Health in Malawi

Primary health care, or PHC, is the first level of contact with the health system. Health Surveillance Assistants and Senior Health Surveillance Assistants, known as HSAs and SHSAs, provide community outreach, health education, prevention and follow-up. A person may then attend a health post, dispensary, health centre or community hospital. District hospitals provide secondary care, while central or specialized hospitals provide tertiary care. Queen Elizabeth Central Hospital, Kamuzu Central Hospital, Mzuzu Central Hospital, Zomba Central Hospital and Zomba Mental Hospital are central or specialized facilities. Referrals connect these levels, although emergencies can require immediate treatment without waiting for the usual referral sequence. Malawi does not have one nationwide family-doctor or health-authority system. Access is mainly organized around a facility's catchment area and district. The Malawi Health Facilities Registry, or MHFR, helps identify facilities, but the actual services, opening arrangements and distance depend on the location. District Health Management Teams and District Health Offices plan and coordinate district services with District Councils. The Ministry of Health sets national policy, standards and quality requirements. Facilities may be public, private-for-profit, private-not-for-profit or operated through contracted providers. Prevention begins in communities and facilities. Services include routine vaccination through the Expanded Programme on Immunization, current polio and measles surveillance and supplementary immunization activities in 2026, malaria prevention with long-lasting insecticidal nets and preventive treatment during pregnancy, HIV, STI and tuberculosis prevention and testing, antenatal and postnatal care, family planning, child growth and nutrition monitoring, vitamin A supplementation, deworming, water and sanitation measures, cholera prevention, blood-pressure and diabetes screening, and mental-health awareness. HSAs are a major link for these services; the Health Sector Strategic Plan III sets a planning target of one HSA for every 1,000 people, while actual coverage can differ by district. Integrated services may combine maternal and child care or chronic HIV and non-communicable-disease care. Outreach began in Mangochi in 2024, with preparation reported for Rumphi and Nkhotakota, but availability remains district-dependent. The Health Benefits Package, or HBP, is the defined package of covered health interventions. At primary and secondary levels it contains 115 interventions. Policy arrangements provide HBP or essential services without a point-of-service charge in public facilities and in CHAM or IHAM facilities covered by a service-level agreement. The practical implementation of the HBP remains part of an ongoing reform, so this does not mean that every treatment, diagnostic test, medicine or provider is free for every patient. The HSSP III entitlement design links access for identified poor and vulnerable people to a national ID and the Unified Beneficiary Registry. It also describes an ID- or PAYE-based arrangement for formal-sector workers without private cover, catchment-based exemptions for government-contracted faith-based facilities, and insurance or full-cost payment for private-insured or non-poor informal patients. Transport, food, accommodation, caregiver time and other indirect costs can still arise even when a covered service has no direct charge. Emergency care should begin with triage and treatment at once. Malawi's public emergency medical number is 998, but reliability and coverage vary. Ambulances are not available across the whole country, so roads, rivers, community transport or self-transport may be involved. A receiving facility should be contacted when possible, especially when referral capacity is uncertain. Carry referral notes, investigation results, medicine information and identification documents where available, but do not delay urgent treatment while trying to collect paperwork. The availability of examinations, medicines and equipment differs substantially between facilities. The 2024 Malawi Harmonized Health Facility Assessment reported that only 2.7% of facilities had all basic equipment, and the mean availability of tracer diagnostics was 27.1%. Malaria diagnosis and treatment exceeded 94.2%, while chemistry, electrolyte, complete blood count and culture services were each below 10%. HIV, tuberculosis, reproductive, maternal, newborn and child health, non-communicable disease and mental-health services remain major priorities. Stock-outs, equipment gaps, staffing shortages, water and power problems and weak connectivity can affect the result and timing of care. Medicines move through the public supply chain supported by the Central Medical Stores Trust. The Pharmacy and Medicines Regulatory Authority, or PMRA, regulates medicine registration, licensing, quality, safety, efficacy, pharmacy personnel, traditional medicines and safety reporting. Use registered medicines and regulated pharmacies or facilities when available. Traditional healers and traditional medicine are a mainly informal alternative; they do not provide an equivalent HBP, referral, quality-control or emergency-care system. After discharge or referral, continuity may involve a return referral, a follow-up appointment, a chronic HIV or non-communicable-disease clinic, community follow-up by an HSA, rehabilitation or medical rehabilitation. Psychiatric referrals may involve Zomba Mental Hospital. Paper referral notes and patient records currently support continuity, while a shared electronic health record remains a planned system rather than a universal service. Medicine availability and follow-up capacity depend on the district and facility. Patients have rights to dignity and respectful treatment, privacy and confidentiality, health information and education, informed consent, participation in decisions and a second opinion. HIV testing and results require confidentiality. Complaints can begin at the facility, through a Health Centre Management Committee or a Hospital Ombudsman, and may also be taken to the Office of the Ombudsman. Complaints about professional conduct or medicines can involve the Medical Council, the Nurses and Midwives Council or PMRA. Patients should provide accurate medical and medicine histories, follow agreed referrals and treatment instructions, bring required identification or registration documents when the access arrangement calls for them, and respect staff and facility property.