Analytical summary - Universal coverage
One of the core objectives of the health sector in Malawi is to ensure that all Malawians have access to basic health services, especially in the rural areas. The Ministry of Health has made a policy commitment to institute service-level agreements with other service providers such as the Christian Health Association of Malawi and Banja la Mtsogolo, a nongovernmental organization, as one of the strategies to improve access to health services, especially by the rural poor.
Specific regulator frameworks have been put in place to ensure that all Malawians have access to basic health services, especially in rural areas. A Memorandum of Understanding has been signed between the Government of Malawi, represented by the Ministry of Health, and the Christian Health Association of Malawi secretariat while a service-level agreement has been signed between district health officers and proprietors of health facilities.
The Ministry of Health conducted a mapping exercise of health facilities in 2010. About 81% of the population resides within 8 km of a health facility. Based on this exercise, locations for constructing new facilities have been identified and those health facilities that need to be rehabilitated or upgraded to a higher level have also been identified. This will facilitate districts to identify facilities that would require service-level agreements.
A health financing strategy towards universal coverage should be extended to the target population and should include:
- all the vulnerable population;
- expanding the package of services based on the evidence from the burden of disease study, the WHO STEPwise approach to surveillance survey;
- provision of an Essential Health Package free of charge at point of service delivery, after wide consultation and reinforcing protection against financial risk.
The Ministry of Health aims to ensure that Essential Health Package services are available to all Malawians. However, there are physical and financial barriers to realizing this ideal. A significant proportion of Malawians are poor and cannot afford to pay for health services. The signing of service-level agreements with Christian Health Association of Malawi institutions for delivery of maternal and newborn services is one way of ensuring that all Malawians, regardless of their socioeconomic status, have access to Essential Health Package services. There is evidence that the removal of user fees in Christian Health Association of Malawi facilities has resulted in an increase in the number of patients seeking care in these facilities.
Universal coverage also looks at geographical coverage in terms of the proportion of the Malawian population living within an 8-km radius of a health facility. Mapping of health facilities has shown areas in Malawi that have limited or no health facilities. Mapping also shows where Christian Health Association of Malawi and other private health facilities are located. The construction of new health facilities will help to increase the proportion of the population who live within a 8-km radius of a health facility.
In some rural areas, health infrastructure is absent or non-functional. In others, the challenge is to provide health services to a widely dispersed population. In urban areas, health services may be physically within the reach of the poor and other vulnerable populations but are provided by unregulated private providers who do not deliver Essential Health Package services.
Although new health facilities have been constructed and some existing ones have been renovated or upgraded, challenges still exist. The implementation of the Umoyo housing programme is continuing but staff accommodation remains a challenge, especially in hard to reach areas. In some rural areas, health facilities are unavailable or dysfunctional, while in others the challenge is the provision of health care to a widely dispersed population.