Malawi health system

The health system in Malawi comprises the public, private-for-profit (PFP) and private not-for-profit (PNFP) sectors, the largest of the latter being the Christian Health Association of Malawi (CHAM). 77% of health services are either free or at a subsidized cost. 

  • Public sector (government) provides 48% of health services, which are free of charge.  
  • PNFP facilities provide 29% of health services at a subsidized cost, with malaria treatment services being offered at no cost in CHAM facilities (16% of PNFPs).  
  • The private sector, which charges a non-subsidized fee, serves 24% of the population. 

Health services are delivered through three levels of care, namely: primary, secondary and tertiary.  

Primary 

Primary health care (PHC) is organized to meet basic health needs of communities. PHC consists of community initiatives, such as iCCM, which is delivered through village clinics by HSAs and SBCC services. The MOH developed a Community Health Strategy for 2018 through 2022, which advocates and promotes delivery of integrated community health services through health posts and dispensaries at the community level.  

The recommended service package for integration includes iCCM, EPI, Community Management of Acute Malnutrition (CMAM), Water, Sanitation and Hygiene (WASH), and health education talk services. Plans are currently underway to scale up the construction of health posts and dispensaries at the community level to deliver the integrated community health services.  

Secondary 

District hospitals constitute the secondary level of the health care system, where facilities are enhanced by the provision of adequate specialized supportive services such as laboratory and diagnostics, which includes malaria species differentiation and parasite density estimation.  

Tertiary 

Tertiary health care consists of highly specialized services provided by central hospitals and other specialist hospitals, including management of severe malaria patients. At the national level, the NMCP is supported by the National Reference Laboratory (for laboratory-related training, quality assurance and quality control; the Integrated Management of Childhood Illnesses (IMCI) unit (community case management); health education services (SBCC), the Pharmacy Medicines Regulatory Authority (PMRA) for pharmacovigilance and other related services for drug monitoring; and the Central Monitoring and Evaluation Division (CMED) for data management and monitoring and evaluation including HMIS.  

The IMCI unit is responsible for training, supervision, supply chain management and data management for HSAs. Currently, the IMCI unit is supporting 4,592 HSAs, who do malaria case management, among other tasks.  

Private sector 

The private sector, including clinics, hospitals, and pharmacies, provides 24% of the health services in Malawi20. This sector contributes to the delivery of malaria services in malaria case management and vector control through routine distribution of LLINs. Among children under five with fever for whom advice or treatment was sought, 21% sought advice from the private health sector, an increase from 18% in the 2014 Malaria Indicator Survey.