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Sharma L, Heung S, Twea P, Yoon I, Nyondo J, Laviwa D, Kasinje K, Connolly E, Nkhoma D, Chindamba M, Tebeje MT, Brady E, Gunda A, Chirwa E, Manthalu G. Donor coordination to support universal health coverage in Malawi. Health Policy Plan 2024; 39:i118-i124. [PMID: 38253443 PMCID: PMC10803193 DOI: 10.1093/heapol/czad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 07/04/2023] [Accepted: 11/06/2023] [Indexed: 01/24/2024] Open
Abstract
Development assistance is a major source of financing for health in least developed countries. However, persistent aid fragmentation has led to inefficiencies and health inequities and constrained progress towards Universal Health Coverage (UHC). Malawi is a case study for this global challenge, with 55% of total health expenditure funded by donors and fragmentation across 166 financing sources and 265 implementing partners. This often leads to poor coordination and misalignment between government priorities and donor projects. To address these challenges, the Malawi Ministry of Health (MoH) has developed and implemented an architecture of aid coordination tools and processes. Using a case study approach, we documented the iterative development, implementation and institutionalization of these tools, which was led by the MoH with technical assistance from the Clinton Health Access Initiative. We reviewed the grey literature, including relevant policy documents, planning tools and databases of government/partner funding commitments, and drew upon the authors' experiences in designing, implementing and scaling up these tools. Overall, the iterative use and revision of these tools by the Government of Malawi across the national and subnational levels, including integration with the government's public financial management system, was critical to successful uptake. The tools are used to inform government and partner resource allocation decisions, assess financing and gaps for national and district plans and inform donor grant applications. As Malawi has launched the Health Sector Strategic Plan 2023-2030, these tools are being adapted for the 'One Plan, One Budget and One Report' approach. However, while the tools are an incremental mechanism to strengthen aid alignment, success has been constrained by the larger context of power imbalances and misaligned incentives between the donor community and the Government of Malawi. Reform of the aid architecture is therefore critical to ensure that these tools achieve maximum impact in Malawi's journey towards UHC.
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Affiliation(s)
- Lalit Sharma
- Health Systems Strengthening, Clinton Health Access Initiative (CHAI), Lilongwe, Private Bag 341, Malawi
| | - Stephanie Heung
- Sustainable Health Financing and Health Workforce, Clinton Health Access Initiative (CHAI), Lilongwe, Private Bag 341, Malawi
| | - Pakwanja Twea
- Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi
| | - Ian Yoon
- Former Health Systems Strengthening, Clinton Health Access Initiative (CHAI), Lilongwe, Private Bag 341, Malawi
| | - Jean Nyondo
- Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi
| | - Dalitso Laviwa
- Sustainable Health Financing, Clinton Health Access Initiative, Blantyre, Private Bag 341, Malawi
| | - Kenasi Kasinje
- Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi
| | - Emilia Connolly
- Partnerships, Policy and Advocacy, Partners In Health, Neno, Malawi
| | - Dominic Nkhoma
- Health Economics and Policy Unit, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Madalitso Chindamba
- Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi
| | - Mihereteab Teshome Tebeje
- Health Systems Strengthening, Clinton Health Access Initiative (CHAI), Lilongwe, Private Bag 341, Malawi
| | - Eoghan Brady
- Health Financing, Clinton Health Access Initiative, Boston, Massachusetts 02127, United States
| | - Andrews Gunda
- Country Director, Clinton Health Access Initiative, Lilongwe Private Bag 341, Malawi
| | - Emily Chirwa
- Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi
| | - Gerald Manthalu
- Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi
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