Ministry of Health and Sanitation has intensified activation of fee paying services in public hospitals to cushion the country’s health system from donor funding cut shocks and secure sustainable domestic financing.
Speaking in Lilongwe yesterday during the 2024/25 Health Sector Strategic Plan (HSSP) III Joint Annual Review meeting, Minister of Health and Sanitation Madalitso Baloyi said the reforms are a direct response to recent suspension of several donor-funded programmes, particularly following cuts in United States Government support which affected service delivery, forced project closures and triggered job losses across the sector.
She said: “Government hospitals, including district and central hospitals have started introducing paying wings where those with capacity to pay can access services.
“This is part of broader health financing reforms to ensure sustainability as donors gradually pull out. We cannot build national capacity by depending entirely on free services.”
Baloyi stressed that the reforms will not disadvantage the poor, saying vulnerable groups will continue to access free care, while systems are being refined to accommodate medical insurance schemes such as the Medical Aid Society of Malawi (Masm).
The minister also said government has started implementation of hospital autonomy project that will grant central hospitals greater decision-making authority and flexibility to generate and manage revenue.
She acknowledged that the health sector currently receives about 9.5 percent of the national budget, below the 15 percent Abuja Declaration target,
but said alternative financing mechanisms are being explored to close the gap.
Held under the theme ‘Accelerating universal health coverage and resilient health systems through collaboration and resource mobilisation’, the joint annual review meeting sought to assess the impact of recent donor funding disruptions and charted reforms aimed at strengthening system resilience.
Civil society representative Maziko Matemba said the suspension of the US Government funding early last year exposed Malawi’s heavy reliance on external support, with many civil society organisations forced to suspend projects and retrench staff.
“When donors change priorities, the system is shaken. This experience should guide future negotiations and planning,” he said.
Matemba said civil society has proposed that at least two percent of the national budget be dedicated to climate change, disasters, emergencies and pandemics, arguing that Malawi lacks a specific budget line for such crises.
He also called for formal social subcontracting arrangements between government and capable non-governmental organisations, saying civil society has complemented public service delivery for more than four decades, particularly in health and community programmes.
Parliamentary Committee on Health chairperson Anthony Masamba backed the introduction of paying wings, arguing that Malawi’s largely free health system has struggled to deliver quality services due to chronic underfunding.
“We are not saying everyone should pay. The vulnerable must be protected. But without reform, quality will continue to suffer,” he said.
Masamba also proposed taxes on products such as sugary drinks, alcohol and cigarettes to support a national health fund.
