HEALTH CARE DELIVERY SYSTEM

IN MALAWI

PRESENTED TO: CMA CLASS

PRESENTED BY: A.LABANA
DATE: 13/02/2024
 BROAD OBJECTIVES

To equip students with knowledge on levels of

health care delivery system, their roles and
functions.

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 SPECIFIC OBJECTIVES

• Explain the three levels of health care delivery

system in Malawi
• Describe the components of essential health
package
• Describe the composition of health care services
provision in Malawi

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 Health system in Malawi
• It comprises the public, private-for-profit (PFP)
and private not-for-profit (PNFP) sectors, the
largest of the latter being the Christian Health
Association of Malawi (CHAM). 77% of health
services are either free or at a subsidized cost.

• Public sector (government) provides 48% of

health services, which are free of charge.
 Health system in Malawi
• PNFP facilities provide 29% of health services at a
subsidized cost, with malaria treatment services
being offered at no cost in CHAM facilities (16% of
PNFPs).

• The private sector, which charges a non-subsidized

fee, serves 24% of the population.

• Health services are delivered through three levels of

care, namely: primary, secondary and tertiary.
 Public sector
• Government departments that provide public services
are:
• The Ministry of Health (MOH)
• District, town and city councils,
• Ministry of Defence and Ministry of Internal
Affairs and Public Security (Police and
Prisons).
• These departments work in collaboration with the
MOH; however respective funding is planned and
disbursed individually.
 Public sector
• Patients enter into the system at the first tier
(primary) and flow to higher tier facilities
(secondary, tertiary) as needed.

• Medical supplies and human resources, however,

flow in the opposite direction.

• The already limited resources are first allocated to

the top tier facilities, leaving the second and third
tier facilities with little to no resources.
 MALAWI’S HEALTH CARE DELIVERY
SYSTEM

• Malawi’s health care delivery system is

organised at three levels namely primary,
secondary and tertiary

• These different levels are linked to each

other through an elaborate referral system
that has been established within the health
system 8
 PRIMARY-LEVEL OF HEALTH CARE
• The primary level of health care consists of
community initiatives, health posts, dispensaries,
maternities, health centres, outreach clinic and
community and rural hospitals

• At community level health services are provided by

a network of community-based cadres such as HSAs,
community based distributing (Family planning)
agents and other volunteers from NGOs mostly
• Each HSA is responsible for about 1000 people 9
 PRIMARY-LEVEL OF HEALTH CARE
continued

• HSAs play an important role in the establishment

of VHCs. The functionality of these committees
also depends on the commitment of the HSAs
• HSAs are mainly involved in promotive and
preventive health services
• Services at this level are conducted through door-
to-door visitations, village clinics, mobile clinics, or
at manned or unmanned health posts/centres
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 PRIMARY-LEVEL OF HEALTH CARE
continued
VILLAGE HEALTH COMMITTEE (VHC)
A village health committee is a means of promoting PHC
activities through community participation
The functions of the VHCs are as follows:
a) Helping raising the standard of sanitation in the community;
b) Reporting to the health workers all health related problems
in
the community bridging the community and the health
workers;
c) Mobilising the community members to participate in health
promotion activities and assisting the health workers to carry
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 Primary health care
• At the primary level (third tier), hospitals have
holding beds, post-natal beds, holding wards,
and are able to provide outpatient, maternity,
and antenatal services.

• If the patient's condition is considered to be

too critical for primary care facilities to handle,
they will be referred to the next level of the
healthcare system.
 SECONDARY LEVEL HEALTH CARE

• The secondary level, consisting of district hospitals

and CHAM hospitals

• District hospitals constitute secondary level of health

care, are referral centres for health centres and they
also service the local town population offering both
inpatient and outpatient services.

• Mainly supports the primary level by providing

surgical backup services, mostly for obstetric
emergencies, and general medical and paediatric 13
 SECONDARY LEVEL OF HEALTH CARE
continued

• The district or CHAM hospitals provide general

services, PHC services and technical supervision to
lower units in the district.
• District hospitals also provide in service training for
health personnel and other support to community
based health programmes in the provision of EHP
• Some of these hospitals also provide some specialized
health care
• Health services at secondary level are managed by the
District Health Management Team (DHMT) headed by
the Director of Health and Social Services (DHSS). 14
 TERTIARY LEVEL OF HEALTH CARE
(HOSPITALS)
• In Malawi Central Hospitals were set up to provide
specialist health services.
• In practice, however, they predominantly provide
EHP services which should be the responsibility of
district health facilities (district hospitals, health
centres and below).
• They are different from district hospitals in that they
provide specialist referral care for their respective
regions.
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• Specialist hospitals offer very specific services
such as mental health services and inpatient
care for Tuberculosis.
• There are currently 5 central hospitals namely
Queen Elizabeth in Blantyre, Kamuzu in
Lilongwe, Mzuzu in Mzimba and Zomba central
Hospital in Zomba and mental hospital in zomba
• All the central hospitals are also teaching
hospitals.
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 Essential Health Package Component
• Prevention and treatment of vaccine preventable
diseases.
• Malaria prevention and treatment
• Reproductive and neonatal health interventions
(including reproductive health, family planning, safe
motherhood and PMTCT)
• Prevention, control and treatment of Tuberculosis.
• Management of Acute Respiratory Infections.
• Prevention, treatment and care for Acute Diarrhoeal
Diseases (including cholera)
 Essential Health Package Component ct..

• Prevention and treatment of sexually transmitted

infections (HIV/AIDS, ARVT andVCT)
• Prevention and treatment of Shistosomiasis and
related complications
• Prevention and management of Malnutrition,
Nutrition deficiencies, and related complications
• Management of eye, ear and skin infections.
• Treatment for common injuries.

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 REFERENCES
1. Malawi Government (2009) Malawi swap programme of
work ii. Ministry of health

2. Nicole Rudner (2011) German Financial Cooperation with

Malawi SWAP II and Results based financing (RBF).Study on
the alignment of financial mechanisms.KfW Development
Bank

3. Global Fund to fight against AIDS, Tuberculosis and Malaria

(2020); Malawi Funding Request Malaria 2020

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