The importance of an efficient and effective health system in the achievement of health-related millennium development goals (MDGs) cannot be overemphasized. Without a functioning health system to deliver basic health care and actions to tackle critical issues such as shocking levels of infant and maternal morbidity and mortality as well as to combat HIV/AIDS and other diseases like malaria and tuberculosis, these health problems are likely to escalate. An efficient health system with effective health governance structures, adequate and appropriate human resources for health and measures to promote access and equity to healthcare services could be a key to the attainment of health related millennium development goals. Hence, the purpose of this review is to come up with a country level report on the knowledge and research gaps related to governance, access and equity and human resources in the health system in Malawi and how they affect the attainment of health-related MDGs 4, 5 and 6 in Malawi.
Using a review of literature, the study conducted a SWOT analysis of governance, human resources for health and access and equity issues in the health system of Malawi to identify strengths, weakness/challenges, opportunities and gaps in these themes that could affect the achievement of health-related MDGs (MDG 4, 5 and 6) in Malawi. Both electronic and hard copies of strategic documents and implementation/progress reports related to MDGs 4, 5 and 6 in Malawi were reviewed.
The review results showed that lack of capacity to participate effectively in the health governance by some stakeholders, limited or poor links between the health system and the communities, ineffective policies and strategies, lack of effective measures to promote access and equity of health services, lack of effective inter-and-multi-sectoral collaborations, lack of good monitoring structures for health information, inadequate capacity to use health data for planning, inadequate human resources for health and lack of appropriate training and deployment of health workers can lead to the inefficiency and ineffectiveness of the health system to promote activities that can facilitate the attainment of health related MDGs (4, 5 and 6).
The review concludes that unless the health system in Malawi is strengthened to ensure that there is capacity development within key health staff both in terms of technical as well as managerial skills; improve the health governance structures to promote equal participation in decision-making related to health issues (particularly those covered by MDG 4, 5 and 6), and increase measures that can promote access and equity to health care services by all people including the marginalized, the health system in Malawi cannot facilitate the attainment of health-related MDGs (4, 5 and 6).
The review hence recommends that further research should be done investigating issues highlighted to impact on governance, human resources and access and equity. Besides, it also recommends that measures that can strengthen the health system in the aforementioned themes should be considered.
