Let health sector breathe

Greetings from the Munda wa Chitedze Farm where we relocated from the hustle and bustle of your city. Here only peace and harmony reign supreme and we don’t suffer in peace like you do in your concrete jungle. We are watching over the last raindrops at the farm and the crop is good in the field.

You see, we cannot determine the tonnage of how much we are going to harvest. We are not alone in this dilemma. You see the Ministry of Agriculture is also failing to release the crop estimates for this year.

It can be that the outlook is a bundle of contradictions since some areas received adequate rains, while others had so little. Besides, the high cost of fertilizers may have affected the output. As usual, the hope is that the ministry does not sex up the figures so that they do not show the success of the Farm Inputs Subsidy Programme as well as the dynamic leadership that has pleased God so much that the rains are adequate.

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Villagers around the Farm know that for decades, Malawi’s healthcare system has been sustained by the generosity of development partners. More than 80 percent of sector resources come from external donors, while government spending remains around 9.1 percent of the national budget—far below the 15 percent Abuja target. Dear Diary, this imbalance has saved lives, but it also leaves the country vulnerable.

When donor priorities shift, the very foundations of our health services tremble. A case in point is how the sector has suffered since January last year when Usaid pulled out its funding to government. The question is not whether aid has been useful—it has been life‑saving.

HIV programmes, malaria control, and maternal health initiatives owe much to external support. But the deeper question is whether Malawi can continue to rely so heavily on others to finance its most basic obligation: the health of its citizens. Sustainability demands that we gradually strengthen our own capacity to fund healthcare, through earmarked taxes, improved efficiency in public spending, and stronger domestic revenue mobilisation.

Get it right, Parliament has begun to press for reforms, including ring‑fencing critical programmes such as HIV and Aids, TB, malaria, sexual and reproductive health, and child health. This is a welcome step. Yet reforms must go further.

We need contingency allocations in the budget to cushion against donor withdrawal. We need accountability mechanisms that ensure every kwacha spent on health translates into medicines on shelves, staff in clinics, and functioning equipment in hospitals. The stakes are high.

In the past year alone, health facilities assisted over 26 million outpatients, yet shortages of medicines and staff remain widespread. Mortality rates in district and central hospitals highlight weaknesses in referral systems and critical care capacity. These are not abstract numbers—they represent families losing loved ones to preventable causes.

The future direction must be bold. Malawi should invest in intensive care units, emergency transport, and integrated care models that combine HIV, TB, non‑communicable diseases, and mental health services. Parliament must embed these reforms into the Health Sector Strategic Plan, ensuring they are not left as isolated pilot projects.

At the same time, sanitation and hygiene must be prioritised, with minimum standards enforced across all facilities. Ultimately, the path forward is about ownership. Donors can supplement, but Malawi must lead.

The crossroads is clear: either remain dependent, or take decisive steps toward self‑sufficiency. The choice will define the health of our nation for generations to come Dear Diary, time has come that the health sector must breathe on its own and move from the life support system.

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