Health Sector Strategic Plan III 2023-2030

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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.