Malawi’s health budget may look impressive on paper but it still fails to meet costed needs and remains far behind regional and international benchmarks essential for quality care.
In the current financial year, government increased its health sector budget to K768 billion from K550 billion in 2024/25, marking a nominal and real increase of 40 per cent and 10 per cent, respectively.
But this increase, according to Unicef’s 2025-2026 Health Budget Brief, is still not enough and makes little difference to the country’s ability to reach minimum investment levels required for a functional health system.
The brief states that the 2025/26 health budget, in per capita terms, translates to $21 (about K37 000), which is way below the country’s Health Sector Strategic Plan target (HSSP) III of $78.70 (about K138 000).
The budget is also far beneath the World Health Organisation (WHO) minimum recommended per capita investment for low-income countries (LICs) which stands at $86 (approximately K151 000).
Unicef further notes that even when off budget resources are added, the figure reaches only $40 (about K70 000), which remains well below global expectations for basic health system performance.
The brief states that although at 9.5 percent of the national budget, the sector has received the second largest share after education (16.6 percent), it still misses the Abuja target of 15 percent set for African governments.
According to Unicef, these persistent gaps demonstrate that the increased budget still does not provide sufficient investment to meet the country’s costed health needs.
The nominal increase of 40 percent, the brief states, is primarily driven by a 97 percent increase in the budget for other recurrent transactions (ORT) under the Ministry of Health, mainly under the medical supplies budget line, which has been increased by 158 percent from K22 billion in last year’s budget to K58 billion in the current budget.
“Going forward, the government is encouraged to sustain health spending towards the $86 per capita investments and Abuja targets,” futher reads the brief.
However, Unicef notes that total expenditure by the ministry and subvented health organisations was generally in line with approved estimates.
Malawi Health Equity Network (Mhen) executive director George Jobe, while commending the increase in the health budget line, agreed with Unicef that the current level of investment remains below the real health needs and benchmarks.
Jobe observed that the country’s per capita health spending confirms a sizeable financing gap that continues to constrain progress toward achieving the Universal Health Coverage (UHC).
“Low investment limits the availability of essential medicines, affects health worker recruitment, weakens infrastructure such as construction of more health facilities to check long distance some communities cover to reach their nearest health facilities,” said Jobe.
He stressed that the current level of investment was slowing down the country’s ability to meet the Sustainable Development Goals (SDG) health targets, many of which remain off track.
He further described as a serious health concern Unicef’s projection that over 70 percent of health facilities will still experience recurrent stockouts.
But Jobe observed that increasing financing without parallel improvements in accountability and supply chain management would not solve the chronic stockouts.
National Alliance of Patient Organisations in Malawi (Napom) chairperson Samuel Kumwanje said while they commend the health budget adjustment, their expectation is to see an improvement in everything.
“We expect the availability of essential medicines and equipment to improve in all public health facilities including the rural areas and also reduce out-of-pocket expenses for patients,” said Kumwanje, who is also chairperson of the Kidney Foundation Association.
When contacted, Secretary for Health Dan Namarika referred Weekend Nation to the ministry’s spokesperson Adrian Chikumbe who did not respond to our inquiry on the issues raised in the Unicef’s brief.
But chairperson of the Parliamentary Committee on Health Anthony Masamba observed that the Unicef’s brief had raised valid and timely concerns which align with what they had observed in parliamentary oversight.
Masamba said: “While commendable progress has been made, the brief rightly warns that these gains remain fragile and far above the SDG Three targets.
“As chair, I welcome Unicef’s emphasis on sustainability and efficiency. Their call for stronger domestic resource mobilisation, protection of frontline services, and alignment of partner financing with HSSP III priorities resonates with our committee’s mandate.”
Masamba added that his committee views Unicef’s assertions not as criticism but as constructive guidance to sharpen their oversight role and ensure fiscal pressures do not erode essential health gains.
However, the chairperson stressed the increase in the budget line does not guarantee improved service delivery.
He said to ensure the 158 percent rise in medical supplies translates into real improvements at facility level, there is need to, among others, strengthen budget credibility oversight and ring-fence allocations.
“We will demand quarterly execution reports from the Ministry of Health and Ministry of Finance, ensuring disbursements match approved allocations within the ±5 percent credibility threshold,” said Masamba, a former journalist.
He said through such measures, his committee would ensure the budget increase is not just a figure on paper but a tangible improvement in drug availability and patient care across the country’s health facilities.
