Majority of citizens say they worry "a lot" about being unable to obtain or afford medical care.
Key findings
- More than seven in 10 Malawians (72%) say they visited a public clinic or hospital during the 12 months prior to the survey. Among those who did: o More than six in 10 (62%) say it was difficult to obtain the services they needed. o One in five (21%) say they had to pay a bribe, give a gift, or do a favour for a health worker in order to receive services. o Large majorities say they encountered a lack of medicines or medical supplies (81%), long wait times (81%), and/or high costs that prevented them from getting the care or medicines they needed (69%).
- Six in 10 Malawians (60%) say that they or a member of their family went without medicine or medical care at least once during the previous year.
- Six in 10 Malawians (60%) say the government is doing "fairly well" or "very well" on improving basic health services.
- But more than eight in 10 citizens (85%) say they worry at least "a little" about being unable to obtain or afford medical care, including 57% who say they worry "a lot."
- Only 4% of Malawians say they have medical aid coverage.
- Almost two-thirds (63%) of respondents want the government to ensure that all citizens have access to adequate health care, even if it means raising taxes.
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Malawi's Vision 2063 calls for universal, high-quality, equitable, and affordable health care as a foundation for a healthy population with improved life expectancy working toward the socio economic transformation of the country (Government of Malawi, 2020). But as in many countries, this is a tall order as Malawi struggles to meet demand for basic health-care services.
The government delivers 60% of the country's medical services, relying on the Christian Health Association of Malawi (29%) and other non-state actors to provide the rest (Khuluza & Haefele Abah, 2019). Uptake of health insurance is low (N'gambi et al., 2022). Among the health sector's many challenges are limited funding, too few facilities, a lack of medical supplies, and an acute shortage of health workers (Msokwa, 2021). In Malawi, the doctor-to-patient ratio was estimated at 0.5 to 10,000 in 2022, compared to the worldwide density of 17.2 to 10,000 (World Health Organization, 2023).
While Malawi provides free services through its public health system, evidence has shown that informal payments to health-care workers are not uncommon (Mphande-Namangale & Kazanga-Chiumia, 2021).
Findings of the most recent Afrobarometer survey show that a majority of Malawians rely on public health facilities for their health-care needs and think the government is doing a good job of improving basic services.
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However, the results also reveal a long list of problems that citizens encounter at public clinics and hospitals, including difficulty obtaining services, demands for bribes in exchange for care, a lack of medicines or medical supplies, long wait times, and unaffordable costs. Very few Malawians have health insurance, and a majority say they went without needed medical care during the previous year. Overwhelmingly, citizens say they worry about being unable to obtain or afford medical care, and a majority want the government to ensure universal health care, even if it has to raise taxes.
Witness Tapani Alfonso Witness Tapani Alfonso is a junior research fellow at the Centre for Social Research at the University of Malawi in Zomba.
Faith Agness Chilimtsidya Faith Agness Chilimtsidya is a research intern at the Centre for Social Research, University of Malawi.
