Assessment of strategic health purchasing arrangements in Malawi

Strategic Health Purchasing has potential to address health system inefficiencies and advance towards Universal Health Coverage. However, limited evidence exists on the progress made in strategic health purchasing in Malawi and how it can be enhanced. This study aims to assess the progress, gaps and opportunities in strategic health purchasing among major purchasers of health in Malawi to inform strategic purchasing reforms. We utilized the Strategic Health Purchasing Progress Tracking Framework to collect data on key domains of purchasing such as benefit specification, provider contracting, payment and performance monitoring arrangements, governance and financial management through analyses of relevant documents and key informant interviews. The findings revealed progress in: 1) Enabling policy frameworks that prioritize implementation of strategic purchasing reforms 2) Cost-effective benefit package accessible to all Malawians at no cost 3) Provider payment mechanisms include input-based payments, fee-for-service and global budgets 4) Selective contracting with some faith-based providers 5) Multiple performance monitoring arrangements like supportive supervision and information management systems exist. However, limitations persist including passive provider payment mechanisms, limited provider autonomy especially for primary health care facilities and rigid public financial management systems. Addressing these gaps is critical in achieving universal health coverage. Drawing lessons from service level agreements (SLAs) to strengthen direct facility financing, prioritizing public financial management reform to allow recognition of primary health facilities as cost centers and strengthening performance monitoring arrangements to allow integration of health information systems are essential.