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Health system outcomes

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Health systems have multiple goals.[1] The world health report 2000[2]defined overall health system outcomes or goals as improving health and health equity in ways that are:

  • responsive
  • financially fair
  • make the best, or most efficient, use of available resources.

There are also important intermediate goals: the route from inputs to health outcomes is through achieving greater access to, and coverage for, effective health interventions without compromising efforts to ensure provider quality and safety.

The health systems access framework[3]

Countries try to protect the health of their citizens. They may be more or less successful, and more or less committed, but the tendency is one of trying to make progress, in three dimensions:

  • First, countries try to broaden the range of benefits (programmes, interventions, goods, services) to which their citizens are entitled.
  • Second, they extend access to these health goods and services to wider population groups and ultimately to all citizens: the notion of universal access to these benefits.
  • Finally, they try to provide citizens with social protection against untoward financial and social consequences of taking up health care. Of particular interest is protection against catastrophic expenditure and poverty.

In health policy and public health literature, the shorthand for these entitlements of universal access to a specified package of health benefits and social protection is universal coverage.

This section of the Health system outcomes profile is structured as follows:


Analytical summary

In collaboration with its development partners and other stakeholders, Malawi developed the Programme of Work, covering the period from 2004 to 2010. The Programme of Work guided the implementation of interventions aimed at improving the health status of the people of Malawi. The overall goal was to improve the quality of life of all the people of Malawi by reducing the risk of ill health and occurrence of premature deaths, thereby contributing to the social and economic development of the country.

The implementation of the Programme of Work has contributed to strengthening the health systems and there has been increased funding to the health sector. Between 2004 and 2009 there has been increased output from the health-training institutions due to increased capacity.

As a result of the implementation of the sector-wide Programme of Work since 2004, there has been an increase not only in the availability of health services but also the access to health services has improved.

In 2002, Malawi developed a resource allocation formula in the health sector to guide allocation of resources to cost centres. Despite the development of this resource allocation formula, there appear to be no criteria for allocation of resources between cost centres, regions and districts. The current resource allocation formula is based on population, number of facilities and existing resources and not on disease burden and prevailing poverty. A new resource allocation formula is to be developed to ensure transparency in the allocation of resources at different levels.

In 2008, the Ministry of Health, in collaboration with WHO, conducted a study on technical efficiency of district hospitals in Malawi.[2] Results from the study show that about half of the hospitals are less than 60% efficient. This indicates the presence of widespread and rampart inefficiency in the health sector. However, there is a great potential to increase outputs with the current level of inputs and consequently contribute to improvement in the health status of the population.

Many factors hinder quality improvement in the health sector in Malawi, including poor facilities, lack of equipment, lack of qualified human resources and weak management. The health sector needs to develop strategies and key interventions designed to improve quality in delivery of Essential Health Package services. The Ministry of Health needs to develop and implement a comprehensive approach to quality of care for effective service delivery at all levels by improving:

  • the policy environment for implementing quality assurance interventions
  • quality in standards and accreditation
  • performance management
  • client and provider satisfaction.

Despite these achievements in the health system, challenges still remain. Based on the Global Burden of Disease study 2002 and the 2009 STEPS survey on noncommunicable diseases,[3] the Health Sector Strategic Plan (2011–2016)[1] has identified priorities for implementation in the next 5 years. The priorities have been based on the 2002 burden of disease study, which ranked the top diseases and conditions. In addition, the Ministry of Health and its development partners have used criteria for prioritizing interventions for inclusion in the Essential Health Package for implementation in the 2011–2016 period, including:

  • burden of disease
  • cost effectiveness
  • access to the poor
  • Millennium Development Goal condition
  • proven successful intervention.

General overview and systemic outcomes

Priorities and ways forward


Endnotes:References, sources, methods, abbreviations, etc.

  1. 1.0 1.1 Everybody’s business. Strengthening health systems to improve health outcomes. WHO’s framework for action (pdf 843.33kb). Geneva, World Health Organization, 2007
  2. 2.0 2.1 The world health report 2000. Health systems: improving performance (pdf 1.65Mb). Geneva, World Health Organization, 2000
  3. 3.0 3.1 The world medicines situation (pdf 1.03Mb). Geneva, World Health Organization, 2004