Donor coordination to support universal health coverage in Malawi

Area of Science:

• Global Health
• Health Systems Strengthening
• Development Assistance

Background:

• Development assistance significantly funds health in least developed countries, but fragmentation causes inefficiencies and hinders Universal Health Coverage (UHC).
• Malawi faces extreme aid fragmentation, with donors funding 55% of health expenditure through numerous sources, leading to poor coordination and misaligned priorities.

Approach:

• A case study documented the iterative development, implementation, and institutionalization of aid coordination tools by Malawi's Ministry of Health (MoH).
• The MoH led the process with technical support, utilizing grey literature and author experience to scale up tools integrated with public financial management systems.

Key Points:

• Iterative use and revision of coordination tools by the Malawian government at national and subnational levels were crucial for successful adoption.
• Tools inform resource allocation, assess financing gaps for national and district plans, and guide donor grant applications.
• Tools are adapting to Malawi's Health Sector Strategic Plan 2023-2030 under a 'One Plan, One Budget and One Report' framework.

Conclusions:

• The coordination tools represent an incremental step towards better aid alignment for Universal Health Coverage (UHC).
• Success is limited by power imbalances and misaligned incentives between donors and the Malawian government, necessitating broader aid architecture reform.