Developing Malawi's Universal Health Coverage Index

Abstract

The inclusion of Universal Health Coverage (UHC) in the Sustainable Development Goals (target 3.8) cemented its position as a key global health priority and highlighted the need to measure it, and to track progress over time. In this study, we aimed to develop a summary measure of UHC for Malawi which will act as a baseline for tracking UHC index between 2020 and 2030. We developed a summary index for UHC by computing the geometric mean of indicators for the two dimensions of UHC; service coverage (SC) and financial risk protection (FRP). The indicators included for both the SC and FRP were based on the Government of Malawi's essential health package (EHP) and data availability. The SC indicator was computed as the geometric mean of preventive and treatment indicators, whereas the FRP indicator was computed as a geometric mean of the incidence of catastrophic healthcare expenditure, and the impoverishing effect of healthcare payments indicators. Data were obtained from various sources including the 2015/2016 Malawi Demographic and Health Survey (MDHS); the 2016/2017 fourth integrated household survey (IHS4); 2018/2019 Malawi Harmonized Health Facility Assessment (HHFA); the MoH HIV and TB data, and the WHO. We also conducted various combinations of input indicators and weights as part of sensitivity analysis to validate the results. The overall summary measure of UHC index was 69.68% after adjusting for inequality and unadjusted measure was 75.03%. As regards the two UHC components, the inequality adjusted summary indicator for SC was estimated to be 51.59% and unadjusted measure was 57.77%, whereas the inequality adjusted summary indicator for FRP was 94.10% and unweighted 97.45%. Overall, with the UHC index of 69.68%, Malawi is doing relatively well in comparison to other low income countries, however, significant gaps and inequalities still exist in Malawi's quest to achieve UHC especially in the SC indicators. It is imperative that targeted health financing and other health sector reforms are made to achieve this goal. Such reforms should be focused on both SC and FRP rather than on only either, of the dimensions of UHC.

The potency of a free maternal healthcare policy in achieving universal health coverage a cross-sectional qualitative study

“…Women who were in their reproductive age and have children aged between three (3) and twelve (12) months and have come to the health facilities to access maternal healthcare services were assigned numbers up to three (3) and every other third person was selected. This process was repeated at the various health facilities until the required number of 72 with 24 participants at each health facility across the three districts was attained.…”

“…[9][10][11] Together with the World Bank, WHO have developed a framework to track the progress of UHC by monitoring both categories, taking into account the overall level and the extent to which UHC is equitable, offering service coverage and financial protection to all people within a population, such as the poor or those living in remote rural areas. 12,13 Ghana introduced a Free Maternal Health Care Policy (FMHCP) under the national health insurance scheme (NHIS) in 2008. 14 Under this policy, all pregnant women are exempted from paying NHIS premiums for new subscriptions or renewal of membership.…”

Factors associated with men’s health facility attendance as clients and caregivers in Malawi: a community-representative survey

“…Health insurance plays a negligible role in health access in Malawi; it comprises less than 5% of total health expenditures and, without a national health insurance scheme, typically only formally employed Malawians have insurance. [29].…”

An evaluation of funding challenges in the Malawian public healthcare delivery sector

“…In Malawi, public healthcare is provided at community, primary, secondary and tertiary levels, and each level links with the upper level through a referral system (Makwero 2018;Mchenga et al 2022). The tertiary level comprises of central hospitals, while the community, primary and secondary levels are managed by district hospitals (Makwero 2018).…”

“…Consequently, the sector has suffered from absenteeism, corrupt practises, and poor performance because of low staff morale (International Monetary Fund 2018). The poor and vulnerable are, as a result, affected by the poor service delivery in the hospitals as they are the ones who mostly seek public healthcare services (Mchenga et al 2022;Myint, Pavlova & Groot 2019).…”