Allocating resources to support universal health coverage: policy processes and implementation in Malawi

Area of Science:

• Health economics
• Public health policy
• Resource allocation

Background:

• Optimizing health outcomes in low- and middle-income countries (LMICs) necessitates efficient resource distribution.
• Technical research on resource allocation efficiency exists, but practical policy guidance is limited.
• Malawi's 2019 revision of its resource allocation formula (RAF) for geographical budget distribution aimed to address these gaps.

Purpose of the Study:

• To discuss Malawi's experience in revising its RAF for equitable geographical distribution of the government health sector budget.
• To outline the policy processes, practical considerations, and political factors involved in revising and implementing the RAF.
• To provide guidance for other countries undertaking similar resource allocation framework revisions.

Main Methods:

• The study details the policy process initiated by district assemblies and led by the Ministry of Health and Population (MOHP).
• It covers technical and deliberative work undertaken by MOHP to develop the revised RAF.
• The article discusses steps taken to date and future actions required for legal establishment and implementation.

Main Results:

• A revised RAF was developed through a collaborative policy process involving district assemblies and the MOHP.
• Practical and political considerations for RAF acceptability and implementation feasibility were highlighted.
• The process involved technical development, deliberation, and planning for legal establishment and rollout.

Conclusions:

• The revision of Malawi's RAF demonstrates a pathway for equitable health resource allocation in LMICs.
• Successful implementation requires addressing practical and political challenges alongside technical development.
• This case study offers valuable insights and a potential framework for other nations revising their resource allocation systems.