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Analytical summary - Leadership and governance

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The health sector was one of the earliest sectors to start the process of decentralization in line with the Decentralization Policy of 1997. In 2004, health devolution guidelines were formulated taking into consideration the prevailing legislation, the policy framework and available local capacity for implementation of the decentralization process. The guidelines further identified the functions and activities to be devolved to district assemblies and defined:

  • the role of the central Ministry of Health in policy development;
  • standards setting;
  • monitoring and evaluating how the devolved functions are executed in line with the Ministry’s overall goals, overarching sectoral plans and policies.

Some of the key challenges with regard to decentralization, including weak coordination of decentralization at national level, underfunding of district implementation plans and high staff turnover within the health sector, tend to affect health services delivery at district level.

The Ministry of Health is responsible for:

  • the development, review and enforcement of health and related policies for the health sector;
  • spearheading sector reforms;
  • regulating the health sector, including the private sector;
  • developing and reviewing standards, norms and management protocols for service delivery and ensuring that these are communicated to lower-level institutions;
  • planning and mobilizing health resources for the health sector, including allocation and management;
  • advising other ministries, departments and agencies on health-related issues;
  • providing technical support supervision;
  • coordinating research;
  • monitoring and evaluation.

Other institutions are involved in provision of health and social services, including the Ministry of Local Government and Rural Development and the private sector. At community level, numerous nongovernment organizations, faith-based organizations and community-based organizations deliver health promotion services. The Christian Health Association of Malawi is the biggest partner for the Ministry of Health in the delivery of health services. The health sector also works with traditional healers through the Malawi Traditional Healers Umbrella Organization.

Health information is used in planning and priority setting, resource allocation, service delivery management, and monitoring and evaluation. For instance, data from the burden of disease study conducted by the College of Medicine in 2001 and revised 2011[1] and the 2009 Ministry of Health STEP survey[2] were used to identify priority diseases and conditions to be included in the Essential Health Package in the Health Sector Strategic Plan 2011–2016.[3]

In Malawi, the health activity planning process has been decentralized. While the Department of Planning and Policy Development at central level provides guidance to the lower levels on the development and implementation of the plans, preparation of such plans are done at national, zonal, central hospital and district levels. However, it is observed that the level of participation of people at community level or even at district level, including those in zone offices, in policy formulation is insignificant and unclear.

The Ministry of Health is strengthening collaboration with regulatory bodies in the development of a common code of practice for health professionals working in the public and private health sector, including international health institutions, research institutions and nongovernmental organizations. In this regard, the Ministry of Health works closely with the regulatory bodies in matters of professional regulation.

A monitoring and evaluation framework has been developed and core health performance indicators have been identified for monitoring the Health Sector Strategic Plan.[3] A Monitoring and Evaluation Technical Working Group with members from Government departments, nongovernmental organizations and development partners has been constituted as part of the sector-wide governance structure to provide technical input and advice on monitoring and evaluation issues in the health sector.

There is a need to strengthen leadership and governance structures in the health sector at all levels so as to enhance the implementation of the Health Sector Strategic Plan.[3] The following priority areas will be strengthened:

  • coordination of decentralization at national level;
  • collaboration through joint planning of interventions;
  • collaboration on monitoring of the implementation of the district implementation plans;
  • harmonization of the planning documents for the Ministry of Health and Ministry of Local Government and Rural Development.


  1. Burden of disease estimates for 2011 and the potential effects of the essential health package on Malawi’s health burden (Word 249kb). College of Medicine 2011
  2. Malawi national STEPS survey for chronic non-communicable diseases and their risk factors. Final report (pdf 1.45Mb). Lilongwe, Government of Malawi, Ministry of Health, and WHO 2010
  3. 3.0 3.1 3.2 Malawi Health Sector Strategic Plan 2011–2016. Moving towards equity and quality (pdf 3.69Mb). Lilongwe, Government of Malawi, Ministry of Health, 2011