Funding cuts have disrupted HIV prevention services in Malawi, leaving stocks of pre-exposure prophylaxis (PrEP) tablets undelivered, suspending voluntary medical male circumcision services and contributing to a 16 percent decline in HIV testing.
The disruptions have exposed the vulnerability of Malawi’s HIV response, which relies heavily on external financing to support community-led interventions, particularly among vulnerable and hard-to-reach populations.
The revelations emerged in Lilongwe yesterday during the opening of a two-day national dialogue involving government, civil society organisations (CSOs), development partners and other stakeholders, which is exploring ways of financing community healthcare services through domestic resources.
UNAids country director David Chipanta said the changing global financing landscape was already affecting the ability of CSOs to complement government efforts in delivering essential healthcare services.
system. | Wycliffe Njiragoma
“HIV testing, for example, has declined by between 15 and 16 percent, while some prevention interventions have stopped because of inadequate funding for community-level service delivery,” he said.
Chipanta also cited stocks of PrEP tablets that remain undelivered due to a shortage of community workers and the suspension of voluntary medical
male circumcision services as evidence of the impact of funding cuts.
He warned that continued
disruptions could reverse gains made in the national HIV response, arguing that health facilities alone cannot effectively reach people who default on treatment or mobilise communities to access available services.
Meanwhile, stakeholders are pushing for a social contracting framework that will allow government to use domestic public funds to formally engage and finance NGOs and community-based organisations to deliver essential health interventions.
Chipanta said Malawi could build on its experience with healthcare service agreements involving the Christian Health Association of Malawi (Cham) to develop a broader framework.
Civil Society Advocacy Forum
vice-chairperson Simon Sikwese said although some funding remained available through the Global Fund, it reached only a limited number of organisations, leaving many community-based initiatives without reliable support.
He said the funding crisis was particularly concerning because community-led organisations reached populations that conventional public health systems often struggled to serve, including key populations, young people, girls and marginalised communities.
Sikwese said CSOs were asking government to establish a formal system
for channelling public resources through grants and sub-grants to NGOs and community-based organisations delivering essential healthcare services.
He cited the National Aids Commission (NAC) grant-making system, the HIV Prevention Act and the Public Procurement and Disposal of Assets Act as existing institutional and legal foundations that could support the proposed arrangement.
However, NAC acting chief executive officer Tione Chilambe said the biggest obstacle was the limited availability of public resources amid competing national priorities.
“The resource envelope is not enough even for government core business,” she said.
Chilambe challenged CSOs to diversify their funding sources by engaging the private sector, arguing that businesses had an interest in supporting healthy communities and a productive workforce.
She cited the CCAP Livingstonia Synod Aids Programme as an organisation that mobilises resources through relationships with churches abroad to support interventions targeting HIV, girls and substance abuse.
Malawi’s HIV response has for long relied heavily on external financing, which accounted for 78 percent of the national response in 2022, with the United States Government contributing about 60 percent of the HIV budget, according to published assessments.
The withdrawal and suspension of US support since January 2025, alongside an eight percent reduction in the Global Fund grant, have since intensified pressure on community-led interventions.
