Health Policy

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    Open Access
    National Population Policy
    (Malawi Government Ministry of Finance, 2023-06-01) Malawi Government Ministry of Finance
    The revised National Population Policy (NPP) provides a guiding framework for managing population issues to improve the quality of life for all Malawians. A well-manageable population will enable the Government to provide adequate and quality social services and economic opportunities for Malawians so that they meaningfully contribute to national development. Malawi has made some progress in demographic and socio-economic indicators since the last Population Policy was put in place. The average number of children a woman has during her lifetime – Total Fertility Rate – has declined from 5.7 in 2010 to 4.2 in 2018. Mortality has declined with life expectancy at birth increasing from 48 in 2008 to 62 in 2018 (males) and 51 in 2008 to 68 in 2018 (female). In addition, HIV prevalence rate reduced from 11.8 in 2004 to 8.8 in 2015-16. Malawi’s human development index improved from 0.431 in 2010 to 0.483 in 2019 representing a 12% increase. While there has been progress, the country still faces the challenge of rapid population growth whereby the population size increased at a fast pace and maternal death remain high. If the current trends continue, the situation will impact the country`s ability to achieve its development objectives. Malawi’s Vision is to become an inclusively wealthy and self-reliant nation by 2063 with the medium-term goal of becoming a lower-middle-income economy by the year 2030. However, the prevailing rapid population growth will exacerbate poor living conditions forcing many to resort to unsustainable survival options that will have a detrimental effect on land, forests, and water resources, on which the nation thrives. The Policy, therefore, provides a guiding framework for programming and coordination of population programmes in Malawi. The Policy goals, objectives, and strategies presented are aligned to the national vision "Malawi 2063" and its first 10-year Implementation Plan (MIP-1). Specifically, the Policy is aligned to the Human Capital Development enabler that focuses on the size and quality of a population in relation to socio-economic development. A population characterized by a healthy, well-educated, and skilled workforce is critical in spurring economic growth. Government is committed to providing leadership and the necessary support for the effective implementation of the Policy. Furthermore, the implementation of the Policy requires multi-sectoral efforts. I, therefore, call upon all stakeholders and development partners to join Government in the implementation of the National Population Policy
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    Open Access
    National Male Engagement Strategy for Gender Equality, Gender Based Violence, HIV and Sexual Reproductive Health Rights: 2023-2030
    (Malawi Government, 2023-07-01) Malawi Government Ministry of Gender, Community Development and Social Welfare
    Meaningful engagement of men and boys is recognised as critical to the advancement of gender equality and equity. A number of creative strategies exist for engaging men and boys, and these include creating opportunities for men to examine and challenge gender socialisation; giving positive reinforcement to boys who support gender equality; and mobilising communities to counter harmful practices and norms. It has, however, been observed that changing norms is extremely challenging given the benefits that patriarchy bestows on men. Gender equality requires men to relinquish their unfair privileges, which is a complex and dynamic process. At an individual level, it can be difficult for men and women to transform beliefs and practices that they have learnt from childhood. In addition, the desire and ability of men and boys (and women) to change depends on their broader contexts and the messages they receive from their environment about gender norms and masculinity and femininity. The Ministry therefore found it imperative to develop the strategy which looks at how best men and boys can be engaged as clients, beneficiaries and agents of change in actively promoting gender equality, women’s empowerment and the transformation of inequitable definitions of masculinity. The Government of Malawi, through the Ministry responsible for Gender, spearheaded the development of the first National Male Engagement Strategy to run from 2023 to 2028 through a wide consultative process, which involved other government ministries and departments, development partners, donors, civil society and NGOs. The strategy will guide all players in the gender sector on how males (boys and men) can complement and not compete with activities focusing on girls and women to achieving gender equity and equality. It is my sincere hope that the commitment that all stakeholders had shown in developing this strategy will continue during its implementation as we all strive to ensure that men and boys take an active role in preventing and responding to GBV, HIV treatment, care and support and SRHR.
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    Health Sector Strategic Plan III 2023-2030
    (Malawi Government. Ministry of Health, 2022-01-01) Malawi Government. Ministry of Health
    The Health Sector Strategic Plan III (HSSP III) outlines the objectives, strategies and activities needed to build upon progress during implementation of the Health Sector Strategic Plan II (HSSP II) and accelerate Malawi’s progress in achieving Malawi’s Universal Health Coverage (UHC) targets by 2030. The HSSP III is motivated by Malawi 2063’s vision of self-reliance and outlines how the health sector will contribute to the human capital development and mindset-change pillars of the vision. In the spirit of inclusivity, the HSSP III development process was extensively consultative and participatory, ensuring that the prioritization of resources and outcomes in the plan reflect a shared vision. Notwithstanding a very challenging environment characterized by up to four waves of the COVID-19 pandemic, the health sector registered notable progress across impact level performance measures. For example, maternal mortality ratio was at 349 deaths per 100,000 live births in 2019 against the HSSP II target of 350 deaths per 100,000 live births; under-5 mortality rate was 39 per 1,000 live births in 2020 against the HSSP II target of 48 deaths per 1,000 live births; infant mortality rate was 29 per 1,000 live births in 2020 against the HSSP II target of 34 deaths per 1,000 live births; and the neonatal mortality rate was 19 per 1,000 live births in 2020 against the HSSP II target of 22 deaths per 1,000 live births. In addition, the HSSP II HIV incidence target of 2 cases per 1,000 adult population aged 15-49 years was surpassed and was at 1.21 in 2020. Despite such progress, however, significant gaps in population health, service delivery and health systems building blocks remain, and require addressing in order to meet UHC goals by 2030. The goal of the HSSP III, therefore, is to move towards UHC by improving health status, financial risk protection and client satisfaction. It is recognized, however, that resources for health care delivery are inadequate. The HSSP III has therefore defined a Health Benefits Package (HBP) previously referred to as Essential Health Package (EHP) in previous HSSPs to maximize population health given the limited available resources. The HSSP III has the following objectives across nine priority areas: 1. Service Delivery: Increase equitable access to and improve quality of health care services. 2. Socio-Economic Determinants: To improve overall health, environmental health and prevent disease through addressing social determinants of health and burden of disease. 3. Infrastructure & Medical Equipment: To improve the availability, accessibility and quality of health infrastructure and medical equipment at all levels of health care. 4. Human Resources: Improve the availability of competent and motivated human resources for health (HRH) for quality health service delivery that is effective, efficient, and equitable. 5. Medical Products and Technology: To improve the availability, quality, and rational utilization of medicines and related medical supplies, balancing among the 3 P’s: patients, products, and personnel. 6. Digital Health: To develop a sustainable and harmonized country led digital health system that covers all areas of service provision and enables efficient delivery of health services at all levels of the health system. 7. Research: To promote and coordinate a health research agenda in order to generate high quality evidence required to inform the development of health and health care delivery. 8. Leadership and Governance: To enhance effectiveness of leadership and governance at all levels of the health sector. 9. Health Financing: To set a well-governed health financing architecture that is able to mobilize adequate resources, distribute the resources in an efficient and equitable way, and strategically purchase services based on a well-defined benefit package in pursuit of UHC goals. Eleven reforms that are deemed game-changing, have been identified, informed by high quality evidence as well as extensive consultations. These are: in Service Delivery - transitioning from vertical programming to integrated platforms of care for service delivery; in Health Workforce – 1) implementation of a performance management system, 2) development of a harmonized in-service training system for human resources for health linked to continuous professional development, and 3) evidence-based matching of health workforce supply and demand; in Infrastructure and Medical Equipment – 1) upgrading of urban health centres to community hospitals to improve city primary and secondary care, and 2) equipment inventory management to achieve procurement and utilization efficiency; in Supply Chain - effective management and coordination across parallel supply chains while working towards greater systems integration through CMST by 2030; in Digital Health - scaling up of digital health systems; in governance – 1) implementation of a “One Plan, One Budget, One M&E” system, and 2) increase provider autonomy; and in Health Financing - strategic purchasing in health financing. The total cost of implementing the intervention matrix for all the eight years is estimated at US$31.2 billion (MWK 32 trillion) representing the full resource need before the prioritization. For the 2023/24 FY, although the need was $4 billion, it was estimated from resource mapping round seven that only approximately $690 million ($537.1 million fungible funding and $153 million non-fungible Government and donor funding) would be available in total. Therefore, the 2023/24 needs were prioritised down for to fit within the $537.1 million envelope estimated. Assuming conservatively that this level of funding persists, the HSSP III will realistically be implemented at $4.7 billion, with an acceptable margin of error, over the eight years. The implementation of the HSSP III will be based on an HSSP III operational plan that will draw from the HSSP III intervention matrix. The Health Sector Working Group (HSWG) will steer the “One Plan, One Budget, One Report” process. The district stakeholder forum will provide overall multi-sectoral and partner coordination at the district level. The Secretary for Health will oversee overall coordination of the sector, while designated directors at the national level will provide overall leadership of their respective thematic areas. The Director of Health and Social Services at the District Council shall provide overall technical coordination in line with Council governance arrangements. Government, Donors and Implementing partners will be guided by MOUs and a Code of Conduct. In order to effectively monitor the HSSP III, 1) the health information system will be decentralized to each decision-making entity at each level of the health system; 2) all partners in the health sector will align and harmonize their data systems to facilitate timely transmission of information to decision makers at all levels of the health system; 3) streamlined and interoperable digital health systems will be imperative; 4) All efforts shall be made toward digitalizing service delivery at the point of care and data shall be collected and extracted from these systems to support service delivery and timely and accurate reporting. HSSP III will be a living document and, in that spirit, MOH plans to publish digital versions of future editions of HSSP III on MOH website to ensure that latest evidence is translated into strategic priorities.
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    Malawi National Cancer Control Strategic Plan 2019-2029
    (Government Printing Press, 2019-01-01) Malawi Government
    In Malawi cancer is of growing concern, causing significant morbidity and mortality due to lack of comprehensive cancer prevention, early detection, treatment and palliative care services. The IARC GLOBOCAN estimates for Malawi indicate total annual new cancer cases at 15,349, with 5966 cases among men and 9383 in women around 2012. Among women, the major cancers were; uterine, cervix (n=3684), Kaposi’s sarcoma (KS, n=997), esophagus (n=895), breast (n=762); among men, the major ones were KS (n=1810), esophagus (n=1094), non-Hodgkin lymphoma (n=695), prostate (n=349) and urinary bladder (n=309). Malawi has the highest age standardized incidence rate (75.9/100,000 women) of cervical cancer in the world, with the risk of one out of 14 Malawian women developing cervical cancer in her life time. The projected cancer burden might be underestimated due to inadequate cancer diagnostic services and underreporting of clinically diagnosed cases given that only 18% of all reported cancers had pathological confirmation. This national cancer control strategy will serve as the policy document for planning and implementing cancer prevention, early detection, treatment, follow-up and palliative care interventions at different levels of governance and for the efficient monitoring and evaluation of the cancer interventions. It outlines a multi-sectoral partnership to address key issues related to specific major cancer types, taking into consideration the disease burden, risk factor prevalence, available resources and a variety of stake holders. This Strategy aligns itself to the efforts of non communicable disease (NCDs), Clinical Directorate and National Health Sector Strategic Plans (HSSPⅡ) (2017-22) and other policy documents. The strategy aims to achieve a state of health for all the people of Malawi with low burden of cancer that would enable them to lead high quality and highly productive lives, boosting national development. It will provide strategic direction in implementing a coordinated and responsive cancer control framework leading to a reduction in incidence, morbidity and mortality and improved quality of life through effective partnerships and collaborations for prevention, diagnostics, treatment, palliation and financing of cancer control activities to improve the wellbeing of Malawians. To achieve the above objectives, planned interventions and monitoring and evaluation are organized into six thematic areas: 1) prevention; 2) screening and early diagnosis; 3) treatment and follow-up care; 4) palliative care and survivorship; 5) governance and financing; 6) cancer control research, monitoring and evaluation. The planned prevention strategies include; avoiding cancer causing chronic infections, tobacco use, reduce alcohol consumption, maintaining a healthy body weight, regular physical activity and consuming healthy diets. Primary interventions encompass those which reduce exposure to potential risk factors associated with cancers as well as immunization against infectious agents commonly associated with cancers such as human papillomaviruses (HPV) and Hepatitis-B viruses. Integrating the various forms of interventions into other programs will likely give optimal public health benefits, with minimal costs and long-term cancer control benefits. Some areas of possible integration include sexual and reproductive health initiatives, human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) control programs, national immunization programs to improve uptake of HPV and Hepatitis B vaccinations, occupational and environmental health initiatives and other lifestyle modification programs targeting the general public. A multi-sectoral approach is critical in the context of tobacco control, since Malawi has some key challenges as tobacco farming and exports are major contributor to Malawi’s economy and the country has not yet ratified WHO Framework Convention on Tobacco Control. Recently, Malawi has completed HPV vaccination of around 23,000 girls aged 9-13-year-old girls with high coverage and is planning a national scale up is underway. A national HIV prevention strategy for the period 2015-2020 is currently being implemented to achieve the UNAIDS 90-90-90 targets by 2020, which will have important implications for the prevention of Kaposi’s Sarcoma. Cancer detection at its early stages enables treatment that is generally more effective, less complex and more affordable, resulting in long-term survival and high cure rates with good quality of life. Early detection involves two major approaches, namely screening involving detection of preclinical disease in asymptomatic people and early diagnosis involving early detection in symptomatic patients. These two are fundamentally different in resource and infrastructure requirements, impact and costs, but require prompt linkage to treatment and follow-up care without delay. In response to the high incidence and mortality from cervical cancer, Ministry of Health and Population (MOHP), is implementing nationwide visual inspection screening with acetic acid (VIA) for cervical neoplasia as part of the Cervical Cancer Control Program (CECAP) in collaboration with its stakeholders. Efforts are taken to expand and improve the coverage of VIA screening and treatment of screen positive women. With a judicious combination of HPV vaccination and screening, Malawi can anticipate dramatic future reductions of cervical cancer. Infrastructure and trained human resources for major cancer treatment modalities such as surgery, radiotherapy, chemotherapy and hormone therapy are grossly inadequate or lacking in Malawi with consequent poor survival outcomes. Type of cancer, stage at diagnosis and quality of treatment and follow-up care are important determinants of treatment outcomes. Efforts will be taken to improve availability and access to cancer early diagnosis and treatment and it is anticipated that most cancer patients will get optimal, resource appropriate Treatment and care in due course. Cancer treatment in Malawi is anticipated to take new dimension with the development of the National Cancer Treatment Center (NCTC) in Lilongwe which is due to open in 2020. The operationalization of the cancer centre will be the single most important initiative in the national cancer control program of Malawi given the fact that cancer treatment is currently highly fragmented and provided in overextended hospitals with limited infrastructure, consumable supply chain problems and limited skilled and experienced human resources. The cancer center is planned within the campus of Kamuzu Central Hospital (KCH), as a matrix type of cancer centre with its own cancer surgery, radiotherapy, chemotherapy, hormone therapy, palliative care, medical records and hospital cancer registry services and sharing pathology and other allied diagnostic and super-specialty treatment services with KCH. Cancer services are provided with highest quality of care in cancer centres that are autonomous, without administrative and beaurocratic entanglements and hitches. It is important that the proposed National Cancer Treatment Center should be an autonomous body with its own governing and scientific councils for is efficient functioning. Government of Malawi recognizes the importance of palliative care to improve the quality of life and symptom burden for all patients and families affected by life threatening illnesses including cancer. In October 2014, MOHP, Government of Malawi formulated a national palliative care policy to take forward the national agenda for the health sector. The National Cancer Control Strategy will heavily rely on the implementation of the national palliative care policy including appropriate access to immediate release morphine for the treatment of severe cancer related pain to achieve tangible progress in extending high quality appropriately staffed palliative care services across Malawi. The national cancer control strategy and its monitoring and evaluation shall be implemented in a program mode under the supervision of a national cancer control coordinator supported and advised by the cancer control advisory committee. Monitoring and evaluation forms an essential component of the cancer strategy and will seek to link and benefit from existing systems such as population based cancer registration, hospital registries, medical records departments, cross sectional surveys, follow-up studies and case series. The inputs of interventions and the evaluation of outcomes will be monitored and evaluated using short-term (1-2 years), medium term (3-5 years) and long term (5-10) time lines. The National Cancer Control Strategy will risk remaining a paper tiger unless it is linked with planned budget outlays and budget lines to support its implementation and evaluation.
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    Open Access
    Malawi Quick Guide to Mental Health
    (Scotland-Malawi Mental Health Education Project, 2021-01-01) Mullin, Donncha S; Stewart, Robert C
    The Malawi Quick Guide to Mental Health was produced to provide practical information for the assessment and management of mental disorders in Malawi. The Guide is for the busy primary care healthcare provider working at first- and second' level healthcare facilities in Malawi. Brought together in May 2020 during the global COVID-19 pandemic, it particularly aims to support non specialist healthcare workers who find themselves caring for people with mental disorders for the first time. In Malawi, there are three Consultant Psychiatrists for a population of approximately 20 million people. It is clear that we cannot rely solely on specialists to provide mental health care.