Publication: Spending for Health in Malawi: Current Trends and Strategies to Improve Efficiency and Equity in Health Financing
Loading...
Date
2021-04-01
ISSN
Published
2021-04-01
Author(s)
Editor(s)
Abstract
Over the past two decades, Malawi has made remarkable progress in improving maternal and child health, as well as nutrition outcomes. The Coronavirus disease 2019 (COVID-19) pandemic can reverse the gains in the health sector in Malawi. In the face of the COVID-19 pandemic, Malawi needs to improve the efficiency of its current spending in the health sector while at the same time strengthening key institutions so that service delivery improves. Structuring spending to support the most vulnerable and improve human capital outcomes more broadly is also important. To support these efforts, the World Bank recently completed a public expenditure review that seeks to identify bottlenecks and solutions in order to improve expenditure on human capital. This policy brief draws on the health module of this review highlighting key gaps, and outlining the measures required to improve financing and health service delivery in Malawi.
Link to Data Set
Citation
“World Bank. 2021. Spending for Health in Malawi: Current Trends and Strategies to Improve Efficiency and Equity in Health Financing. Health, Nutrition and Population Policy Brief;. © World Bank. http://hdl.handle.net/10986/35864 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Public Spending in Russia for Health Care : Issues and Options(Washington, DC, 2008-08)This report examines three critically important areas to inform discussions on the appropriate level of health care spending in the Russian Federation: (i) the efficiency of spending on health care services; (ii) distributional impacts of spending on health care services; and (iii) the key factors that will influence the growth in health care spending over the next 20 years. There are few data showing how spending in health care in the Russian Federation translates into better health outcomes such as improved mortality, improved morbidity, increased economic output and productivity, improvements in the number of life years gained, or more sophisticated composite measures such as Quality Adjusted Life Years (QALYs). There is also limited data on outputs of hospitals and other healthcare providers which allow controlling for case mix, socioeconomic status, supply-side variables, and quality of care. Therefore, it is difficult to assess the efficiency or distributional impacts of health interventions. While the analysis draws on primary data specifically collected for the study, the absence of detailed output and outcome data necessarily limits the scope of the study and its findings.Publication Government Spending on Health in Lao PDR : Evidence and Issues(Washington, DC, 2012-12)The note analyzes overall trends in government health financing and expenditure patterns and discusses some of the efficiency and equity issues pertaining to current government health spending patterns. The policy note is one of a series of health financing analyses, complementing earlier policy notes focusing on out-of-pocket spending as well as community-based and social health insurance schemes in the country. This reliance on out-of-pocket payments represents a considerable financial barrier to utilization of health services. The prominence of out-of-pocket spending in the form of user fees and revolving drug funds (RDFs) also raises concerns over management of funds at health facility level and regarding the potential for over prescription. In contrast, social health insurance expenditures are very low in Lao PDR: social insurance schemes cover about 11.4 percent of the population but account for only about 2.8 percent of total health spending. The Lao government has committed to increasing government spending to 9 percent of the budget, implying roughly a three-fold rise compared to plan spending for fiscal year 2011/12. If the policy goal is to raise government health spending equitably across the provinces, achieving it will be challenging. The overall economic outlook for Lao PDR is positive. Economic growth is projected to be 8.3 percent in 2012, and is expected to be in the range of 7-8 percent over the period 2013-2015. This note is one of a series of complementary health financing analyses on out-of-pocket spending and community-based and social health insurance schemes in the country. Additional analytical work in progress will review and assess demand-side pilot interventions currently being initiated by the government, such as the national free maternal and child health policy and the conditional cash transfer pilot.Publication Republic of Congo : Enhancing Efficiency in Education and Health Public Spending for Improved Quality Service Delivery for All(Washington, DC, 2014-06)The development of a wealthier, literate, and healthy society is a fundamental goal of Congo's national development plan (NDP) 2012-16 and poverty reduction strategy paper (PRSP) 2012-16. Appropriate funding allocations and efficient use of funds in education and health are fundamental for the development of the sectors. This public expenditure review (PER) of the Congolese education and health sectors aims at providing inputs to improve efficiency and equity in spending in these sectors. It takes into account the following findings of the macro PER: (i) spending on the social sectors is still low although it has increased over time; (ii) the fiscal space generated by the increased oil revenues has largely boosted investment expenditure; and (iii) budget execution is low which contributes to lower the real level of public spending. The PER is divided in two main parts. Part I, constitutes an overview of the two sector reports. Thus, it presents a brief analysis of the context of the country, a summary of findings of the education and health PER, a discussion on cross-cutting themes on spending in the two sectors, and a summary of recommendations. Part II includes the education and health PER.Publication Reprioritizing Government Spending on Health : Pushing an Elephant Up the Stairs?(World Bank, Washington, DC, 2014-01)Countries vary widely with respect to the share of government spending on health, a metric that can serve as a proxy for the extent to which health is prioritized by governments. World Health Organization (WHO) data estimate that, in 2011, health's share of aggregate government expenditure in the 170 countries for which data were available averaged 12 percent. However, country differences were striking: ranging from a low of 1 percent in Myanmar to a high of 28 percent in Costa Rica. Some of the observed differences in health's share of government spending across countries are unsurprisingly related to differences in national income. However, significant variations exist in health's share of government spending even after controlling for national income. This paper provides a global overview of health's share of government spending and summarizes key theoretical and empirical perspectives on allocation of public resources to health vis-a-vis other sectors from the perspective of reprioritization, one of the modalities for realizing fiscal space for health. Theory and cross-country empirical analyses do not provide clear, cut explanations for the observed variations in government prioritization of health. Standard economic theory arguments that are often used to justify public financing for health are equally applicable to many other sectors including defense, education, and infrastructure. To date, empirical work on prioritization has been sparse: available cross-country econometric analyses suggests that factors such as democratization, lower levels of corruption, ethnolinguistic homogeneity, and more women in public office are correlated with higher shares of public spending on health; however, these findings are not robust and are sensitive to model specification. Evidence from case studies suggests that country-specific political economy considerations are key, and that results-focused reform efforts, in particular efforts to explicitly expand the breadth and depth of health coverage as opposed to efforts focused only on government budgetary targets, are more likely to result in sustained and politically-feasible prioritization of health from a fiscal space perspective.Publication Rapid Assessment of the Effect of the Economic Crisis on Health Spending in Mongolia(World Bank, Washington, DC, 2010-12)This rapid assessment examines the effect of Mongolia's economic crisis on government health budgets and health expenditure, household out-of-pocket spending and donor health commitments. This study was part of a larger assessment conducted in four countries on the effects of the economic crisis on health spending. A standardized approach was developed for all country case studies and consisted of a desk review of internationally-available literature and databases, extensive in-country review of data and documents available in government and donor offices, and semi-structured interviews with government staff, health providers and development partners. This assessment in Mongolia reveals a substantial reduction in the government health budget: the 2009 national health budget was significantly lower than the previous year's, and then was further reduced by 10 percent in a subsequent budget amendment. At national level, budget cuts were concentrated in investment line items. Among recurrent line items, the pharmaceutical budget was hardhit, but salaries were largely preserved, and there were no retrenchments. Similar patterns were observed at sub-national level for hospital budgets, which depend on the central allocations, but not for primary care facilities, which are funded on a capitation basis. Compared to other sectors, the health sector was relatively protected during the economic crisis and the share of health in the total government budget was higher after the budget amendment than before. To protect households from the effects of the economic crisis on health spending, the government undertook specific policy measures to expand health insurance coverage to vulnerable groups. Donor commitments to the health sector during the crisis largely tracked previously planned commitments.
Users also downloaded
Showing related downloaded files
Publication Accessing Economic and Political Impacts of Hydrological Variability on Treaties : Case Studies on the Zambezi and Mekong Basins(2012-03-01)International river basins will likely face higher hydrologic variability due to climate change. Increased floods and droughts would have economic and political consequences. Riparians of transboundary basins governed by water treaties could experience non-compliance and inter-state tensions if flow falls below levels presumed in a treaty. Flow information is essential to cope with these challenges through water storage, allocation, and use. This paper demonstrates a simple yet robust method, which measures gauge station runoff with wetness values derived from satellite data (1988-2010), for expanding sub-basin stream flow information to the entire river basin where natural flow information is limited. It demonstrates the approach with flow level data that provide estimates of monthly runoff in near real time in two international river basins: Zambezi and Mekong. The paper includes an economic framework incorporating information on existing institutions to assess potential economic and political impacts and to inform policy on conflict and cooperation between riparians. The authors conclude that satellite data modeled with gauge station runoff reduce the uncertainty inherent in negotiating an international water agreement under increased hydrological variability, and thus can assist policy makers to devise more efficient institutional apparatus.Publication What are the Main Variables that Influence the Dynamics of Ecuador’s Sovereign Risk?(Taylor & Francis, 2023-01-16)This paper analyzes the determinants of Ecuador’s sovereign spreads as measured by the EMBI index. We use Bayesian algorithms to estimate a structural vector autoregressive model with three blocks (international, regional, and domestic). Global variables drive most of the dynamics of the Ecuadorian EMBI, also influenced by the evolution of sovereign risks in other Latin American countries like Chile and Peru. We likewise show that the increase in public debt is the primary domestic variable affecting the Ecuadorian EMBI.Publication Strategic Planning for Poverty Reduction in Vietnam : Progress and Challenges for Meeting the Localized Millennium Development Goals(World Bank, Washington, DC, 2003-01)This paper discusses the progress that Vietnam has made toward meeting a core set of development goals that the government recently adopted as part of its Comprehensive Poverty Reduction and Growth Strategy (CPRGS). These goals are strongly related to the Millennium Development Goals (MDGs), but are adapted and expanded to reflect Vietnam's national challenges and the government's ambitious development plans. For each Vietnam Development Goal, the authors describe recent trends in relation to the trajectories implied by the MDGs, outline the intermediate targets identified by the government, and discuss the challenges involved in meeting these. Relative to other countries of similar per capita expenditures, Vietnam has made rapid progress in a number of key areas. Poverty has halved over the 1990s, enrollment rates in primary education have risen to 91 percent (although there is a quality problem), indicators of gender equity have been strengthened, child mortality has been reduced, maternal health has improved, and real progress has been made in combating malaria and other communicable diseases. In contrast, Vietnam scores worse than other comparable countries in the areas of child malnutrition, access to clean water, and combating HIV/AIDS. A number of important crosscutting issues emerge from this analysis that need to be addressed. One such challenge is improving equity, both in terms of ensuring that the benefits of growth are distributed evenly across the population and in terms of access to public services. This will involve addressing the affordability of education and curative health care for poor households. Improvements in public expenditure planning are needed to align resources better to stated desired outcomes and to link nationally-defined targets to subnational planning and budgeting processes. There is also a need to address capacity and data gaps which will be crucial for effective monitoring.Publication Rwanda Diagnostic Review of Consumer Protection and Financial Literacy(World Bank, Washington, DC, 2013-11)Although the Parliament of Rwanda has passed an impressive array of financial sector laws since 2008, the laws relevant to financial consumer protection are very limited and in some cases overlapping. Consumer protection in Rwandan banking, microfinance, and insurance sectors is fragmented because of insufficiently defined roles and responsibilities among institutions and unclear enforcement capacity. While there are some strong provisions in some areas such as electronic money transfer, electronic transmission, credit information, and market conduct regulation in the insurance industry, many other areas are lagging. Rwandan authorities recognize that a sound financial consumer protection framework is fundamental to improving usage and quality of financial services, access to them, and overall deepening of the financial sector. This World Bank diagnostic review was requested by the National Bank of Rwanda (BNR) in November 2012. Modules on banking and microfinance sectors were developed based on publicly available information and data during the World Bank mission in Rwanda, and the review of the insurance sector was conducted through a desk review using the data obtained from BNR data requests and questionnaires, and the analysis is therefore constrained by it. Volume I of the review summarizes its key findings and recommendations, and volume II provides a detailed assessment against the World Bank’s good practices on financial consumer protection.Publication Public Spending In Health Sector in Malawi(World Bank, Washington, DC, 2020-12)Malawi’s economic growth has been low and volatile for the past two decades, leading to stagnating high poverty levels. The Coronavirus (COVID-19) pandemic will negatively affected economic growth leading to lower government revenue. Despite low per capita growth, Malawi has made strong progress in many areas of human capital development since 2000. Notwithstanding the above, Malawi still faces considerable gaps in human capital, which will impede its ability to reduce poverty in the medium term. Malawi lags behind in some health and nutrition outcomes, including HIV and malaria prevalence. Strengthening human capital in Malawi will be critical to reduce poverty, increase inclusion in society, and create jobs. The World Bank launched a new Human capital index (HCI) in October 2018 as part of its broader Human capital project. One factor that contributes to low human capital outcomes is Malawi’s adolescent fertility rate, one of the highest rates of in the world, with 132 births per 1,000 women aged 15-19. The main underlying cause for the high adolescent fertility rate is the high rate of child marriage. The government is making efforts to strengthen human capital. To strengthen human capital in the face of limited fiscal space, Malawi needs to improve the efficiency and effectiveness of government and donor spending on human capital. To address this problem, there is need to integrate financial reporting systems at district and central government levels. This will enhance government’s ability to monitor and evaluate expenditure and program implementation across sectors.