Malawi health system

Structure

5 Zonal Offices that provide technical support to District Health Management Teams (DHMTs) in planning, delivery and monitoring of health service delivery at the district level and facilitate central hospitals’ supervision of districts

3 levels of care: Primary, secondary and tertiary

  • Primary care: village clinics in rural hard-to-reach areas and health centres where curative, maternity, and preventive services are offered in the Essential Health Package (EHP) free of charge
    • EHP covers malaria
  • Secondary care services: district hospitals

    • District hospitals and Christian Health Association of Malawi (CHAM) hospitals provide general services, Primary Health Care (PHC) services, and technical supervision to lower units
    • District hospitals provide service training for health personnel
    • CHAM operates 36% (170) of health facilities (mostly rural)
    • Government pays for certain programme-specific essential medicines and all local staffing costs
  • Tertiary care services: central hospitals
    • Central hospitals that offer specialized services
    • There are approximately 679 public sector health facilities, 509 of which are administered by the GoM
    • The for-profit private health sector plays a minimal role in the provision of health services (4% of health services).

    C-stock (monitoring and evaluation)

    Government working to implement cStock: an electronic Logistics Management Information System (eLMIS) tool that re-supplies health products and enables Health Surveillance Assistants (HSAs) in hard-to-reach areas to report in a timely manner

    • Results show significantly improved visibility into and management of product availability at the community level for CCM – including malaria

    • Approved by MoH for nation-wide scale up and is being implemented by 3,075 HSAs in hard-to-reach areas

    Challenges

    1. Supply chain management

    • Capacity and security challenges at the Central Medical Store Trust (CMST)
    • Procurement, storage and distribution of malaria commodities procured by the Global Fund and other donors is currently managed through a parallel system
      • Use of parallel supply chains is a temporary measure while CMST undergoes improvements in commodity storage distribution and management

    2. Human resources

    • Shortage of trained health workers and the skill mix needed to meet the health needs of the growing population
    • Vacancy rates:
      • Ministry of Health: 47%
      • Allied Clinical Health Professionals (Clinical Officers, Medical Assistants, etc.): 69%
      • Allied Health Technical Services (Laboratory and Radiography cadres): 52%;
      • Pharmacy: 88%
      • Nursing Services: 68%
      • Preventive Health Services including HSAs: 36%

    3. Infrastructure and accessibility to services

    • 81% of the population have access to a health clinic within 8km of their home
    • Ability to provide health support to widely dispersed populations, or health facilities are not available or functional
    • Urban areas: unregulated private providers who do not deliver Essential Health Package (EHP) services
      • The removal of user fees in CHAM facilities has resulted in an increase in the number of patients seeking care in these facilities

    4. Monitoring and evaluation

    • DHIS II data management is electronic at the district level but data is still paper-based at health centres
    • Timeliness, completeness, and accuracy of data