Allocating resources to support universal health coverage: policy processes and implementation in Malawi

Abstract

Optimising the use of limited health resources in low-income and middle-income countries towards the maximisation of health outcomes requires efficient distribution of resources across health services and geographical areas. While technical research exists on how efficiencies can be achieved in resource allocation, there is limited guidance on the policy processes required to convert these technical inputs into practicable solutions. In this article, we discuss Malawi’s experience in 2019 of revising its resource allocation formula (RAF) for the geographical distribution of the government health sector budget to the decentralised units in-charge of delivering primary and secondary healthcare. The policy process to revise the RAF in Malawi was initiated by district assemblies seeking a more equitable distribution of government resources, with the Ministry of Health and Population (MOHP) leading the technical and deliberative work. This article discusses all the steps undertaken by MOHP, Malawi to date as well as the steps necessary looking forward to legally establish the newly developed RAF and to start implementing it. We highlight the practical and political considerations in ensuring the acceptability and implementation feasibility of a revised RAF. It is hoped that this discussion will serve as guidance to other countries undergoing a revision of their resource allocation frameworks.

Factors Shaping Network Emergence: A Cross-Country Comparison of Quality of Care Networks in Bangladesh, Ethiopia, Malawi, and Uganda

“…Across the four countries, QCN's emergence was supported by the network's alignment with national priorities to improve quality of care, as reflected in national health sector plans, as well as government efforts to make progress on the Sustainable Development Goals (SDGs). [77][78][79][80] A respondent from UNICEF described how these high-level government commitments were critical to QCN emergence in Bangladesh:…”

Political economy analysis of universal health coverage and health financing reforms in low- and middle-income countries: the role of stakeholder engagement in the research process

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“…These include: (i) redistribution of existing fi nancial resources was not possible, (ii) the total resource envelope did not grow enough to achieve optimal distribution of the additional resources to operationalize the formula, and (iii) there was wavering political support to implement the formula due to regular changes at ministerial level at the MOHP. In 2019, a new formula was developed by updating data on population size, disease burden and coverage rates, unit costs of treatment, and cost variations across the districts (Twea et al 2020). The 2019 formula is also aligned to the country's health benefi t package, the EHP, which aims to advance the principles of health maximization, cost-effectiveness, and equity (Twea et al 2020).…”

“…In 2019, a new formula was developed by updating data on population size, disease burden and coverage rates, unit costs of treatment, and cost variations across the districts (Twea et al 2020). The 2019 formula is also aligned to the country's health benefi t package, the EHP, which aims to advance the principles of health maximization, cost-effectiveness, and equity (Twea et al 2020).…”