.png?sfvrsn=6d0e27cd_1 "Partnership for Change - v7 (1)")
By Lusayo Banda, Communications Manager, Amref Malawi
As Malawi’s Parliament scrutinises the proposed MK1.02 trillion (Approximately 586 million USD) national budget, civil society organisations sent a clear message that health, especially for women, children and adolescents cannot remain underfunded.
During an engagement at the Parliament Building, CSOs working under the Collaborative Advocacy Action Plan (CAAP) in Malawi met with the Parliamentary Committee on Health to analyze the 2026/2027 health budget and push for more deliberate investment towards women’s, children’s, and adolescents’ health (WCAH).
At 9.2% of the national budget, the proposed allocation falls short of the 15% commitment Malawi made under the Abuja Declaration. The gap reflects limitations in what the health system can realistically deliver.
Mounting fiscal pressure and declining external support
Malawi now spends more on debt servicing than on health and education combined. Debt repayments absorb 27% of the national budget, significantly limiting fiscal space for health investment.
At the same time, declining external support is deepening the challenge. For example, funding from the United States Government is estimated to have dropped by US$62 million between 2024 and 2025, leaving critical gaps in HIV, TB and MNCH services.
A coordinated civil society response
At this critical time, the engagement brought together Members of Parliament, the Ministry of Health, and health advocates including Amref Health Africa in Malawi, Malawi Health Equity Network, Family Planning Association of Malawi, ActionAid Malawi, OXFAM, Water Aid, IPAS, and the Malawi Sexual Reproductive Health and Rights Alliance among others.
Together, CSOs delivered a clear, coordinated message shaped by CAAP priorities: Malawi’s health budget must do more to respond to the needs of women, children, and adolescents. CSOs walked Members of Parliament through the numbers, highlighting where allocations fall short and what that means for service delivery on the ground.
Progress at risk without sustained investment
Based on findings from the recently released Malawi Demographic Health Survey 2024, Malawi has made considerable progress in advancing the health of women, children, and adolescents.
Maternal mortality has fallen by nearly half in the past ten years. From 439 maternal deaths per 100,000 live births in 2015 to 224 in 2024.
Childhood mortality has been reduced significantly between 2016 and 2024. For example, under-5 mortality rates reduced from 64 per 1,000 livebirths to 48, infant mortality from 42 per 1,000 livebirths to 35 and neonatal mortality rate from 27 per 1,000 livebirths to 243
66% of married women are using modern family planning methods, up from 58% in 2016.
Despite gains, stakeholders cautioned against complacency amid tightening fiscal space.
System constraints threaten WCAH
With district health budgets reduced by 24%, there are growing concerns about whether facilities can maintain essential services. In some districts, a single health worker often serves far more people than recommended, often without adequate supplies, transport, or support.
In Malawi, the population-to-health-worker ratio has stagnated at around 2.85 health workers per 1,000 population against the WHO target of 4.45 per 1,000. While the vacancy rate for nurses and midwives stands at around 54%, a situation that compromises the quality of health services, especially to women, children, and adolescents.
Recommendations to strengthen health financing
Chairperson of the Parliamentary Committee on Health, Hon. Anthony Masamba, MP, emphasized the importance of using the budget review process to go beyond identifying challenges.
“This budget analysis is an important step in ensuring that our allocations respond to the real health needs of Malawians. We must move beyond identifying gaps and focus on practical solutions that strengthen service delivery, particularly for women, children, and adolescents, as Malawi navigates declining donor support alongside rising demand for health services.”
Increasing domestic resource mobilization for health remains a key priority for Parliament. As highlighted by Hon. Anthony Masamba, the Parliament of Malawi is currently reviewing a range of options to increase revenue, including leveraging sin taxes on products containing sugar.
Key recommendations put forward during the engagement include:
Increase domestic health financing to meet the Abuja target of 15% and the WHO benchmark of US$86 per capita (from the current US$39.8).
Prioritise RMNCAH investment, ensuring at least 30% of the health budget is allocated by 2030.
Expand access to family planning, reduce unmet need to below 11%, and strengthen private sector engagement.
Roll out direct health facility financing across all 28 districts to improve efficiency and availability of essential commodities.
Establish a pooled health fund to strengthen resource management and expand financing sources, including through targeted levies.
This engagement comes as Members of Parliament review allocations across Ministries, Departments and Agencies ahead of full budget deliberations.
For CSOs the financing review meeting provided a key opportunity to influence how national priorities are reflected in the final budget. As the Country Director of Amref Health Africa in Malawi, Hester Mkwinda Nyasulu noted:
“As Parliament reviews this budget, there is a real opportunity to make deliberate choices that prioritise women, children and adolescents. The progress Malawi has made is significant, but it is not guaranteed. Sustained investment in health is what will determine whether that progress continues.”
CSOs want to ensure that these decisions are informed not only by budget considerations but by the realities within communities and health facilities.
Continued collaboration
As the budget cycle progresses, CAAP partners will focus on ensuring adequate allocations to RMNCAH and the timely disbursement of funds, including for family planning commodities, through continued collaboration between Parliament, Ministry of Finance and the Ministry of Health’s Reproductive Health Directorate.
The meeting reaffirmed the central role of civil society in strengthening mutual accountability, including within the context of government-to-government financing arrangements, where transparency and oversight remain critical.
CAAP’s multi-stakeholder approach, bringing together government, civil society, and partners, will continue to serve as a key platform for aligning priorities, strengthening oversight, and driving collective action to sustain and accelerate gains for women’s, children’s, and adolescents’ health, including SRHR.