Analytical summary - Service delivery
In Malawi, the Ministry of Health is responsible for:
- the development, review and enforcement of health and related policies for the health sector
- spearheading sector reforms
- regulating the health sector, including the private sector
- developing and reviewing standards, norms and management protocols for service delivery
- planning and mobilizing health resources for the health sector, including allocation and management
- advising other ministries, departments and agencies on health-related issues
- providing technical support supervision
- coordinating research
- monitoring and evaluation.
Since 2004, the Ministry of Health in collaboration with development partners has been implementing a health service delivery strategy based on the delivery of the Essential Health Package. The implementing framework is guided by the National Health Policy, the Public Health Act (1948) (which is being reviewed), the Decentralization Policy, the Malawi Growth and Development Strategy II 2011–2016 and Vision 2020, among others.
Malawi has a three-tier health care delivery system based on three levels of health care:
- Primary health care or community care is organized mostly to meet the primary health services. This consists of community initiatives, heath posts, dispensaries, maternity units, health centres and community and rural hospitals.
- District hospitals constitute the secondary level of health care and provide specialized services to patients referred from the primary health care level, through outpatient and inpatient services and community health services. These services are enhanced by provision of adequate specialized supportive services, such as laboratory, diagnostic, blood bank, rehabilitation and physiotherapy services.
- Tertiary health care, which consists of highly specialized services, is provided by central hospitals and other specialist hospitals providing care for specific disease conditions or specific groups of patients.
These different levels are linked to each other through an elaborate referral system that has been established within the health system.
Health care services are provided by both the public and private sectors. The public sector includes all facilities under the Ministry of Health, the Ministry of Local Government and Rural Development, the Ministry of Forestry, the Police, the Prisons and the Army. The public sector provides services free of charge at the point of service delivery.
The private sector plays an important role in the delivery of health services. At community level, numerous nongovernmental organizations, faith-based organizations and community-based organizations deliver health promotion services but the majority of the providers and the services they offer are unknown to the Ministry of Health and stakeholders. The Ministry of Health and stakeholders in the health sector have mainly involved traditional birth attendants, which were introduced to expand maternal and child health services to the community.
The Ministry of Health recognizes the role of traditional healers in the delivery of health services. However, formal linkage between the Ministry of Health and traditional healers has been weak. The Malawi Traditional Medicine Policy has been developed to guide the practice of traditional medicine in the country.
The private sector consists of private for-profit and private not-for-profit providers, mainly the Christian Association of Malawi, which provides services and trains health workers in its health-training institutions. The Christian Association of Malawi facilities, mostly located in rural areas, charge user fees to cover operational costs. The charging of user fees is a major barrier to accessing services for most poor people living in the rural areas.
Malawi recognizes the importance of providing quality health services. However, there are factors that hinder the provision of quality health services, including poor infrastructure, lack of equipment, lack of qualified human resources and weak management. Some of these issues are already being addressed.
The Health Sector Strategic Plan 2011–2016 intends to address the above challenges by implementing strategies and interventions to improve quality in the delivery of the essential package of health services, including:
- reviewing and implementing the Quality Assurance Policy
- improving quality standards and accreditation
- improving performance management and client and provider satisfaction.