By Raymond Nakulenga
Malawi is grappling to sustain a booming population with its stunted economy and inadequate resource distribution. According to the World Bank’s 2023 data, Malawi’s population stands at roughly 21 million (20,931,751).
To paint a picture of concern, as of 2023, 46 percent of the country’ population does not have access to health care, representing just below half (9.7 million) of the total population (Data Policy Navigator, 2024).
The issue is not just who needs these health care facilities but where and what type of health care is to be provided based on location and age group of the population. In 2019, a Capital Investment Plan was launched by the Ministry of Health to ensure that 95 percent of the Malawian population had close access to health care facilities within a 5KM radius.
The proximity of health facilities is crucial, especially for women and children. According to the 2020 Malawi Integrated Household Survey Report, 52 percent of Malawi’s population is female and 34.4 percent of the population is aged below 15 (IHS5, 2020).
Major health aspects, such as reproductive health and malaria, have improved due to projects like the Safe Motherhood initiative and USAID’s President’s Malaria Initiative (PMI). These projects have seen a 45.9 percent decrease in malaria caused child deaths and an increase from 14 percent to 48 percent in women receiving three doses of preventative malaria treatment during pregnancy since the PMI’s project inception in 2007 (USAID, 2024).
Despite the alleviation of pressure on government’s ability to distribute health care services through donor-aided projects, significant difficulties remain in providing equal health care across the three regions of the country. According to IHS5, over 50 percent of the population believes health care provision is inadequate, with 56 percent of the rural population expressing dissatisfaction with the health system. This dissatisfaction is somewhat lower in urban areas but still concerning, as 34 percent of the population is not satisfied with the health system. Notably, 57 percent of female household heads characterized the country’s health care as ‘inadequate’ based on their nearest access points, (IHS5, 2020).
The availability of essential medications or lack thereof, is a major contributing factor to the inadequate health care offered to the general public. In 2020, Abu, Ugbede-Ojo Ojonugwa’s paper on “Availability of essential medicines in Malawi’ public health facilities: Enablers and Barriers” highlighted major shortages in essential medicines for HIV and AIDS, Malaria and family planning.
His research found that only 7 percent of the health facilities across the country were stocked with all essential medications. “The shortage of some life-saving essential medicines in Malawi’s public health facilities has dire consequences for the national health system, with significant impact on the most vulnerable population, women and children,” wrote Abu, Ugbede-Ojo Ojonugwa.
It is evident that the lack of firm and accountable governance is a major issue, disrupting the civil service apparatus from the highest offices to the most basic workers.
However, the government of Malawi has also played a key role in in striving to achieve Universal Health Care (UHC). Recognizing that health care outcomes are affected by factors such as gender, wealth, geography and educational status, the government, through the Ministry of Health, implemented the Health Sector Strategic Plan II (HSSP II), a five-year plan aimed at accommodating the population through strategies such as health maximization, prioritizing essential health services under a constrained financial plan. Services such as maternal and reproductive health were prioritized.
Equity is also a key aspect in the HSSP II. “Interventions targeting women and children under-five were prioritized. Additionally, if an intervention was easily delivered at community level, thereby largely targeting rural populations this was also considered,” (HSSP II, 2017). This aspect is crucial as it helps those who cannot afford paid health care services.
Although Malawi achieved most of its Millennium Development Goals under health in 2016, it is impossible to ignore the high levels of disapproval by a growing population demanding easy access to consistently available health care. The 20 million Malawians have the right to access the health care they need.