Delivering affordable healthcare in sub-Saharan Africa

Malawi has significant healthcare challenges, including high infant mortality and a high burden of disease, especially HIV/AIDS, malaria and tuberculosis.

The country has had a health benefits package, termed the Essential Health Package (EHP), since 2004.

However, the cost of the EHP has always well exceeded the level of resources available and it has not been fully provided.

This has resulted in a package that is unaffordable, with large gaps in coverage and with large parts of the country, particularly rural areas, with little healthcare at all.

Now, a team from the University of York’s Centre for Health Economics (CHE), has developed a new $264m healthcare package using data provided by the Ministry of Health in Malawi, the World Health Organization and international NGOs.

Research fellow, Paul Revill said: “Malawi has always struggled with a very chaotic and fragmented system which has been subject to different trends and donor imposed preferences.

“Some things work well but the whole system collectively is not working well. This new EHP should indicate what is a priority.”

Top healthcare interventions include: male circumcision; management of obstructed labour; certain preventative therapies for HIV and treatment for TB in adults and children.

Research fellow Jessica Ochalek said the team had worked in close collaboration with officials from the Ministry of Health in Malawi.

She added: “The whole package is built around what is going to have the maximum population health impact.

“What we are not doing is telling the Ministry of Health in Malawi what to do. There are going to have to be some really important trade-offs. We have now provided them with a tool which allows them to quantify those different trade-offs.”

According to the researchers, $61 has the potential to avert one disability-adjusted life year (DALY)* in Malawi.

Jessica Ochalek added: “This is about empowering the Ministry of Health. It is an analysis of the data available and the evidence suggests this package would avert 49.5 million DALYs, assuming the interventions included in it can be delivered fully.”

“It can also inform international funders of healthcare – the Bill & Melinda Gates Foundation has already expressed an interest in the work.”

MacPhail Magwira PhD, Secretary for Health in Malawi, said: “We are highly appreciative of the work that the University of York has undertaken and we are sure it will contribute to improvement in health service delivery in Malawi. The efficient use of resources is one of the central objectives of the Ministry of Health and the framework developed by York contributes to that. The work also advances Government’s commitment to providing an affordable package of health service delivery to all Malawians, free at the point of access.

The Ministry of Health’s collaboration with the researchers at the Centre for Health Economics reflects Government’s commitment to engaging with global leading experts in various fields in order to improve public service delivery and we look forward to continued future engagements."

*DALYs are a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.