of the population, primarily among higher-income groups.

The National Health Financing Strategy (2023–2030) recognizes these gaps and highlights the need to strengthen pooled financing arrangements, including the potential establishment of a National Health Fund, to enhance financial protection and ensure more equitable access to essential health services, particularly those living in rural areas.

The Ministry of Health’s Essential Health Package prioritizes conditions such as diabetes and hypertension for primary and secondary care, but limited readiness and financing constraints have impeded full implementation.

The National Health Financing Strategy (2023–2030) emphasizes strengthening public–private partnerships (PPPs) as a mechanism to improve service delivery at public health facilities.