Strengthening National Health Accounts for informed health financing in Malawi
5 December 2024
Author: Godfrey Pumbwa

National Health Accounts (NHA) play a pivotal role in health sector planning and reform, offering crucial insights into how resources are mobilised and managed, who funds health spending, and the sustainability of financing mechanisms. NHA data sheds light on the pooling of funds to ensure equitable risk protection, the financial burden on households, and the extent of out-of-pocket payments relative to domestic financing. It also provides a comprehensive assessment of spending efficiency across healthcare levels and functions, the allocation of resources to specific conditions or services, and the alignment of expenditures with the burden of disease. 

Malawi’s Ministry of Health and its partners acknowledge the critical role of tracking health resource flows in informing effective health financing policies. However, there has not been consistency in the production of NHA data. The most recent report, which covers the 2018/19 fiscal year, is outdated and insufficient to guide evolving strategies. This inconsistency in producing NHA data stems from limited technical expertise to produce, interpret and analyse data independently. The Ministry has thus relied on donor funding and external experts. 

To address this gap and strengthen Malawi’s Ministry of Health capacity to produce and utilise NHA data, the African Institute for Development Policy (AFIDEP) spearheaded a comprehensive training workshop covering data mapping, analysis and report writing, on November 11–15, 2024, in Salima, Malawi. Highlighting the significance of the training, Thulasoni Msuku, Principal Economist in the Ministry of Health, noted: “This training is a very important exercise because it will give us a fresh status. The last NHA was done in 2019. So today, in 2024, we are using the statistics generated in 2019. This exercise will give us a clear picture of where we are in terms of health and self-reliance. Don’t forget that our Agenda 2063 is talking about being self-reliant.” 

The training brought together technical teams from the Ministry of Health, Ministry of Finance, WHO Malawi, and Kamuzu University of Health Sciences (Health Economics and Policy Unit, HEPU). Participants gained hands-on experience with every stage of the NHA production process. During the training, participants were equipped with technical expertise to address data gaps, conduct data mapping, and validate health expenditure data for the fiscal years 2019/20, 2020/21, and 2021/22. Participants also developed an NHA Roadmap, outlining a clear timeline for producing the next round of NHA data (2022–2024) to ensure evidence-based decision-making remains a cornerstone of Malawi’s health financing strategies. 

Timange Banda, an economist in the Ministry of Health’s Planning Department, emphasised the impact of the training: “This training has strengthened my understanding and skills in analysing NHA data and report writing. With the skills I’ve gained, I can now contribute more effectively to evidence-based decision-making and ensure accurate data inform our health financing strategies.” Precious Chitsulo, an associate research fellow at HEPU, also noted: We’ve been using NHA data, but learning now how it’s produced, and seeing how HEPU can support its production and improve its quality is truly fulfilling.” 

Through this capacity-building initiative, AFIDEP has equipped Malawi’s Ministry of Health with the tools to make data-driven decisions that prioritise equitable and sustainable health financing. The training fostered a culture of evidence-based policymaking and promoted practices that align with the country’s self-reliance goals under Agenda 2063.