Persistent funding gaps keep haunting Malawi’s donor-dependent healthcare sector amid donor fatigue. Our News Analyst WYCLIFFE NJIRAGOMA engaged Parliamentary Health Committee chairperson Anthony Masamba on the need to strengthen service delivery and oversight. Excerpts:
Q: Malawi Government’s healthcare spending remains around 9.1 percent of the national budget, far below the 15 percent Abuja target, while more than 80 percent of sector resources come from development partners. What does this say about the sustainability of the life-saving sector?
A: Reliance on external partners for over 80 percent of health financing exposes the system to shocks when donor priorities shift. This is unsustainable and Parliament is pressing for reforms that can expand domestic revenue through earmarked funds, taxes and improved efficiency in public spending so that Malawi gradually strengthens its own capacity to finance health services.
Q: In view of ongoing aid, what assurances can Parliament give an ordinary Malawian that essential services such as HIV programmes, medicines supply and primary healthcare will not be disrupted?
A: Our committee is working closely with the Ministry of Health to ring-fence critical programmes such as HIV and Aids, TB, malaria, sexual reproductive health, newborn and child health and primary healthcare in the budget. The committee’s oversight role will foster accountability and transparency in ensuring procurement of medicines and frontline services remain top priorities. While external support is declining, we are advocating for contingency allocations and stronger accountability mechanisms to safeguard continuity.
Q: In the national budget ending this month, health facilities assisted about 26.1 million outpatients, yet many facilities continue to face shortages of medicines, equipment and health workers. Are the proposed allocations sufficient to match this rising demand?
A: The allocations are not fully sufficient. Demand is rising faster than resources and shortages of medicines and staff remain evident. The health committee is pushing for incremental increases in healthcare spending and better targeting of funds to frontline facilities, so that resources match the actual burden of disease and patient volumes.
Q: The country recorded at least 21 deaths per 1 000 admitted patients, with significantly higher rates reported in central and district hospitals. What do these figures say about the effectiveness of the country’s referral system and critical care services?
A: These figures highlight weaknesses in both referral pathways and critical care capacity. The committee recognises that many district hospitals lack adequate equipment and trained personnel, leading to preventable deaths. We are, thus, advocating for investments in intensive care units, emergency transport and stronger referral protocols to improve outcomes.
Q: The Ministry of Health is piloting integrated care models that combine HIV and Aids, non-communicable diseases, tuberculosis and mental health services, but implementation remains limited to a few districts. What role is Parliament playing to ensure such reforms move beyond trials?
A: Parliament is pushing for nationwide scale-up by demanding that pilot results be translated into policy and budget commitments. Through oversight, we are embedding integrated care—combining HIV and Aids, NCDs, TB and mental health—in the Health Sector Strategic Plan, not left as isolated experiments.
Q: What is your take on official data which shows that only 44 percent of health facilities have adequate sanitation services and just 27 percent have functional hygiene facilities?
A: This is unacceptable and our committee is pressing for minimum standards in all health facilities, with sanitation and hygiene prioritised in capital budgets. Importantly, we welcome the President’s Executive Order on Sanitation (2026), which mandates urgent improvements in public places, schools and workplaces to combat cholera and other waterborne diseases. We will see to it that this directive is enforced within health facilities and demand stronger collaboration with local councils to integrate water and sanitation infrastructure into health planning.
Q: What are you doing to ensure private health facilities, which contribute significantly to service delivery, consistently report data into national health information systems?
A: Parliament could consider stronger measures to ensure private sector transparency and accountability. Existing frameworks already address malpractice. For example, Executive Order No. 1 of 2026 bans public health workers from owning private clinics or pharmacies to reduce conflicts of interest. To strengthen accountability further, Parliament could explore amendments to the Public Health Act or new regulations under the Ministry of Health to make reporting into the national health information system mandatory. This would improve data quality, enhance national planning, and ensure that private sector contributions are aligned with public health priorities.
