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Allocating resources to support universal health coverage: policy processes and implementation in Malawi
  1. Pakwanja Twea1,
  2. Gerald Manthalu1,
  3. Sakshi Mohan2
  1. 1Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi
  2. 2Center for Health Economics (CHE), University of York, York, UK
  1. Correspondence to Sakshi Mohan; sakshi.mohan{at}


Optimising the use of limited health resources in low-income and middle-income countries towards the maximisation of health outcomes requires efficient distribution of resources across health services and geographical areas. While technical research exists on how efficiencies can be achieved in resource allocation, there is limited guidance on the policy processes required to convert these technical inputs into practicable solutions. In this article, we discuss Malawi’s experience in 2019 of revising its resource allocation formula (RAF) for the geographical distribution of the government health sector budget to the decentralised units in-charge of delivering primary and secondary healthcare. The policy process to revise the RAF in Malawi was initiated by district assemblies seeking a more equitable distribution of government resources, with the Ministry of Health and Population (MOHP) leading the technical and deliberative work. This article discusses all the steps undertaken by MOHP, Malawi to date as well as the steps necessary looking forward to legally establish the newly developed RAF and to start implementing it. We highlight the practical and political considerations in ensuring the acceptability and implementation feasibility of a revised RAF. It is hoped that this discussion will serve as guidance to other countries undergoing a revision of their resource allocation frameworks.

  • health policy
  • health economics

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  • Handling editor Seye Abimbola

  • Contributors PT and GM led the policy process described in the paper, provided valuable insights in drafting the manuscript and necessary revisions to the content of the paper based on their knowledge of the local policy processes and experience implementing the described process on the ground. SM is the main author and guarantor of the paper, responsible for drafting the manuscript and carrying out the literature search.

  • Funding The study was study by UK Research and Innovation as part of the Global Challenges Research Fund (Thanzi la Onse grant number MR/P028004/1). The funder had no involvement in the conduct of the study.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No additional data are available.