Trial version, Version d'essai, Versão de teste

Analytical summary - Community ownership and participation

From AHO

Jump to: navigation, search

In the context of decentralization, the Ministry of Health in Malawi has put in place structures to facilitate community ownership and participation. Village health committees have been established to ensure individuals participate in activities that promote good health. Health facility advisory committees have also been instituted at health facility level to facilitate user and provider interaction.

Through these structures, communities are involved in monitoring delivery and usage of drugs from the central medical stores, participating in identifying health priorities, as well as in the delivery of the community component of the Essential Health Package. One of the challenges is that these committees have not been effective because the elected members have not been oriented on their functions.

In addition, the committees lack resources to conduct their business. Appropriate local by-laws at district and community levels should be developed and enforced to empower communities to perform certain actions on their own and demand the services that they need. Multisectoral structures for coordinating health service planning and implementation at community level should be established and sustained.

Health promotion activities in Malawi have not been implemented in a coordinated manner in light of dynamic changes and emerging health-related issues such as HIV/AIDS, sexual and reproductive health, and gender. Yet health promotion enables communities to develop skills to appreciate and participate in the decision-making processes, planning, delivery and evaluation of health services.

The Ministry of Health developed a National Health Promotion Policy in 2009 with a view to creating public awareness, facilitate community involvement, and participation in and promoting activities that will foster the adoption and maintenance of healthy behaviour and encourage healthy lifestyles.[1]

A joint programme of work for a health sector wide approach (SWAp) (2004─2010) Republic of Malawi[2] aimed at providing an Essential Health Package to ensure increased availability of quality Essential Health Package services and increased accessibility to the Essential Health Package and other health services for all people, including the poor. In 2008, the Malawi Health Equity Network conducted a service delivery satisfaction survey to assess satisfaction with health services among rights holders.[3]

The results of the survey indicate that 83.6% and 76.4% of the rights holders in urban and rural areas, respectively, are satisfied with the health services provided. Those that were satisfied with the health services cited the following reasons among others:

  • presence of qualified and experienced staff (67%)
  • provision of information on ailment (27%)
  • good-quality service (33%)
  • better advice on medication (21%).[3]

Civil society organizations in Malawi are involved in health service delivery at all levels in a number of ways. At national level, they contribute to policy-making processes through participation in various governance structures. In addition, these organizations play an advocacy role for increased resources to the health sector.

At community level, civil society organizations are:

  • instrumental in community mobilization
  • involved in issues of health rights and raising awareness on prevention and control of diseases
  • involved in resource mobilization for health service provision.

Civil society organizations also advocate for the promotion of accountability and transparency in the provision of health services and monitor the implementation of health services at local level.


  1. National Health Promotion Policy 2009. Lilongwe, Government of Malawi, Ministry of Health, 2009
  2. A joint programme of work for a health sector wide approach (SWAp) (2004─2010) Republic of Malawi (pdf 2.15Mb). Lilongwe, Ministry of Health, Department of Planning
  3. 3.0 3.1 Service delivery satisfaction survey report. Malawi Health Equity Network, 2008