National Community Health Strategy FINAL

Malawi is a landlocked country with a population of nearly 17 million people – which is estimated to surpass 20 million in the next five years. Malawi has 28 administrative districts, which are further divided into traditional authorities (TA) and villages, the smallest administrative unit. Malawi’s economy has expanded over the past  30 years, with real GDP growth estimated at 2.9% in 2016. It remains predominantly an agricultural country, with agriculture, forestry, and fishing contributing 28% of GDP. Currently, GDP per capita is approximately $380, and given that inflation and population growth currently outpace economic growth, average living standards are falling. In 2010-11, 29% of households lived under the international poverty line of $2 per day. Poverty remains particularly prevalent in rural areas, where over 14 million people –more than 80% of the population – live.

Despite recent achievements, Malawi has not yet achieved optimal health outcomes. Life expectancy remains low at 61 years. Over half of the country’s total disability-adjusted life years are a result of the top four leading causes– HIV/AIDS, lower respiratory infections, malaria, and diarrheal diseases. Malawi has reduced its child mortality rate, leading to achievement of Millennium Development Goal (MDG) 4. However, other indicators remain stagnant or even face declines. For example, the percentage of facilities able to deliver Malawi’s essential health package (EHP) fell from 74% in 2011 to 52% in 2015. Therefore, fewer people are accessing critical health services.

The Malawi health sector operates under a decentralised system guided by the Local Government Act (1998). The Act delegates authority and funding from central government ministries to district assemblies, who guide health sector planning, budgeting, procurement, and service delivery at district and community levels. At central level, the Ministry of Health (MoH) sets strategic direction and formulates sector-wide governing policies. 29 district health offices oversee services provided in and outside of the district hospital. Five Zonal Health Support Offices (ZHSOs) provide technical support to districts in planning, delivery, supervision, and monitoring of health services. In total, the percent of government expenditure going toward public health averaged 10.4% from 2012-13 to 2014-15, well below the Abuja target of 15%. Therefore, donors have contributed the majority of resources for the health sector in recent years.