Community health –the provision of basic health services in rural and urban communities with the participation of people who live there – is essential to improving health and livelihoods in Malawi. Community health activities have contributed to historical improvements in Malawi’s health outcomes, especially for women and children, such as the decline in child mortality and malaria fatality rates. Going forward, community health will help Malawi to achieve its commitment to the Sustainable Development Goals (SDG); in particular, SDG 3 on universal health coverage. Therefore, building a strong community health system is core to Malawi’s development agenda.
Malawi’s community health system faces resource constraints and inconsistencies around quality of service – which negatively affect health outcomes. Malawi has a shortage of at least 7,000 community health workers (CHWs), and existing CHWs are unevenly distributed across the country. Community health workers also face challenges related to lack of clarity on their roles and tasks, inadequate training and supervision, and limited access to transport. Communities experience frequent stock outs of medicines and lack sufficient infrastructure (e.g., health delivery structures). Moreover, planning and implementation gaps are common due to ongoing challenges with decentralisation; inadequate institutional coordination, especially between government and partners; fragmented data collection; and lack of sustained community engagement. These challenges contribute to adverse health outcomes across the country; for example, life expectancy remains low at 61 years and the maternal mortality rate is high at 439 per 100,000 live births.
Recognising the importance of community health and the opportunity to address these challenges, the Ministry of Health (MoH) has developed the country’s first National Community Health Strategy (NCHS) for the period of 2017-2022. The Community Health Services (CHS) Section has led this work in coordination with the Department for Planning and Policy Development (DPPD). The NCHS ties into the Health Sector Strategic Plan (HSSP II), which underscores primary health care and community participation as core principles. Extensive consultation guided the development of the NCHS: over 500 stakeholders across
the health system, local government, and communities helped to highlight strengths and challenges, identify and prioritise key issues and activities, and develop the implementation plan.