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The health care system

Health services in Malawi are provided by public, private for profit (PFP) and private not for profit (PNFP) sectors. The public sector includes all health facilities under the Ministry of Health (MOH), district, town and city councils, Ministry of Defence, Ministry of Internal Affairs and Public Security (Police and Prisons) and the Ministry of Natural Resources, Energy and Mining (Ministry of Health, 2008b). Public provision of health care is enshrined in the republican constitution which states that the State is obliged “to provide adequate health care, commensurate with the health needs of Malawian society and international standards of health care(Ministry of Justice, 2006).


Health services in the public sector are free-of-charge at the point of use. The PFP sector consists of private hospitals, clinics, laboratories and pharmacies. Traditional healers are also prominent and would be classified as PFP. The PNFP sector comprises of religious institutions, non-governmental organisations (NGOs), statutory corporations and companies. The major religious provider is the Christian Health Association of Malawi (CHAM) which provides approximately 29% of all health services in Malawi (MSPA 2014). Most private and private-not-for-profit providers charge user fees for their services. Table 1 shows the distribution of health facilities by type and ownership.

Table 1: Health facilities offering free services in Malawi

Facility Type CHAM Government NGO Private Total
Dispensary 4 49 4 30 87
Health Centre 107 413 4 18 542
Health Post 18 132 2   152
Hospital 38 45 1 1 85
Outreach 968 4,008 43 71 5,090
Village Clinic   3,542     3,542
Total 1,135 8,189 54 120 9,498

Source: UNICEF Health Facility Mapping Report (2016)

Malawi’s health system is organized at four levels namely: community, primary, secondary and tertiary. These different levels are linked to each other through an established referral system. Community, Primary and Secondary level care falls under district councils. The District Health Officer (DHO) is the head of the district health care system and reports to the District Commissioner (DC) who is the Controlling Officer of public institutions at district level.

Community level

At community level, health services are provided by health surveillance assistants (HSAs), health posts, dispensaries, and maternity clinics. Eash HSA is meant to be responsible for a catchment area of 1,000 and there are currently 7,932 HSAs supported by 1,282 Senior HSAs in post. HSAs mainly provide promotive and preventive health care through door-to-door visitations, village and outreach clinics and mobile clinics (Ministry of Health, 2011).

Primary level

At primary level, health services are provided by health centres and community hospitals. Health centres offer outpatient and maternity services and are meant to serve a population of 10,000. Community hospitals are larger than health centres. They offer outpatient and inpatient services and conduct minor procedures. Their bed capacity can reach up to 250 beds (Ministry of Health, 2011).

Secondary level

The secondary level of care consists of district hospitals and CHAM hospitals of equivalent capacity. Based on Table 6 in the HSSPII, secondary level health care facilities account for 9.5% of all health care facilities. They provide referral services to health centres and community hospitals and also provide their surrounding populations with both outpatient and inpatient services.

Tertiary level

The tertiary level consists of central hospitals. They ideally provide specialist health services at regional level and also provide referral services to district hospitals within their region.  In practice, however, around 70% of the services they provide are either primary or secondary services due to lack of a gate-keeping system (Ministry of Health, 2011).

Ministry of Health headquarters

The functions of the central level include policy making, standards setting, quality assurance, strategic planning, resource mobilization, technical support, monitoring and evaluation and international representation. Five Zonal Quality Management Offices (QMOs) are an extension of the central level and provide technical support to districts.

District Health Offices

The functions of the district health offices (DHOs) include: managing all public health facilities at district level and directing provision of both primary and secondary level health services at district level. DHOs report to District Commissioners who are under Ministry of Local Government. At technical level, DHOs
receive technical backstopping from Zonal Quality Management Office (QMDs) who are under the Ministry of Health.


MoH policy is that every Malawian should reside within an 8km radius of a health facility. The proportion of the population living within 8km radius of health facility (health centres and hospitals) stands at 90% in 2016, an increase from 81% in 2011. This indicates that there is still a proportion of the population that is underserved; especially those residing in the rural and hard to reach areas and 56% of Malawian adult women still cite distance to health facility as a key barrier to health access when they are sick.

Figure: Proportion of population living within 8km of a Health Centre or Hospital

Source: UNICEF Health Facility Mapping (2016)

Most of the health facility infrastructure across both Government and CHAM is dilapidated due to long periods of lack of maintenance.