National Health Policy “Towards Universal Health Coverage”

1.1. The National Health Policy The National Health Policy provides policy direction on key issues that are central to the development and functioning of the health system in Malawi. The Policy has been developed in line with the Constitution of the Republic of Malawi, which stipulates that the State is obliged “to provide adequate health care, commensurate with the health needs of Malawian society and international standards of health care” 1 . In this respect, the Constitution guarantees all Malawians the highest quality healthcare services within the limited resources available. The policy has also been developed in line with the Malawi Growth and Development Strategy (MGDS), an overarching development plan for Malawi that recognizes that a healthy and educated population is essential if Malawi is to achieve sustainable socio- economic growth. The Policy is also aligned to Sustainable Development Goals (SDGs). The Policy outlines a coordinated approach to be employed by the Government of Malawi to achieve the health sector goals, which are: to improve the health status of all Malawians; to ensure that the population is satisfied with the health services that they receive; and to ensure that the population does not suffer avoidable financial and social risks in the process of accessing health care at any level of the health care delivery system. The National Health Policy will be implemented through the following priority areas: Health Service Delivery; Preventive Health and Social Determinants for Health; Leadership and Governance; Health Financing; Human Resources for Health; Medicines, Medical Supplies, Medical Equipment and Infrastructure; Population Management; and Health Information and Research. The Policy will be implemented between 2018 and 2030 to align it with the SDGs implementation period and will be reviewed after every five years. .  1 Section 13 (c) of the Constitution of the Republic of Malawi. 1

1.2. Background Malawi’s Health Care System has four delivery levels, namely: community, primary, secondary and tertiary, with inter-level referrals as required. Formal care is provided by three categories of providers comprising: public, private-not-for-profit, and private-for- profit. The Government of Malawi through the Ministry of Health and Population is the largest provider of modern healthcare services followed by the Christian Health Association of Malawi (CHAM), followed by a large number of independent private health facilities. The Malawi Healthcare System uses the Essential Health Package (EHP) service delivery model. The first EHP was defined in 2000 with a core list of priority interventions to guide the allocation of scarce resources. Currently, the Government of Malawi through the Ministry of Health and Population has revised the package to be commensurate with health maximization principles, and to ensure equity, continuum of care and complementarity of services. Government provides free EHP services at point of delivery in public health facilities. Where there is no public facility within an 8km radius, but there is a CHAM facility, CHAM provides a package of preselected services for free at point of delivery through Service Level Agreements2. Based on the Local Government Act (1998) and the Decentralization Policy (1998), community, primary and secondary service delivery levels belong to the district health system, under the mandate of the councils, while the provision of care at tertiary service delivery level is the responsibility of the Ministry of Health and Population. During the Millennium Development Goals (MDGs) implementation period (2000-2015), Malawi made significant progress in improving health outcomes, primarily through increased access to essential health services leading to high population coverage. Although there have been increases in access to essential health care services, several key challenges that directly impact negatively on the achievement of health sector goals remain. Some of the challenges are: a) limited access to health care services, b) low quality of health  2 The recently revised Memorandum of Understanding between Government and CHAM provides for provision of free preselected services not only based on the 8 km radius but also takes into account population and difficulties in geographical access in CHAM facilities with less than 8 km radius from a publicfacility. 2 services that are on offer to clients, which directly leads to compromised effective care, and c) inefficiencies in the healthcare delivery system. The root causes of these challenges include: x Healthcare service provision does not adhere to the Essential Health Package principles, resulting in bloated lists of services that are available on paper but not in reality. x Increased preventable diseases/conditions, environmental and social risk factors that are directly impacting on health. x Leadership and governance challenges across the health sector and at all levels of the health system. x Insufficient health sector financial resources and inefficiencies in the allocation and utilization of the financial resources. x Human Resource for Health capacity challenges. x Unavailability, low quality and misuse of medicines and medical supplies. x Rapid population growth due to high fertility rates. x Low quality, inaccessible and non-standard information resulting in limited evidence-based decision-making. These challenges have been exacerbated by the lack of a coherent policy framework to guide implementation of the interventions in a coordinated manner in the sector.

1.3. Current Status Malawi has made great strides in improving health outcomes over the past decade. The maternal mortality ratio (MMR) declined from 984 per 100,000 live births in 2004 to 439 per 100,000 live births in 2016 while the infant mortality rate (IMR) decreased from 104 deaths per 1,000 live births in the year 2000 to 42 per 1,000 live births in 2016. The neonatal mortality rate has gone down from 42 deaths per 1,000 live births in the year 2000 to 27 deaths per 1,000 live births in 2016. The child mortality rate has decreased from 95 deaths per 1,000 live births in the year 2000 to 23 deaths per 1,000 live births in 2016, while the under-five mortality rate has gone down from 189 deaths per 1,000 live births in the year 2000 to 64 deaths per 1,000 live births in 2016. 3 There has also been remarkable progress in the fight against HIV and AIDS, with HIV prevalence decreasing from 16.4% in 1999 to 8.8% in 2016. Prevention of Mother to Child Transmission (PMTCT) was scaled up through Option B+ from 44% in 2010 to 80% in 2014. Mortality due to malaria has reduced, as demonstrated by a reduction in the malaria case fatality rate (CFR) from 100 per 100,000 in 2005 to 77 per 100,000 in 20153. These improvements in health outcomes have been attributed to huge investments in addressing access, such as construction of new health facilities particularly in rural areas, training of additional health workers, and improvements in the availability of essential medicines and equipment. Consequently, access to and utilization of health services have increased. There have also been successes in terms of improved availability and coordination of health financing, especially between 2004 and 2012. The SWAp Pool Fund led to greater availability and efficiency in the utilization of health care resources. As a result, Total Health Expenditure (THE) increased from US$18 per capita in 2004 to US$39 per capita in 2012 and rising minimally to US$39.2 in 2015. Despite these achievements, the health sector still faces many challenges. Mortality and morbidity among mothers and children is still unacceptably high; about 3 million Malawians are estimated to be living outside an 8km radius of a public or CHAM health facility; per capita health sector expenditure was at US$39.2 in 2015 which was less than half of what the WHO recommends for countries like Malawi4; and the proportion of health care expenditure incurred outside of the health sector plans has increased exponentially, causing coordination challenges on the health system. The available investment and capacity in human resources, infrastructure, equipment and supplies have failed to keep pace with the increased access and demand for health services brought on by a very high population growth rate, which has in turn led to a decline in quality of care. Client satisfaction has not been a priority for a long period of time in the health system. Government has, however, elevated issues of client care and satisfaction to be one of three main health goals of the Malawi health system. The establishment of the Quality  3 WHO 2016 World Malaria Report http://www.who.int/malaria/publications/worldͲmalariaͲreportͲ 2016/WMRͲ2016Ͳannexes.pdf 4 TheWHOrecommendsthatatleastUS$86mustbeavailableperheadindevelopinghealthsystems. 4 Management Directorate will result in issues of client care and safety being prioritized alongside issues of health status and financial risk protection. The Government realizes that these challenges cannot be addressed by isolated sub-sectoral policies. In this regard, the National Health Policy intends to concretize and build on the sustained gains that have been made over the years and will leverage and reinforce the implementation of health systems reforms to respond to the challenges that remain.

1.4. Problem Statement For many years, the health sector in the country has been guided by multiple, isolated sub- sectoral policy frameworks and strategic plans. This has resulted in uncoordinated approaches in addressing the challenges facing health service delivery. Fragmentation and insufficient policy coordination have contributed to incoherent responses to the health sector challenges and their root causes.

1.5. Purpose of the Policy The purpose of the National Health Policy is to provide a unified guiding framework for achieving the health sector goals of the country through addressing the identified key challenges and their root causes, thereby improving the functioning of the Malawi Health System. Addressing these bottlenecks will further position the country on the path to achieving the health-related targets within the Sustainable Development Goals. 5 CHAPTER 2: LINKAGES WITH OTHER POLICIES, LEGISLATION AND GUIDING PRINCIPLES

2.1 Linkages with other policies and legislation The Policy will operate in line with other existing legal and policy frameworks at both national and global levels as indicated in the following sub-sections.

2.1.1. Linkages with overarching national documents The National Health Policy has linkages with the following overarching national documents: The Constitution The Policy is aligned with the Constitution under Chapters III and IV. In section 13, the Constitution provides that: ‘The State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving (the goal of:) (c) Health - To provide adequate health care, commensurate with the health needs of Malawian society and international standards of health care’. Vision 2020 Vision 2020 is an overarching Policy document for the Government of Malawi. It outlines key strategic options for improving the health status of Malawians so that they can achieve better health via improved availability, accessibility and quality of healthcare services. It also recognizes the need to integrate traditional and alternative medicines in the modern healthcare system. Malawi Growth and Development Strategy The MGDS, as an overarching strategic document, identifies Health as one of the national priorities. The MGDS recognizes that a healthy and educated population is essential if Malawi is to achieve sustainable socio-economic growth. The Policy shall strive to uphold the vision to have ‘a healthy population that effectively contributes to the social and economic growth and prosperity of the country’. The Policy was developed at the same time as MGDS III was being developed. 6 Health Sector Strategic Plan II (2017-2022) The Health Sector Strategic Plan II (HSSP II) 2017-2022 is the health sector’s medium term strategic plan. It outlines objectives, strategies and activities of the health sector. The HSSP II will operationalize the National Health Policy.

2.1.2. Linkages with Legislation The Policy shall operate in a legal environment where other legislation touches on health issues and/or facilitates the delivery of healthcare services, as follows: Public Health Act (1948) The Public Health Act consolidates the law regarding the preservation of public health in Malawi. It addresses issues regarding infectious diseases and creates institutions for responding to emerging public health challenges. Local Government Act (1998) The Local Government Act (1998) consolidates the law regarding local government. It provides for health service delivery to be decentralized to district and city councils and empowers communities to be responsible for their own health and healthcare services. It also mandates the Ministry of Health and Population to be responsible for health-related policies, training and supervision. Medical Practitioners and Dentists Act (1987) The Act provides for the establishment of the Medical Council of Malawi, the registration and disciplining of medical practitioners and dentists, the regulation of training within Malawi of medical personnel, and generally for the control and regulation of the medical profession and practice in Malawi. Nurses and Midwives Act (1995) The Act establishes a Nurses and Midwives Council with the purpose of administering the certification, licensing and disciplining of nurses and midwives. 7 Pharmacy, Medicines and Poisons Act (1988) The Act provides for the establishment of the Pharmacy, Medicines and Poisons Board; the registration and disciplining of pharmacists, pharmacy technologists and pharmacy assistants; the training within Malawi of pharmacists, pharmacy technologists and pharmacy assistants; the licensing of traders in medicines and poisons, and for the control and regulation of the profession of pharmacy in Malawi in general. Public Private Partnership Act (2011) The Act provides for partnerships between the public sector and private sector for the supply of infrastructure and delivery of services as means of contributing towards sustaining economic growth, social development and infrastructure development. The Act also provides for the development and implementation of public private partnership arrangements in Malawi for the delivery of infrastructure and services. The PPPs proposed in this Policy are in line with this Act. Public Financial Management Act (2003) The Act fosters and enhances effective and responsible economic and. financial management by Government, including adherence to policy objectives; it provides accompanying accountability arrangements, together with compliance with those arrangements. The Ministry of Health and Population must, in compliance with this Act, ensure responsible economic and financial management of health sector resources, and must be accountable for the same. Further, the Ministry must produce a national health sector budget for the areas under its responsibility. Public Procurement Act (2003) The Act provides for the principles and procedures to regulate and to be applied in the public procurement of goods, works and services in Malawi, including in the health sector.

2.1.3. Linkages with other National Policies The Policy also has linkages with other national policies, some of which are: 8 National HIV and AIDS Policy The National HIV and AIDs Policy aims to facilitate evidence-based programming and strengthening of the National HIV and AIDS Response while recognizing the emerging issues, gaps, challenges and lessons learnt during the implementation of the first Policy. The Policy shall strive to provide good governance for effective National HIV and AIDS programming. Decentralization Policy The Decentralization Policy seeks to create a democratic environment and the institutions for governance and development at the local level that facilitate grassroots participation in decision making. The Decentralization Policy will support the district health systems (comprising community, primary and secondary service delivery levels) to accelerate efforts to achieve the health sector goals, which are: improving the health status of Malawians, providing adequate financial risk protection and improving client satisfaction. National Education Policy With regard to health, the National Education Policy advocates for the promotion of: school health; water, sanitation, and hygiene; HIV and AIDs; gender; and for the management of health training institutions. The Policy shall provide frameworks for implementing these programmes. National Nutrition Policy The Nutrition Policy seeks to promote evidence-based programming and strengthening of the national nutrition response. The NHP shall promote good sanitation and good hygiene practices, and address the management of malnutrition, undernutrition and overnutrition, and non-communicable diseases related to nutrition. National Gender Policy The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men, girls and boys at individual, household, and community levels for sustainable and equitable development. 9 Other Sectoral Policies The health sector has strong linkages with other social and sectoral policies as a crossing- cutting issue. These policies include the National Social Support Policy and the National Youth Policy.

2.2 Linkages with international instruments Malawi is a signatory to a number of international conventions and the policy took cognizance of the country’s international commitments. These include: Sustainable Development Goals (2016-2030) The SDG Goal number 3 aims to achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. This Policy also aims at achieving universal health coverage and SDG related health targets. The expected outcomes of this Policy are closely linked to the expected outcomes of the SDGs. Abuja Declaration 2001 The Abuja Declaration calls for governments in Africa to commit at least 15% of their total expenditure to health. The Policy also sets the 15% total public expenditure target towards health. Ouagadougou Declaration on Primary Health Care (PHC) and Health Systems (2008) The declaration sets a framework for African countries to achieve primary healthcare led health systems. The declaration has nine thematic areas, namely: leadership and governance for health; health services delivery; human resources for health; health financing; health information systems; health technologies; community ownership and participation; partnerships for health development, and research for health. The thematic areas proposed in this Policy are consistent with the Ouagadougou Declaration. Paris Declaration on Aid Effectiveness (2005). The Paris Declaration lays out a practical, action-orientated roadmap to improve the quality of aid and its impact on development. It puts in place a series of specific measures for 10 implementation and establishes performance indicators that assess progress. It also calls for an international monitoring system to ensure that donors and recipients hold each other accountable – a feature that is unique among international agreements. The National Health Policy has aid effectiveness and national ownership as key guiding principles.

2.3 Guiding Principles/Core Values The guiding principles/core values demonstrate government’s commitment to the attainment of equitable, accessible, affordable and sustainable high-quality evidence-based health care. The following are the guiding principles/core values for the National Health Policy: i. National Ownership and Leadership: In the interest of national development and self-reliance, and in fulfillment of the principles of aid effectiveness, all partners in the health sector shall respect national ownership of the Policy. To this end, Government leadership will remain central in guiding the implementation of the National Health Policy. ii. Primary Health Care: Provision of health services shall be based on the principle of Primary Health Care (PHC) as a basic philosophy and strategy for national health development. iii. Human Rights-Based Approach and Equity: All the people of Malawi shall have the right to good health, and equitable access to health services without any form of discrimination, whether it be based on ethnicity, gender, age, disability, religion, political belief, geographical location, or economic and/or other social conditions. iv. Gender Sensitivity: Gender mainstreaming shall be central in the implementation of this Policy. v. Ethical Considerations: The ethical requirements of confidentiality, safety and efficacy in both the provision of health care and health care research shall be adhered to. vi. Efficiency and Effectiveness: All stakeholders shall be expected to use available resources for health efficiently and effectively to maximize health gains. Opportunities shall be created to facilitate integration of health service 11 delivery to leverage efficiency and effectiveness in addressing the health needs of the people of Malawi. vii. Transparency and Accountability: Stakeholders shall discharge their respective mandates in a manner that is transparent and takes full responsibility for the decisions they make. viii. Inter-sectoral and Intra-Ministerial Collaboration: Collaboration shall be strengthened between Ministries, Departments and Agencies (MDAs), the private sector and Civil Society Organizations in the development and implementation of health and health-related policies and programmes. ix. Community Participation: Community participation shall be central in addressing the health needs of the people of Malawi. x. Evidence-based decision-making: All health interventions shall be based on proven and cost-effective national and international best practice. xi. Decentralization: Health service provision and management shall be in line with the Local Government Act (1998), which entails devolving district health service delivery to local government structures. xii. Appropriate Technology: Health care providers shall use health care technologies that are safe, appropriate, relevant and cost-effective. xiii. Public private mix: The Malawi healthcare system shall be run using both public and private structures. Public private partnerships will be promoted as means to ensure effective healthcare service delivery at all levels. 12 CHAPTER 3: BROAD POLICY DIRECTIONS

3.1. Policy goal The overall goal of the National Health Policy is to improve the health status of all Malawians, and to increase client satisfaction and financial risk protection towards the attainment of Universal Health Coverage5. Specifically, the Policy will have the following outcomes at population level:

3.1.1 Health Status Outcomes by 2030 i. Increased life expectancy at birth from 64 years in 2016 to 74 years. ii. Maternal mortality reduced from 439 deaths per 100,000 live births in 2016 to 70 per 100,000 live births. iii. Neonatal mortality reduced from 27 deaths per 1000 live births in 2016 to 12 deaths per 1000 live births. iv. Under five mortality reduced from 64 deaths per 1000 live births in 2016 to 25 deaths per 1000 live births. v. Stunting in under-fives reduced from 37% in 2015 to 20%. vi. Epidemics of malaria, tuberculosis, HIV/AIDS and NTDs reduced, and hepatitis, water-borne diseases and other communicable diseases combated. vii. Premature mortality from non-communicable diseases reduced by one third through prevention and treatment, and mental health well-being promoted. viii. Total fertility rate reduced from 4.4 children per woman in 2016 to 2.2 children per woman in 2030. ix. The number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination (including radiation) substantially reduced; x. The prevention and treatment of substance abuse strengthened, including narcotic drug abuse and harmful use of alcohol. xi. The mortality rate from cardio-vascular diseases amongst the population aged 35-60 years reduced from 12% in 2015 to 3%.  5 UniversalHealthCoverageisdefinedasensuringthatallpeoplehaveaccesstoneededhealthservicesof sufficient quality, while also ensuring that people do not suffer financial hardship. In Malawi, Universal HealthCoverageisintermsoftheEssentialHealthPackage(EHP). 13 xii. Reduced number of road traffic fatal injury deaths within 30 days, per 100,000 population, from 1019 in 2013 to 200. xiii. Suicide mortality rate reduced from 16% in 2015 to 5%. xiv. Significant socioeconomic, geographical, gender and disability related differences in critical health outcomes eliminated.

3.1.2. Client satisfaction outcomes by 2030 Proportion of population satisfied by the public health system increased from 85% in 2014 to 98%.

3.1.3. Financial risk protection outcomes by 2030 i. Proportion of out-of-pocket payment for health as a share of total health expenditure reduced from 10.8% in 2015 to 7%. ii. Proportion of the population covered by the National Health Insurance Scheme increased from 0 per cent in 2017 to 50%. iii. Percentage of Government of Malawi budget expenditure on health increased from 10.8% of the total budget in the 2017/18 financial year to at least 15% of the total Government expenditure in the 2029/30 financial year.

3.2. Policy Objectives The broad objectives of this policy are to: i. Improve service delivery by ensuring Universal Health Coverage of essential health care services, paying particular attention to vulnerable populations. ii. Promote preventive health at all levels of the health care system, reduce risk factors, and address social determinants of health. iii. Provide effective leadership and management that is accountable and transparent at national, and local authority levels. iv. Increase health financing equitably and efficiently and enhance its predictability and sustainability. v. Improve the availability of competent and motivated human resources for health for quality health service delivery that is effective, efficient and equitable. 14 vi. Improve the availability, accessibility and quality of health infrastructure, medical equipment, medicines and medical supplies at all levels of health care. vii. Slow down population growth to a sustainable level through voluntary and quality family planning services, the safe motherhood programme, and the provision of information and education. viii. Strengthen capacity in health research and health information system management for evidence-based policy making. 15 CHAPTER 4: POLICY PRIORITY AREAS The National Health Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives. The priority areas are: 1. Service delivery 2. Preventive health and social determinants for health 3. Leadership and governance 4. Health financing 5. Human resources for health 6. Medicines, medical supplies, medical equipment and infrastructure 7. Population management 8. Health information and research.

4.1. Policy Priority Area 1: Service Delivery Health services in Malawi are delivered through a variety of facilities, ranging from central hospitals providing tertiary care, to district hospitals, health centres and health posts, whose services range across secondary and primary health care levels, most of which are in the Essential Health Package (EHP). The EHP covers a variety of conditions and consists of promotion, preventive, curative and rehabilitative services that are likely to have the greatest impact on the majority of the population. However, health service delivery is faced with numerous challenges, including: poor access; low quality of services; an unresponsive health system; a shortage of ambulance vehicles and a poor referral system. Policy Statement Government will ensure that universal health coverage of essential health care services, especially to vulnerable populations, is attained. Strategies: i. Define specific packages of essential health services for tertiary, secondary and primary health facilities with a focus on health prevention and promotion; ii. Strengthen the prevention, management and control of EHP conditions; 16 iii. Strengthen implementation of evidence-based interventions to increase coverage and access to health services; iv. Develop and implement appropriate referral systems at all levels of the health care delivery system; v. Integrate delivery of health services; vi. Promote active community participation in the delivery of health services; vii. Strengthen partnerships with private health care providers, including those offering specialized services, to expand equitable access to essential health care; viii. Provide healthcare services to identifiable and legitimate beneficiaries; ix. Strengthen the provision of treatment, control and management of acute malnutrition for under-five children, pregnant and lactating women, adolescents and other vulnerable groups.

4.2. Policy Priority Area 2: Preventive Health and Social Determinants for Health The Government of Malawi recognises the fact that more than 50% of the diseases affecting the population are preventable. There is therefore need to place great weight on health prevention and promotion activities to reduce the burden of preventable, communicable and treatable diseases to a level of no public health significance in Malawi. This requires a fundamental shift of mindset from emphasizing the curative approach in disease management to addressing healthcare at the prevention stage. Prevention should be the cornerstone of every aspect of the health system and all the people of Malawi should be empowered to be active participants in self-care, the prevention of disease, and maintaining wellness. Additionally, the Government of Malawi should ensure that all government policies have integrated health related issues adequately, particularly on health prevention. Secondly, the conditions in which people are born, grow, work and socialize have an impact on their health and lead to inequities in health and health outcomes. Social determinants of health are not adequately addressed for the following reasons: limited capacity of individuals and communities to understand and manage social determinants of 17 health; limited respect for the rights of individuals and communities; inadequate resources, and weak inter-sectoral collaboration. Policy Statements a. Government will ensure that preventive and health promotion interventions are strengthened at all levels of the health care delivery system. Strategies: i. Ensure that health is integrated in all government policies; ii. Promote healthy behaviours and lifestyles at the individual and community levels; iii. Strengthen prevention and management of infectious diseases and non- communicable diseases including HIV and AIDs, malaria, TB and cancer; iv. Promote nutritional and food safety throughout the life-course; v. Promote water quality surveillance, good sanitation and hygiene practices through community led sanitation and sanitation marketing; vi. Promote the adoption of safe water and sanitation practices at individual and household levels; vii. Strengthen disaster, outbreak and epidemic preparedness and response; viii. Improve management and disposal of both liquid and solid waste; ix. Review cultural practices and discourage those that impact adversely on the population and development; x. Strengthen vector and vermin control at household, community and institutional levels. b. Government shall ensure policy coherence and effective multi-sectoral collaboration at all levels. Strategies: i. Promote inter-sectoral coordination in policy formulation and implementation at national and local authority levels; 18 ii. Strengthen mechanisms for addressing health inequalities and safeguarding human rights, including for women, youths, the elderly and other vulnerable persons; iii. Strengthen mechanisms for mainstreaming health issues in all related policies and programmes.

4.3. Policy Priority Area 3: Leadership and Governance Leadership and governance in building a health system involve ensuring that strategic policy frameworks exist and are combined with effective oversight, coalition-building, regulation, attention to system design and accountability. Setting and implementing a national health development agenda require robust leadership and governance structures at all levels of the health system. There are, however, a number of serious challenges in leadership and governance that are negatively impacting on service delivery and other health system functions. First, there is weak leadership and management of the health sector at all levels due to: inadequate capacity; weak coordination and reinforcement of policies and regulations; weak risk management; centralized decision making; and inadequate community empowerment. Secondly, there is weak coordination between GoM and health partners resulting in poor alignment of financing and programmes with national priorities, leading to fragmented implementation. There is inadequate joint planning and harmonization of GoM and health partner plans and budgets; weak procurement planning; parallel procurement by donors; and inadequate communication mechanisms among Government, donors and implementing partners at each level. Policy Statements a. Government will ensure that effective leadership, governance and accountability structures are in place and functional at all levels of the health care system. Strategies: i. Build and sustain leadership and management capacities in the health sector; ii. Reinforce adherence to, and implementation of, policies, guidelines and protocols to effectively guide the health system; iii. Enhance pro-active risk assessment and management; 19 iv. Strengthen financial, procurement and supply chain management at all levels; v. Strengthen effectiveness of regulatory bodies; vi. Ensure autonomy of providers at tertiary level; vii. Empower communities to provide effective oversight of the community health system in line with decentralization policies of Government; viii. Reform district health system policy guidelines in line with decentralization. b. Government will ensure that all health stakeholders are well coordinated, and are aligned to national and local authority health priorities. Strategies: i. Reinforce effective stakeholder coordination, government-led joint planning, implementation and monitoring and evaluation at national, and local authority levels; ii. Reinforce transparency, accountability and alignment of partner resources to national, and local authority processes and plans.

4.4. Policy Priority Area 4: Health Financing Health financing is concerned with how resources are raised, pooled and used in a health care system. Consequently, health financing challenges centre on resource mobilization, resource pooling and resource allocation. Specific challenges are: 1) Insufficient, unpredictable and unsustainable domestic and external health financing due to: a weak domestic revenue base; under-developed and under-utilized domestic private pools and resources; under-utilized and fragmented external health financing, and 2) Available domestic and donor resources are inefficiently and inequitably allocated and managed at all levels. Policy Statements a. The Policy will ensure that adequate domestic and international resources are sustainably, efficiently and equitably mobilized and managed at the national and local authority levels. 20 Strategies: i. Lobby for increased domestic tax-based financing for health care; ii. Develop and implement a universal and mandatory health insurance scheme with contributions from the formal sector and non-poor informal sector; iii. Promote optional supplementary health insurance schemes; iv. Continue providing optional paying services in central hospitals and roll them out to district hospitals; v. Promote efficient public private partnerships and corporate social responsibility; vi. Strengthen donor and partner coordination and alignment to national, and local authority priorities; vii. Promote pro-active mechanisms for mobilizing external resources; viii. Strengthen pooling and management of local and external sector resources at all levels of the health system; ix. Promote prudence, efficiency, transparency and accountability in the use of financial resources. b. The Policy will promote and reinforce equitable and responsive resource allocation, and efficient service-purchasing arrangements at all levels of health care. Strategies: i. Strengthen mechanisms for equitable and efficient allocation of health resources; ii. Institutionalize pay-for-performance initiatives at each level of care; iii. Institutionalize mechanisms to track health resources at national and local authority levels; iv. Reinforce implementation of the Essential Health Package (EHP) in line with available health sector resources; v. Enhance implementation of reforms to tackle inefficiencies at all levels of the health system.

4.5. Policy Priority Area 5: Human Resources for Health The Government of Malawi recognizes that sustaining gains made in the delivery of health care services requires robust and manageable strategies for the management of Human 21 Resources for Health (HRH). There are, however, key challenges in HRH that threaten to derail the progress that has been made in health service delivery. The major challenge identified in HRH is inadequate numbers of competent and motivated health workers at all levels due to: low and uncoordinated production; weak recruitment, deployment and retention processes; weak human resource management systems; poor health worker attitudes; low productivity; inappropriate skills mix allocation at health facilities; inadequate and uncoordinated continuous professional development; and a weak HRH regulation system. Policy Statement Government will ensure that sufficient numbers of competent, productive and motivated health workers are produced, recruited, deployed and retained in line with the health needs of the population at all levels of healthcare service delivery. Strategies: i. Strengthen stewardship and governance of HRH to ensure adherence to regulations and professional work ethics at all levels of the health system. ii. Institutionalize implementation of regular comprehensive HRH assessments and analyses to inform the development of periodic HRH production, recruitment and management strategies for the health sector. iii. Conduct periodic reviews of the establishment to analyse how it compares with the HRH needs. iv. Produce relevant numbers and cadres of health workers (pre-service) in line with projected needs and competency requirements for each level of the health care delivery system. v. Strengthen recruitment and deployment of HRH at service delivery level by allocating HRH skills mix based on facility type and sub-population needs. vi. Improve health worker motivation and retention, satisfaction and performance through implementation of innovative incentives and performance systems tailored to rural, peri-urban and urban area needs. vii. Strengthen human resources management systems at all levels by utilizing relevant electronic HR information systems to reduce inefficiencies in HRH management. 22 viii. Improve coordination of pre-service training through development of an annual HRH pre-service training plan, and enforce the use of relevant electronic information systems to track government scholarship beneficiaries and the enforcement of bonding requirements. ix. Improve the coordination of in-service training through the development of training plans at technical directorate level, using electronic information systems to track allocation and implementation of training.

4.6 Policy Priority Area 6: Medicines, Medical Supplies, Medical Equipment and Infrastructure The Government of Malawi recognizes that increased coverage of high-quality Essential Health Package (EHP) services is, to a large extent, dependent on the availability of quality essential medicines and medical supplies, adequate and safe medical equipment, and infrastructure that meets minimum standards. There are four main challenges that have been identified under this policy theme, as follows: 1) Limited availability of essential medicines and medical supplies due to persistent stock outs, leakages, inadequate financing, irrational prescriptions, weak regulation of complementary/alternative medicines, weak medicines research, and weak supply chain management systems; 2) Limited availability and poor quality of medical equipment due to: inadequate and ineffective procurement; weak procurement planning, coordination and management; inadequate resources; weak enforcement of standards; and theft of medical equipment; 3) Inadequate standardization of infrastructure, equipment, and medicines and medical supplies due to weak procurement management and regulation of donations; 4) Inadequate numbers and insufficient quality of health infrastructure relative to population needs due to: weak domestic financing; weak infrastructure procurement and management practices; weak planning, coordination and implementation of infrastructure plans; poor workmanship in construction and maintenance; and lack of scheduled and routine maintenance of infrastructure. 23 Policy Statements a. The Policy will ensure that safe, efficacious and cost-effective medicines and medical supplies are available at all times at each service delivery point, in line with the needs of the population and standards of care. Strategies: i. Strengthen the procurement of cost-effective medicines, medical supplies, vaccines, laboratory reagents and health technologies in line with the EHP; ii. Strengthen the distribution of medicines and medical supplies; iii. Promote rational prescription and use of medicines at all levels of health care; iv. Strengthen the security of medicines and medical supplies at all levels; v. Develop and enforce guidelines on the use of alternative medicines; vi. Promote the use of evidence-based complementary/alternative medicines; vii. Strengthen research on medicines. b. The Policy will facilitate the availability of safe, cost-effective and functional medical equipment at all service delivery levels at all times. Strategies: i. Strengthen management in the procurement of medical equipment; ii. Develop and enforce measures to eliminate theft of medical equipment; iii. Promote efficient utilization of medical equipment; iv. Strengthen the capacity of the Physical Assets Management Unit. c. The Policy will ensure that acquisition of infrastructure, medical equipment, medicines and medical supplies follows standardized criteria and health needs in line with the laid down standards and regulations. Strategies: i. Enforce adherence to Capital Investment Plan of the sector; ii. Enforce minimum standards for health infrastructure and medical equipment. 24 d. Government will ensure that every sub-population has access to a health facility offering quality EHP within a radius of 5km. Strategies: i. Improve quality and capacity of existing infrastructure; ii. Increase the number of health facilities based on need. e. The Policy will ensure that health infrastructure and medical equipment provided at a health facility are accessible by all, regardless of disability, gender, ethnicity, age, and other vulnerabilities. Strategy: Review and revise norms, guidelines and standards for health infrastructure and medical equipment to reflect the needs for all groups of people, including persons with disability, and children.

4.7 Policy Priority Area 7: Population Management Population influences all aspects of socio-economic development. Malawi`s population has grown from 4 million in 1966 to 13.1 million in 2008 and further to 14.8 million in 2012. The year 2017 population is estimated at 18.2 million. Malawi’s population is growing rapidly at 2.8 percent per annum mainly due to an extremely high fertility rate of about 4.4%. At the current population growth and fertility rates, it is estimated that the population will at least triple by 2050. Rapid population growth exerts pressure on the provision of social services such as education and health care, and it undermines efforts to preserve the environment, adapt to the consequences of climate change, and uplift the wellbeing of Malawians. High fertility is a key barrier to the socioeconomic empowerment of women, and a major contributor to high child and maternal mortality. Thus, Government’s overall goal on population embraces the demographic dividend framework and is consistent with the national development agenda of achieving sustainable development. The Government will primarily focus on managing the country’s unsustainably high rate of population growth through voluntary and quality family planning services. The Government will further support broader interventions in developing its 25 youthful population into a valuable resource for socioeconomic development through investments in education, innovation and entrepreneurial skills development, youth friendly reproductive and health services, and delayed entry into marriage and parenthood. Policy Statement The Policy will ensure that effective population management is provided through quality family planning services, the safe motherhood programme, and the provision of information and education to the youth. Strategies: i. Provide guidelines for the integration of population concerns into development plans at national, and local government levels; ii. Strengthen the design and implementation of the safe motherhood programme; iii. Strengthen the design and implementation of the Family Planning and Sexual and Reproductive Health programme (FP/SRH); iv. Promote behavioral change in issues of family planning and sexual reproductive health at the individual and community levels; v. Enhance collaboration with other public and private institutions in the provision of sexual and reproductive health services; vi. Institutionalize an information dissemination system on population and family planning issues.

4.8 Policy Priority Area 8: Health Information and Research Health information and research are important in supporting evidence-based decision- making at all levels of the health care system. One of the key challenges under this theme is weak national and local monitoring, evaluation and learning systems due to: parallel reporting mechanisms; poor quality of data; inadequate investments; weak planning and implementation of monitoring and evaluation (M&E) activities; and limited capacity to use data for decision making. Another challenge is that health decision making is informed by no or limited research due to: inadequate capacity for health research; inadequate resources for research; and non-adherence to the national health research frameworks and agenda. 26 Policy Statements a. The Policy will ensure that robust monitoring, evaluation and learning systems are in place and enforced at all levels of the health system. Strategies: i. Enforce alignment of all information management systems across the health sector to the national M&E framework; ii. Strengthen mechanisms for evidence-informed policy and decision making; iii. Strengthen adherence to data management standards; iv. Strengthen the feedback mechanism; v. Institutionalize mechanisms for monitoring of health policies, strategies and plans at all levels of the health system; vi. Strengthen effective planning and coordination of monitoring and evaluation activities in the health sector. b. Government will ensure that policy making in the health sector is informed by high quality research findings. Strategies: i. Strengthen local capacity to carry out policy relevant health research; ii. Enforce adherence to the national health research framework and agenda; iii. Strengthen mechanisms for the approval and monitoring of health research. 27 CHAPTER 5: IMPLEMENTATION ARRANGEMENTS

5.1. Institutional arrangements Issues of health attract the attention of a range of key stakeholders that include Government Ministries, Departments and Agencies, private sector organizations, development partners, civil society organizations, and non-governmental organizations. The role of key stakeholders in the implementation, monitoring and evaluation of the policy is therefore as follows: The Office of the President and Cabinet will be responsible for providing policy guidance, direction and monitoring the implementation of the policy. The Ministry of Health and Population will be responsible for providing oversight, strategic leadership, policy direction, coordination, resource mobilization, capacity building, quality management, disease surveillance and control, and monitoring and evaluation in the implementation of the National Health Policy. The Health Service Commission will be responsible for the recruitment and promotion of health workers and the setting of other conditions of service. The Health Sector Working Group will be responsible for enhancing coordination across multiple health sector stakeholders to avoid duplication of efforts. Health development partners will be responsible for co-funding, and aligning to, priority interventions. Health regulatory bodies will be responsible for registering professional health workers and ensuring health services are provided, following the highest possible ethical standards. The regulatory bodies are the Pharmacy, Medicines and Poisons Board (PMPB), Nurses and Midwives Council of Malawi (NMCM) and the Medical Council of Malawi (MCM). Health training and research institutions will be responsible for training health workers and conducting research. Some of these training institutions are the University of Malawi, CHAM training colleges, Staff Development Institute (SDI) and Malawi Institute of Management (MIM). 28 The Malawi Traditional Healers Umbrella Organisations will be responsible for the coordination of practices using traditional medicines or complementary alternative medicines. Ministry of Local Government & Rural Development will be responsible for the implementation of health and population interventions at the district and lower levels. Ministry of Finance, Economic Planning & Development will be responsible for ensuring adequate mobilization, and efficient and effective use of resources. It will be responsible for considering health projects in the Public Sector Investment Programme (PSIP). Ministry of Education, Science & Technology will manage health training institutions and implementation of the school health programmes. Ministry of Agriculture, Irrigation & Water Development will be responsible for development and implementation of policies and plans to ensure adequate, reliable and nutritious food supply. It will also be responsible for the provision of safe and potable drinking water to promote the health status of the population. Ministry of Gender, Children, Disability and Social Welfare will be responsible for promoting gender awareness. While mainstreaming knowledge about gender it will contribute to the prevention of sexual and gender-based violence, and any form of discrimination. It will also contribute to the promotion of sexual and reproductive health rights. Ministry of Natural Resources, Energy & Environment will be responsible for ensuring the safety of employees and communities working and living within and around the mines and other environmentally hazardous areas. Ministry of Labour, Youth, Sports & Manpower Development will facilitate occupational safety and health in workplaces, and reaching the youth with health messages. Ministry of Justice & Constitutional Affairs will facilitate the development and review of health-related legislation and regulations. 29 Ministry of Transport and Public Works (Buildings Department) will be responsible for guiding the construction of health buildings and the maintenance of roads, which are critical for effective patient referral and prevention of accidents. Directorate of Road Traffic and Safety Services will be responsible for ensuring that all road users are following laid down laws and regulations. Ministry of Civic Education, Culture & Community Development and the Ministry of Information & Communications Technology will ensure communication, information and civic education on issues related to the National Health Policy. Department of Human Resources Management & Development will be responsible for human resource planning, management and development. Department of Disaster Management Affairs will be responsible for adequate disaster preparedness interventions. Malawi Human Rights Commission will be responsible for ensuring health rights are respected. The Private Sector, including non-state actors, will contribute to the delivery of effective and high-quality essential health services. The Law Commission will be responsible for the revision and drafting of new health related legislation. Non-Governmental Organizations, Civil Society Organizations, Faith-Based Organizations and Traditional leaders will be responsible for advocating for increased resources to the health sector, and for delivering quality health services, acting as a bridge between Government and communities in ensuring that communities access quality health services. The Media will be responsible for promoting and disseminating health information.

5.2. Implementation Plan To ensure effective implementation of the policy, a detailed implementation plan has been developed and is attached as ANNEX 1. The plan provides a linkage between the policy goal 30 and objectives on one hand, and strategies and institutions responsible for implementing those strategies on the other hand. It also includes a timeframe for the implementation of each strategy.

5.3. Monitoring and Evaluation The implementation of the policy requires an effective and efficient monitoring and evaluation (M&E) system. The system shall provide the feedback information needed to identify implementation challenges and gaps. A detailed monitoring and evaluation plan for this policy, with appropriate performance indicators, outputs and targets is presented in ANNEX 2.

5.4. Implementation Costs The National Health Policy will be implemented by the five-year rolling Health Sector Strategic Plan. The cost of HSSP II for the first five period of the policy (2017/18-21/22) is estimated at $2,613 Million. The resources will be provided by Government, Donors and CSOs. 31

ANNEX 1: IMPLEMENTATION PLAN POLICY PRIORITY AREA 1: SERVICE DELIVERY Policy Statement: Government will ensure that universal health coverage of essential health care services, especially to vulnerable populations, is attained. Objective Strategy Responsibility/Stakeholders Time-frame Define specific packages of essential health MoHP, Ministry of Local Government & 2018-2030 To improve service delivery by services for tertiary, secondary and primary Rural Development (LGRD), Ministry of ensuring universal health Finance, Economic Planning & health facilities coverage of essential health care Development (MFEPD), DHOs, Central services, paying particular Hospitals, CHAM, private for profit health organizations, National AIDS attention to vulnerable Commission (NAC), Development populations. Partners Strengthen implementation of evidence- MoHP, MLGRD, Ministry of Transport 2018-2030 based interventions to increase coverage and Public Works (MoTPW), MFEPD, DHOs, Central Hospitals, CHAM, private and access to health services for profit health organizations, NAC, Implementing Partners Develop and implement appropriate referral MoHP, MLGRD, Ministry of Transport 2018-2030 system at all levels of health care delivery and Public Works (MoTPW), MFEPD, DHOs, Central Hospitals, CHAM, private system for profit health organizations, NAC, Implementing Partners. 32 Integrate delivery of health services MoHP, MLGRD, MoTPW, MFEPD, 2018-2030 DHOs, Central Hospitals, CHAM, private for profit health organizations, NAC, Implementing Partners. MoHP, MLGRD, DHOs, NGOs/INGOs 2018-2030 Promote active community participation in Private Health Sector Association, Health delivery of health services Service Commission, DPs, NAC. MoHP, MLGRD, MFEPD, DHOs, 2018-2030 Strengthen partnerships with private health Central Hospitals, CHAM, private for providers including those offering profit health organizations, BLM, Private specialized services, to expand equitable Sector Association, NAC. access to essential health care. National Registration Bureau, MoLGRD, 2018-2030 Provide health care services to identifiable MoHP. and legitimate beneficiaries MoHP, UN organizations, DHOs, 2018-2030 Strengthen provision of treatment, control Ministry of Agriculture, Irrigation & and management of acute malnutrition for Water Development, (MoAIWD), under-five children, pregnant and lactating CHAM, private for profit health women, adolescents and other vulnerable organizations, NAC. groups. 33 POLICY PRIORITY AREA 2: PREVENTIVE HEALTH AND SOCIAL DETERMINANTS FOR HEALTH Policy Statement a: Government will ensure that preventive and health promotion interventions are strengthened at all levels of the health care delivery system Objective Strategy Responsibility/Stakeholders Time-frame Promote healthy behaviours and lifestyles at MoHP, MLGRD, MFEPD, DHOs, 2018-2030 To promote preventive health at the individual and community levels Central Hospitals, CHAM, private for all levels of the health care profit health organizations, NAC, system, reduce risk factors and Development Partners address social determinants of Strengthen prevention and management of MoHP, MLGRD, MFEPD, DHOs, 2018-2030 health. infectious diseases and non-communicable Central Hospitals, CHAM, private for profit health organizations, NAC, diseases Development Partners Promote nutritional and food safety MoHP, MLGRD, MFEPD, DHOs, 2018-2030 throughout the life-course Central Hospitals, CHAM, private for profit health organizations, NAC, Development Partners Promote water quality surveillance, and MoHP, MLGRD, MFEPD, DHOs, 2018-2030 good sanitation and hygiene practices Central Hospitals, CHAM, private for profit health organizations, NAC, through community led sanitation and Development Partners sanitation marketing 34 Strengthen disaster, outbreak and epidemic MoHP, MLGRD, MFEPD, DHOs, 2018-2030 preparedness and response Central Hospitals, CHAM, private for profit health organizations, NAC, Development Partners Improve management and disposal of both MoHP, MLGRD, MFEPD, DHOs, 2018-2030 liquid and solid waste Central Hospitals, CHAM, private for profit health organizations, NAC, Development Partners Review cultural practices and discourage MoHP, MLGRD, MFEPD, DHOs, 2018-2030 those that impact adversely on population Central Hospitals, CHAM, private for profit health organizations, NAC, and development Development Partners Strengthen vector and vermin control at MoHP, MLGRD, MFEPD, DHOs, 2018-2030 household, community and institutional Central Hospitals, CHAM, private for profit health organizations, NAC, levels Development Partners Policy Statement b: Government shall ensure policy coherence and effective multi-sectoral collaboration at all levels. Objective Strategy Responsibility/Stakeholders Time-frame Promote inter-sectoral coordination in MoHP, MLGRD, MFEPD, DHOs, 2018-2030 To promote preventive health at policy formulation and implementation at Central Hospitals, CHAM, private for all levels of the health care profit health organizations, NAC, national and local authority levels system, reduce risk factors and Development Partners 35 address social determinants of Strengthen mechanisms for addressing MoHP, MLGRD, MFEPD, DHOs, 2018-2030 health. health inequalities and safeguarding human Central Hospitals, CHAM, private for profit health organizations, NAC, rights, including for women, youths, elderly Development Partners and other vulnerable persons Strengthen mechanisms for mainstreaming MoHP, MLGRD, MFEPD, DHOs, 2018-2030 health issues in all related policies and Central Hospitals, CHAM, private for profit health organizations, NAC, programmes Development Partners POLICY PRIORITY AREA 3: LEADERSHIP AND GOVERNANCE Policy Statement a: Government will ensure that effective leadership, governance and accountability structures are in place and functional at all levels of the health system. Objective Strategy Responsibility/Stakeholders Time-frame Build and sustain leadership and MoHP, MLGRD, DHOs, Central 2018-2030 To provide effective leadership management capacities in the health sector Hospitals, CHAM, professional and management that is associations in the health sector, MIM, accountable and transparent at DHRMD, OPC, SDI national, and local authority levels Reinforce adherence to, and MoHP, MLGRD, MFEPD, Ministry of 2018-2030 implementation of, policies, guidelines and Justice (MoJ), Ministry of Gender, Children, Disability & Social Welfare protocols to effectively guide the health (MGCDSW), Law Commission, Malawi system Human Rights Commission (MHRC), Medical Council of Malawi (MCM), 36 Nurses and Midwives Council of Malawi (NMCM), Pharmacy, Medicines and Poisons Board (PMPB), Health Donor Partners (HDPs), and Private health sector umbrella bodies. Enhance pro-active risk assessment and MoHP, MLGRD, MFEPD, MoJ, ICAM 2018-2030 management Strengthen financial, procurement and MoHP, MLGRD, MFEPD, Malawi 2018-2030 supply chain management at all levels Institute of Procurement and Supply (MIPS), Health Donor Partners Strengthen effectiveness of regulatory MoHP, MLGRD, MoJ, MCM, NMCM, 2018-2030 bodies PMPB, HDPs Ensure autonomy of providers at tertiary MoHP, MoJ, MFEPD, MLGRD, Law 2018-2030 level Commission, academic research institutions, Health Training Institutions (HTIs), Central Hospitals, DHOs. Empower communities to provide effective MoHP, MoJ, MFEPD, MLGRD, DHOs. 2018-2030 oversight of the community health system in line with decentralization policies of Government. 37 Reform district health system policy MoHP, MoJ, MFEPD, MLGRD, Law 2018-2030 guidelines in line with decentralization Commission, academic research institutions, Health Training Institutions (HTIs), Central Hospitals, DHOs. Policy Statement b: Government will ensure that all health stakeholders are well coordinated, and aligned to national, and local authority health priorities. Objective Strategy Responsibility/Stakeholders Time-frame To provide effective leadership Reinforce effective stakeholder MoHP, MLGRD, MFEPD, MoJ, Health 2018-2030 and management that is coordination, Government-led joint Donor Partners accountable and transparent at planning, implementation and monitoring national, and local authority levels and evaluation at national and local authority levels. Reinforce transparency, accountability and MoHP, MLGRD, MFEPD, MoJ, Health 2018-2030 alignment of partner resources to national Donor Partners and local authority processes and plans. POLICY PRIORITY AREA 4: HEALTH FINANCING Policy Statement a: The Policy will ensure that adequate domestic and international resources are sustainably, efficiently and equitably mobilized and managed at the national, and local authority levels. Objective Strategies Responsibility/Stakeholders Time-frame 38 Lobby for increased domestic tax-based MoHP, MLGRD, MFEPD, MoJ, Health 2018-2030 To increase health financing financing Donor Partners equitably and efficiently and enhance its predictability and Develop and implement a universal and MoHP, MLGRD, MFEPD, MoJ, Health 2018-2030 sustainability mandatory Health Insurance Scheme with Donor Partners, MRA, NSO, Ministry of Trade, Industry and Private Sector contributions from the formal sector and Development (MTIPSD) non-poor informal sector Promote optional supplementary health MoHP, MLGRD, MFEPD, MoJ, Health 2018-2030 insurance schemes Donor Partners, MRA, NSO, MTIPSD. Continue providing optional paying services MoHP, MoJ, MFEPD, MLGRD, Central 2018-2030 in central hospitals and roll them out to Hospitals, DHOs. district hospitals Promote efficient public private MoHP, MFEPD, MLGRD, MoJ, PPP 2018-2030 partnerships and corporate social Commission, Regulatory Bodies, MTIPSD, Malawi Investment and Trade responsibility Centre (MITC), CHAM, BLM, other private for profit organizations, and Private sector umbrella organizations. Strengthen donor and partner coordination MoHP, MLGRD, MFEPD, MoJ, Health 2018-2030 and alignment to national, and local Donor Partners, DHOs authority priorities Promote pro-active mechanisms for MoHP, MLGRD, MFEPD, Health Donor 2018-2030 39 mobilizing external resources Partners, DHOs Strengthen pooling and management of MoHP, MLGRD, MFEPD, Health Donor local and external sector resources at all Partners, DHOs levels of the health system. Promote prudence, efficiency, transparency MoHP, MLGRD, MFEPD, MoJ, Health 2018-2030 and accountability in the use of financial Donor Partners, DHOs, Health CSOs, ICAM, Malawi Law Society resources Policy Statement b: The Policy will promote and reinforce equitable and responsive resource allocation, and efficient provider-purchasing arrangements at all levels of health care. Objective Strategy Responsibility/Stakeholders Time-frame Strengthen mechanisms for equitable and MoHP, MLGRD, MFEPD, Health Donor 2018-2030 To increase health financing efficient allocation of health resources Partners, DHOs, Private Health equitably and efficiently and Organizations enhance its predictability and sustainability Institutionalize pay-for-performance MoHP, MLGRD, MFEPD, Health Donor 2018-2030 initiatives at each level of care Partners, MoJ, DHOs Institutionalize mechanisms to track health MoHP, MLGRD, MFEPD, Health Donor 2018-2030 resources at national, and local authority Partners, Households, Private Organizations, NGOs, Regulatory Bodies levels Reinforce implementation of the Essential MoHP, MLGRD, MFEPD, Health Donor 2018-2030 40 Health Package (EHP) in line with available Partners, DHOs health sector resources Enhance implementation of reforms to Office of President and Cabinet (OPC), 2018-2030 tackle inefficiencies at all levels of the Parliamentary Committees, MoHP, MLGRD, MFEPD, Health Donor health system Partners, MoJ, DHOs POLICY PRIORITY AREA 5: HUMAN RESOURCES FOR HEALTH Policy statement: Government will ensure that sufficient numbers of competent and motivated health workers are produced, recruited, deployed and retained in line with the health needs of the population at all levels of healthcare service delivery. Objective Strategies Responsibility/Stakeholders Time-frame To improve the availability of Strengthen stewardship and governance of MoHP, Regulatory bodies, MLGRD, 2018-2030 competent and motivated human HRH to ensure adherence to regulations and Training Institutions resources for health for quality professional work ethics at all levels of the health service delivery that is health system effective, efficient and equitable Institutionalize implementation of periodic MoHP, MLGRD, MFEPD, Health Donor 2018-2030 comprehensive HRH assessments and Partners, Dept of Human Resource Management & Development (DHRMD), analyses to inform the development of DHOs periodic HRH production, recruitment and management strategies for the health sector Conduct periodic reviews of the MoHP. MLGRD, Training Institutions, 2018-2030 41 establishment to match the HRH needs DHRMD Produce relevant numbers and cadres of MoHP, MLGRD, MFEPD, Health Donor 2018-2030 health workers (pre-service) in line with Partners, Training Institutions, DHOs, Regulatory Bodies projected needs and competency requirements for each level of the health care delivery system Strengthen recruitment and deployment of MoHP, MoEST, MLGRD, MGCDSW, 2018-2030 HRH at service delivery level by allocating DHRMD, MFEPD, Health Training Institutions, Regulatory bodies, and HRH skills mix based on facility type and private health sector sub-population needs Improve health worker motivation and MoHP, MoEST, MLGRD, MGCDSW, 2018-2030 retention, satisfaction and performance DHRMD, MFEPD, Health Training Institutions, Regulatory bodies, and through implementation of innovative private health sector incentives tailored to rural, peri-urban and urban area needs. Strengthen human resource management MoHP, MoEST, MLGRD, MGCDSW, 2018-2030 systems at all levels by utilizing relevant DHRMD, Health Training Institutions electronic HR information systems to reduce inefficiencies in HRH management Improve coordination of pre-service training MoHP, MoEST, MLGRD, MGCDSW 2018-2030 through development of an annual HRH 42 pre-service training plan, and enforce the use of relevant electronic information systems to track government scholarship beneficiaries and enforcement of bonding requirements Improve the coordination of in-service MoHP, MoEST, MLGRD 2018-2030 training through the development of training plans at technical directorate level and use of electronic information systems to track allocation and implementation of training POLICY PRIORITY AREA 6: MEDICINES, MEDICAL SUPPLIES, MEDICAL EQUIPMENT AND INFRASTRUCTURE Policy Statement a: The Policy will ensure that safe, efficacious and cost-effective medicines and medical supplies are available at all times at each service delivery point in line with the needs of the population and standards of care. Objectives Strategies Responsibility/Stakeholders Time-frame Strengthen the procurement of cost- MoHP, CMST, MFEPD, DHOs, Central 2018-2030 To improve the availability, effective medicines, medical supplies, Hospitals, Office of the Director of Public accessibility and quality of health Procurement (ODPP), Health Donor vaccines, laboratory reagents and health infrastructure, medical equipment, Partners technologies in line with the EHP medicines and medical supplies at all levels of health care. Strengthen the distribution of medicines and MoHP, CMST, MFEPD, DHO, Central 2018-2030 medical supplies Hospitals, ODPP, Health Donor Partners, 43 Private Warehouses and Distributors Promote rational prescription and use of MoHP, Central Hospitals, PMPB, DHOs 2018-2030 medicines at all levels of health care. Strengthen the security of medicines and MoHP, Central Hospitals, PMPB, DHOs 2018-2030 medical supplies at all levels. Develop and enforce guidelines on the use MoHP, Central Hospitals, PMPB, DHOs 2018-2030 of alternative medicines are in place and are adhered to. Promote the use of evidence-based MoHP, Central Hospitals, PMPB, DHOs 2018-2030 alternative medicine Policy Statement b: The Policy will ensure that safe, cost-effective and functional medical equipment is available at all service delivery points at all times. Objective Strategy Responsibility/Stakeholders Time-frame Strengthen management in the procurement MoHP, MFEPD, MIPS, DHOs, Central 2018-2030 To improve the availability, of medical equipment Hospitals, MoLGRD accessibility and quality of health infrastructure, medical equipment Develop and enforce measures to eliminate MoHP, Central Hospitals, DHOs, Malawi 2018-2030 and medicines and medical Police, MoLGRD theft of medical equipment supplies at all levels of health care Promote efficient utilization of medical MoHP, DHOs, Central Hospitals, 2018-2030 equipment MoLGRD 44 Strengthen the capacity of the Physical MoHP 2018-2030 Assets Management Unit Policy Statement c: The Policy will ensure that acquisition of infrastructure, medical equipment, medicines and medical supplies follow standardized criteria and health needs in line with the laid down standards and regulations. Objective Strategy Responsibility/Stakeholders Time-frame To improve the availability, Enforce adherence to Capital Investment MoHP, MFEPD, Department of 2018-2030 accessibility and quality of health Plans Buildings, DHOs, Central Hospitals, MoLGRD, Health Donor Partners infrastructure, medical equipment and medicines and medical Enforce minimum standards for health MoHP, MFEPD, Department of 2018-2030 supplies at all levels of health care infrastructure and medical equipment Buildings, DHOs, Central Hospitals, MoLGRD, Health Donor Partners, Malawi Institute of Engineers (MIE) Policy Statement d: Government will ensure that every sub-population has access to a health facility offering quality primary EHP within a radius of 5km. Objective Strategy Responsibility/Stakeholders Time-frame Improve the quality and capacity of existing MoHP, MFEPD, Department of 2018-2030 To improve the availability, infrastructure Buildings, DHOs, Central Hospitals, accessibility and quality of health MoLGRD, Health Donor Partners infrastructure, medical equipment and medicines and medical Increase the number of health facilities MoHP, MFEPD, Department of 2018-2030 supplies at all levels of health care Buildings, DHOs, Central Hospitals, based on need 45 MoLGRD, Health Donor Partners Policy Statement e: The Policy will ensure that health infrastructure and medical equipment provided are accessible by all, regardless of physical and mental challenges, gender, ethnicity, age and other vulnerabilities. Objective Responsibility/Stakeholders Time-frame Strategy To improve the availability, Review and revise norms, guidelines and MoHP, MFEPD, Department of 2018-2030 accessibility and quality of health standards for health infrastructure and Buildings, DHOs, Central Hospitals, infrastructure, medical equipment medical equipment to reflect the needs for MoLGRD, Health Donor Partners, MIE, FEDOMA, MGCDSW and medicines and medical all groups including people with physical supplies at all levels of health care and mental challenges, and children. 46 POLICY PRIORITY AREA 7: POPULATION MANAGEMENT Policy Statement: The Policy will ensure that effective population management interventions are provided through quality family planning services, the safe motherhood programme, and the provision of information and education. Objective Strategy Responsibility/Stakeholders Time-frame To slow down population growth Provide guidelines for the integration of MoHP, DHOs, Central Hospitals, 2018-2030 to a sustainable level through population concerns into development plans MoLGRD, Health Donor Partners, Health CSOs voluntary and quality family at national, and local government levels planning services, the safe motherhood programme and the Strengthen the design and implementation MoHP, DHOs, Central Hospitals, 2018-2030 MoLGRD, Health Donor Partners, Health provision of information and of the safe motherhood programme CSOs education. Strengthen the design and implementation MoHP, DHOs, Central Hospitals, 2018-2030 of sexual and reproductive health MoLGRD, Health Donor Partners, Health CSOs programmes Enhance collaboration with other public and MoHP, DHOs, Central Hospitals, 2018-2030 private institutions in the provision of MoLGRD, Health Donor Partners, Health CSOs sexual and reproductive health services Institutionalize an information MoHP, DHOs, Central Hospitals, 2018-2030 dissemination system on population and MoLGRD, Health Donor Partners, Health family planning issues CSOs, DoDMA 47 POLICY PRIORITY AREA 8: HEALTH INFORMATION AND RESEARCH Policy Statement a: The Policy will ensure that robust monitoring, evaluation and learning systems are in place at all levels of the health system. Objective Strategy Responsibility/Stakeholders Time-frame Enforce alignment of all information MoHP, DHOs, Central Hospitals, 2018-2030 To strengthen capacity in health management systems across the health MoLGRD, Health Donor Partners, Health research and health information CSOs sector to the national M&E framework system management for evidence based policy making. Strengthen mechanisms for evidence MoHP, DHOs, Central Hospitals, 2018-2030 informed policy and decision making MoLGRD, Health Donor Partners, Health CSOs Strengthen adherence to data management MoHP, DHOs, Central Hospitals, 2018-2030 standards MoLGRD, Health Donor Partners, Health CSOs Strengthen the feedback mechanism MoHP, DHOs, Central Hospitals, 2018-2030 MoLGRD, Health Donor Partners, Health CSOs Institutionalize mechanisms for monitoring MoHP, DHOs, Central Hospitals, 2018-2030 health policies, strategies and plans at all MoLGRD, Health Donor Partners, Health CSOs levels of the health system 48 Strengthen effective planning and MoHP, DHOs, Central Hospitals, 2018-2030 coordination of monitoring and evaluation MoLGRD, Health Donor Partners, Health CSOs activities in the health sector Policy Statement b: Government will ensure that policy making in health sector is informed by high quality research. Objective Strategy Responsibility/Stakeholders Time-frame Strengthen local capacity to carry out policy MoHP, MGCDSW, Central Hospitals, 2018-2030 To strengthen capacity in health relevant health research. DHOs, National Health Research Council, research and health information Health Regulatory bodies, CHAM, system management for evidence umbrella bodies for the private-for-profit based policy making. hospitals, HDPs, National Statistical Office, and HTIs. Enforce adherence to the national health MoHP, COM, all designated research 2018-2030 research frameworks and agenda. committees Strengthen mechanisms for the approval MoHP, COM, all designated research 2018-2030 and monitoring of health research committees 49

ANNEX 2: MONITORING AND EVALUATION PLAN POLICY PRIORITY AREA 1: SERVICE DELIVERY Outcome: Increased Universal Health Coverage of essential health care services Objective(s) Output(s) Performance Baseline Target Source(s) of Assumptions/ Indicator(s) Verification Risks Defined specific Percentage of health 54 100 Service Availability Availability of Improve service packages of essential facilities delivering and Readiness adequate resources delivery by health services for essential health services Assessment ensuring tertiary, secondary (disaggregated by levels Universal and primary health of care) Health facilities Coverage of essential health Increased use of Percentage of 24 90 MDHS Availability of care services, evidence-based households having full adequate resources paying interventions to ITN coverage particular improve coverage Percentage of children 76 100 MDHS Change of mind set attention to and access to health aged 12 to 23 months by the population vulnerable services that have received all populations essential vaccinations ART coverage 6 69% 90% HIV/AIDS Availability of Department adequate resources  6 %ofadultsandchildrenlivingwithHIVcurrentlyreceivingARTinaccordancewithnationallyapprovedtreatmentprotocols(WHO/UNAIDSstandards)among theestimatednumberofadultsandchildrenlivingwithHIV 50 An efficient referral Ratio of ambulances to 1 to 100,000 1 to 50,000 HTSS (PAM) Availability of system developed population adequate resources and functional at all levels Ratio of specialists to 0.025 per 10,000 1: 50,000 iHRIS Availability of population adequate resources Delivery of health Percentage of health 54 100 Service Availability Availability of services integrated facilities delivering and Readiness adequate resources essential health services Assessment (disaggregated by levels of care) Improved % functional Village N/A 1 per village District Health Full community Health Committees Reports decentralization is participation in adopted delivery of health services Strengthened % of SLAs - % of 63% 100% Dept. of Planning Availability of partnerships with CHAM/Private facilities and Policy adequate resources private health eligible for SLAs that Development providers including have signed an SLA with those offering DHO/MoHP specialized services, to expand equitable access to essential health care. 51 National Identity Percentage of public 0% 100% Dept. of Planning Cabinet approves Cards are used in health facilities and Policy Policy accessing public demanding production of Development recommendation health facilities National ID cards before accessing services Strengthened % of children ages 6-23 8% 50% Malawi Availability of provision of months who meet the Demographic Health adequate resources treatment, control minimum acceptable Surveys and management of dietary standards acute malnutrition for under-five children, pregnant % of under-fives who 37% 20% Malawi Availability of and lactating are stunted Demographic Health adequate resources women, adolescents Surveys and other vulnerable groups % of women aged 15-49 33% 15% Malawi Availability of who are anaemic Demographic Health adequate resources Surveys 52 POLICY PRIORITY AREA 2: PREVENTIVE HEALTH AND SOCIAL DETERMINANTS FOR HEALTH Outcome: Improved preventive health at all levels of the health care system, reduced risk factors, and improved social determinants of health Objective(s) Output(s) Performance Baseline Target Source(s) of Assumptions/ Indicator(s) Verification Risks National Health Number of National 13 15 National Health Availability of To promote Promotion and Health Promotion and Promotion and adequate resources preventive diseases health diseases health diseases health health at all campaigns campaigns conducted campaigns reports levels of the conducted health care system, reduce Planned Malaria % of Malaria control N/A 100% Programme Reports Availability of risk factors, and control campaigns campaigns undertaken adequate resources address social undertaken determinants of health. Increased number of % of household that treat 31% 80% MDHS Change of mindset households that treat water prior to drinking of the population water prior to drinking Increased number of % of household that 52% 90% MDHS Change of mindset households that have have improved toilets of the population improved toilet facilities facilities 53 Fewer children % of children who are 5% 2% MDHS Effective anti- under five who are obese overnutrition obese messages lead to a change of mindset Fewer women who % of women who are 21% 10% MDHS Effective anti- are obese obese overnutrition messages lead to a change of mindset POLICY PRIORITY AREA 3: LEADERSHIP AND GOVERNANCE Outcome: Improved functionality of national, and local governance structures Objective(s) Output(s) Performance Baseline Target Source(s) of Assumptions/ Risks Indicator(s) Verification Leadership and Proportion of Senior 0% 50% Health Sector Availability of To provide management Health Sector Managers Annual Report adequate resources effective capacities in the who have successfully leadership and health sector built undergone Management management and sustained & Leadership training that is each year accountable and transparent at Risk assessment Proportion of cost 0% 100% Annual Internal Willingness to foster national, and and management centres with risk Audit Report governance and local authority enhanced management and disaster accountability recovery plan 54 levels Strengthened Proportion of N/A 100% Procurement Report Willingness to foster financial, procurement handled governance and procurement and through government accountability supply chain procurement system management at all levels Percentage reduction in 0% 100% Financial and Willingness to foster financial and Procurement Audit governance and procurement audit Reports accountability queries Regulatory Percentage of planned N/A 100% Regulatory Bodies Availability of bodies standard monitoring Report adequate human strengthened visits conducted in a year expertise and financial resources All central Number of central 0 5 Annual Health Sustained willingness hospitals at hospitals with an Sector Reform to foster governance tertiary level autonomous Hospital Report and accountability attain autonomy Board in place Communities Percentage of functional N/A 100% Health Sector Full decentralization empowered to Village Health Annual Report provide effective Committees oversight of the community health system in line with decentralization policies of 55 Government. District Health Proportion of health 0% 100% Health Sector Full decentralization System Policy centres that have Annual Report Guidelines functional health facility developed in line management committees with decentralization policies POLICY PRIORITY AREA 4: HEALTH FINANCING Outcome: Increased percentage of public sector health expenditure as a share of total public expenditure Objective(s) Output(s) Performance Baseline Target Source(s) of Assumptions/ Indicator(s) Verification Risks Increased domestic Government 10.85% 15% NHA Report Availability of To increase tax-based financing expenditure on health adequate resources health financing for the health sector as percentage of total equitably and Government efficiently and expenditure enhance its predictability National Health Percentage of people 0% 50% NHIS Report Political will and and Insurance Scheme enrolled in NHIS adequate system sustainability established establishment Optional Number of people 0.01% 10% NHA Report Change of mind set supplementary enrolled in private by the population health insurance insurance schemes on insuring their 56 schemes promoted health risks Paying services Percentage of district 0% 100% Health Sector Annual Availability of established in hospitals operating Report adequate resources central and district paying services hospitals Public private Private expenditure as 17.5% 35% NHA Report Conducive partnerships a percentage of total environment for the established health expenditure private sector Donor and partner Proportion of donors 24% 100% Aid Coordination Framework for Aid coordination and partners with Reports Coordination in enhanced to ensure approved MoUs place alignment to national, and local authority priorities Pooling and Percentage reduction 40% 20% NHA Report Framework for Aid management of of fragmented pools of Coordination in local and external health resources place sector resources strengthened Pro-active Percentage increase in 0% 100% Department of Health Active seeking of mechanisms for number of health Research health research mobilizing external grants mobilized from grants resources promoted external resources Prudence, Percentage reduction 0% 100% Financial and Willingness to efficiency, in financial and Procurement Audit foster governance transparency and procurement audit Reports and accountability accountability in 57 the use of financial queries resources promoted Mechanisms for Revised allocation 0 1 Department of Availability of equitable and formula in place Planning and Policy technical and efficient allocation Development financial resources of health resources strengthened Pay-for- Guidelines for Pay-for- 0 1 Department of Availability of performance performance in place Planning and Policy technical and initiatives Development financial resources institutionalized Mechanisms to Conduct NHA and Once every two Once every 2 Department of Availability of track health Resource Mapping years years Planning and Policy technical and resources at biennially Development financial resources national, sub- national and local authority levels institutionalized Implementation of Number of packages 1 3 HSSP II Availability of the Essential Health approved and being adequate resources Package (EHP) in implemented line with available health sector resources reinforced Implementation of Number of reforms 1 3 Health Sector Annual Willingness to reforms to tackle tackling inefficiencies Report foster governance 58 inefficiencies being implemented and accountability reinforced POLICY PRIORITY AREA 5: HUMAN RESOURCES FOR HEALTH Outcome: Increased percentage of public and CHAM facilities with 100% establishment filled at primary level, 75% at secondary level, and 50% at tertiary level by 2030. Objective(s) Output(s) Performance Baseline Target Source(s) of Assumptions/ Indicator(s) Verification Risks Stewardship and Percentage reduction of 0% 50% Regulatory Bodies Availability of To improve the governance of HRH cases of professional adequate resources availability of strengthened misconduct competent and Change of mindset motivated of health workers human Periodic Number of HRH 0 3 HR Department Availability of resources for comprehensive assessment reports adequate resources health for HRH assessments produced quality health and analyses service delivery institutionalized that is effective, efficient and Relevant numbers Percentage of filled 48% 100% iHRIS Availability of equitable and cadres of health positions in priority adequate human workers (pre- health cadres expertise and service) are financial resources produced in line with projected needs and competency requirements for 59 each level of the health care delivery system Recruitment and Percentage of health 45% 100% iHRIS Availability of deployment of facilities with minimum adequate human HRH at service staff norms expertise and delivery level financial resources strengthened Motivation and Percentage reduction in N/A 80% iHRIS Adequate monetary retention of human staff turn over and non-monetary resource improved incentives are in through place implementation of Percentage of filled 48% 100% iHRIS Availability of innovative positions in priority adequate human incentives tailored health cadres expertise and to rural, peri-urban financial resources and urban area needs. Human resources Percentage of iHRIS N/A 100% iHRIS Availability of management reports produced adequate human systems expertise and strengthened at all financial resources levels Annual HRH pre- Annual HRH pre-service 0 1 HR Department Availability of service training training plan adequate resources plan developed, informed by relevant training 60 institutions In-service training In-service training plan 0 1 HR Department Availability of plan developed adequate resources POLICY PRIORITY AREA 6: MEDICINES, MEDICAL SUPPLIES, MEDICAL EQUIPMENT AND INFRASTRUCTURE Outcome: Increased percentage of population with access to a health facility offering 24-hour quality EHP within 5km radius Objective(s) Output(s) Performance Baseline Target Source(s) of Assumptions/ Indicator(s) Verification Risks Procurement of Procurement 0 1 Pharmacy, Availability of To improve the cost-effective Guidelines Procurement Unit adequate resources availability, medicines, medical accessibility supplies, vaccines, Percentage of Amoxicillin 250mg capsules 0% LMIS Availability of and quality of laboratory reagents, health 6%, Paracetamol 500mg adequate financial health and health facilities with tablets 3%, Sulphadoxine resources infrastructure, technologies stock outs of 500mg 5%, medical strengthened tracer drugs7 Cotrimoxazole480mg tablets equipment and 1%, Oxytocin 10 IU 1%, medicines and medical Glove disposable latex medium supplies at all (box) 4%, Syringe,  7 TT vaccines, LA, Oxytocyin, ORS, cotrimoxazole, diazepam inj., rapid HIV test kits, TB essential medicines, magnesium sulphate, gentamycin, metronidazole, ampicillin, benzyl penicillin, safe blood,RDTs. 61 levels of health autodestruct, 5ml, disposable, care hyperluer with 21g needle 15%, ORS 1%, Sodium chloride 0.9%, 500ml, viaflex (bottle/pouch) 7%. Overall Stock out rate = 5% Distribution of Percentage of Overall Stock out rate = 5% 0% LMIS Availability of medicines and health adequate financial medical supplies facilities with resources strengthened stock outs of tracer drugs Rational Gap of tracer Overall Stock out rate = 5% 0% LMIS Availability of prescription and use medicines adequate financial of medicines at all dispensed resources levels of health care against promoted. number cases recorded Security of Percentage 0% 80% Drug Theft Change of mindset medicines and reduction of Investigation Unit of health workers medical supplies at recorded theft Report all levels of medicines strengthened. and medical supplies Guidelines on the Guidelines in 0 1 HTSS Department Availability of use of alternative place and (Pharmacy) adequate resources medicines are in approved place 62 Use of evidence Guidelines in 0 1 HTSS Department Availability of based alternative place and (Pharmacy) adequate resources medicine promoted approved Management in the Procurement 0 1 HTSS Department Availability of procurement of Guidelines in (Pharmacy) adequate resources medical equipment place strengthened Physical 0 1 HTSS Department Availability of Asset (Pharmacy) adequate resources Management Policy in place Measures to Percentage 0% 80% Drug Theft Change of mindset eliminate theft of reduction of Investigation Unit of health workers medical equipment recorded theft Report developed and of medical enforced equipment Medical equipment Percentage of N/A 100% HTSS Department Availability of usage and Physical users trained (PAM) adequate resources Assets in appropriate Management Unit use of medical capacity equipment strengthened Percentage of N/A 100% HTSS Department Availability of filled (PAM) adequate resources positions of Medical Engineers 63 Adherence to Percentage of N/A 100% Planning and Policy Availability of Capital Investment infrastructure Department adequate resources Plans enforced investments (Infrastructure Unit) implemented from CIP Minimum standards Infrastructure 0 1 Planning and Policy Availability of for health standards Department adequate resources infrastructure and guidelines in (Infrastructure Unit) medical equipment place enforced Quality and Infrastructure 0 1 Planning and Policy Availability of capacity of existing standards Department adequate resources infrastructure guidelines in (Infrastructure Unit) improved place Norms, guidelines Revised 0 1 HTSS Department Availability of and standards for guidelines in (Pharmacy) adequate resources health place infrastructure and medical equipment revised 64 POLICY PRIORITY AREA 7: POPULATION MANAGEMENT Outcome: Reduce total fertility rate from 4.4 children per woman in 2016 to 2.2 children per woman in 2030. Objective(s) Outputs Performance Indicator(s) Baseline Target Source(s) of Assumptions/ Verification Risks National guidelines National guidelines in place 0 1 Health Sector Annual Availability of To slow down for the integration Review Report adequate resources population of population growth to a concerns into sustainable development plans level through developed voluntary and quality family Safe motherhood Safe motherhood programme N/A 100% Programme Reports Availability of planning programme strengthened adequate resources services, the strengthened safe Sexual and Total fertility rate 4.4% 2.2% MDHS Change of mindset motherhood reproductive health of the population programme, and programmes on uptake of the provision of implemented family planning information and methods education Collaboration with % of private institutions N/A 50% MDHS Change of mindset other public and providing sexual and of the population private institutions reproductive health services in the provision of sexual and reproductive health services enhanced 65 Information Information dissemination 0 1 Health Sector Annual Availability of dissemination system on family planning Review Report adequate resources system on issues in place population and family planning issues institutionalised POLICY PRIORITY AREA 8: HEALTH INFORMATION AND RESEARCH Outcome: Increased proportion of policies and decisions that are evidence informed at national, local authority and health facility level Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Assumptions/ Risks Verification Alignment of all Core national health indicators are 0 1 DHIS Availability of To strengthen information in place technical and capacity in management expertise resources health research systems across the and health health sector to the information national M&E system framework is Interoperability standards, 0 1 CMED Availability of management for enforced guidelines and requirements technical and evidence based developed expertise resources policy making Mechanisms for Guidelines for Health Policy N/A 1 Policy Availability of evidence informed Development are revised and in Development technical and policy and decision place Unit expertise resources making strengthened 66 Adherence to data Annual Data Quality Assessments N/A 100% CMED Availability of management conducted technical and standards expertise resources strengthened Percentage of Health Facilities N/A 100% CMED Availability of provided with Data Quality technical and improvement mentorship financial resources Feedback Percentage of health facilities N/A 100% CMED Availability of mechanism provided with feedback on their technical and strengthened HMIS data by the relevant expertise resources supervisory level Mechanisms for A tool for monitoring 0 1 Policy Availability of monitoring implementation of policies, Development technical and implementation of strategies, plans is in place Unit expertise resources health policies, strategies and plans institutionalised Effective planning Number of Joint Health Sector 1 2 Health Sector Availability of and coordination of Annual Reviews Mid-year and resources monitoring and Annual evaluation activities Review strengthened Reports Local capacity to Percentage of health expenditure 0.7 2 National Availability of carry out policy allocated to health research Health resources relevant health activities Accounts research Report strengthened. 67 Adherence to Percentage of research conducted 76.5 100 Health Availability of national health in line with national health Research adequate financial research frameworks research agenda Department resources and of and agenda technical expertise strengthened Mechanisms for the Percentage of research conducted 76.5 100 Health Availability of approval and in line with national health Research adequate financial monitoring of health research agenda Department resources and of research technical expertise strengthened Mechanisms for Knowledge translation platform in 0 1 Health Knowledge place Research translation Department strengthened 68 Government of Malawi Ministry of Health and Population P.O. Box 30377 Lilongwe Malawi Website: www.health.gov.mw Email: MoHPI@health.gov.mw Venus Printing Press, LL. 01 753 358