Malawi is a low-income country located in Southern Africa and has a land area of approximately 118,000 square kilometers. It shares boundaries with Zambia to the west, Mozambique to the east, south and southwest and Tanzania to the north and north-east. The country is divided into three administrative regions namely Northern, Central and Southern regions. There are 28 administrative districts in Malawi as shown in Figure 1.
Figure 1: Administrative Map of Malawi
Each district is further divided into traditional authorities (TAs) and a village is the smallest administrative unit in Malawi. Politically, each district is also further divided into constituencies which are represented by Members of Parliament (MPs). Malawi has a multi-party system adopted in 1994. The country is ruled by a President who is elected using the first past the post electoral system. For operational purposes, the MoH has created 5 health zones with the Southern and Central Region each divided in two zones. The 5 health zones are as follows: North, Central East, Central West, South East and South West.
In 2017 Malawi’s population was estimated at 18.6 million people of which 85% live in rural areas. With a fertility rate of 5.7, the country’s population has almost doubled in the past 20 years. Malawi has a population density of 157.6 people/square km and is considered one of the most densely populated countries in Africa. Figure 2 shows population density by district.
Malawi’s literacy rate is estimated at 62%: it is higher among men (69%) than women (59%). Low literacy rates, especially among women affect the health of the population. Knowledge about diseases such as HIV and AIDS increases the higher educational level and better educated persons are more likely to access modern health care services compared to those with little or no education. Although enrolment in primary school has increased since the introduction of free primary school education, the challenge is that only 30% of children who begin Standard 1 complete primary education.
Figure 2: Map of Malawi showing Population Density by district, National census 2008 report
Malawi’s GDP has grown from 0.16 billion USD in 1960 to 5.44 billion USD in 2016. It was at its highest at 8 billion USD in 2011. In 2016 the country’s GDP per capita was at 300 USD with an inflation rate of 20% by December of the same year The Malawi Demographic Health Survey 2016 estimates that approximately 46% of the population are in the bottom 2 health quintiles. Poverty is generally higher among rural inhabitants compared to those in urban areas; 75%of those that live in urban areasare in the highestwealth quantile while nearly 50% of those in rural areas are in the bottom two wealth quantiles. The agriculture sector accounts for 35% of the national GDP, and according to the 2016 Malawi Demographic and Health Survey (MDHS), more women (59%) than men (44%) work in this sector.
The health status of the Malawi population
The health sector is characterized by a heavy burden of diseases evidenced by high levels of child and adult mortality and the high prevalence of communicable diseases such as TB, Malaria, HIV and AIDS and other tropical diseases. Evidence from a 2009 STEPS Survey report suggests that there is also an epidemiological shift characterized by a growing burden of non-communicable diseases in Malawi. It is estimated that 33% of adults aged 25-64 have hypertension, 5.6% have diabetes and about 5,000 new cases of cancer are registered each year. The prevalence of HIV among persons aged 15-49 years is estimated at 8.6 %; there were 36,000 new HIV infections; 24,000 AIDS related deaths; 1000,000 (CI; 970,000 – 1,100,000) of which 66 % were accessing antiretrovirals. According to the WHO in 2016 Malawi had a TB incident rate of 159/100,000 and 53 % TB/HIV coinfection rate in the same year. The 2017 Global Tuberculosis report estimates that 0.75 % and 6.4 % of new and relapse TB cases respectively, have Multi Drug/Rifampicin Resistant TB.
Malaria is still a major public health problem in Malawi. According to the WHO there were an estimated 4.5 million Malaria cases and 7000 Malaria deaths. Malaria accounts for about 34% of all outpatient visits, about 40% of all hospitalizations of children under five years old and 40% of all hospital deaths. The 2016 MDHS showed that 37 % of children under five are stunted; this is an improvement from the 47 % in 2010. 39 % of those in rural areas are stunted versus 25 % in urban areas. This has an important implication on demand for health care services for infants and children under-5 years of age, especially in rural areas. Malawi’s maternal mortality ratio (MMR) is estimated at 675/100,000 live births (a reduction from 984/100,000 live births in 2004). Significant progress has been made towards achieving MDG 4, with neonatal mortality rate now standing at 31 per 1000 live births.