National Action Plan for the Prevention and Management of Non-Communicable Diseases in Malawi 2017 - 2022

Objectives

The 2017-2022 National Action Plan for Non-Communicable Diseases and Mental Health seeks a Malawi in which all people enjoy improved quality of life through reduced morbidity and mortality from non-communicable diseases and related conditions.[1][2]Its overall goal is to reduce preventable morbidity, disability and avoidable mortality from non-communicable diseases and injuries.[2]It contributes to the global ambition of reducing premature mortality from non-communicable diseases by 25% by 2025.[3]

• Raise the priority of non-communicable diseases in national, district and community development work by June 2022.[2][4]
• Establish and strengthen national policies, plans and a multisectoral framework for prevention and control, including integration into national health planning and health-system reorientation.[4][5]
• Reduce exposure to tobacco use, harmful alcohol use, unhealthy diets and physical inactivity through population prevention, policy and lifestyle change.[6][4]
• Strengthen surveillance, monitoring, evaluation and research; health-system capacity; programme coordination; resource mobilisation; and partnerships by June 2022.[4][7][8]
• Deliver prevention, screening and early diagnosis, treatment and follow-up, rehabilitation and palliative care across the continuum of care.[6][9]

The Plan organises action around chronic non-communicable diseases, including cardiovascular, diabetes, chronic respiratory, kidney, neurological and blood conditions; cancers; injury, trauma and violence; and mental health and neurological disorders.[4]It also addresses epilepsy, mental illnesses and substance use, congenital conditions, and priority injury conditions.[6][10][11]

• Strengthen chronic disease services through screening, early diagnosis, referral, essential medicines, equipment, trained staff and clinical guidelines.[7][12]
• Improve cancer care through a national cancer centre, palliative care expansion, cancer workforce development and better access to cytotoxic and other cancer medicines.[13][14][15]
• Reduce trauma, injury and violence through primary prevention, emergency care, rehabilitation, integrated survivor support and multisectoral violence prevention.[16][17][18]
• Promote mental health, protect the rights of vulnerable groups, integrate mental health and epilepsy into primary and secondary care, and expand specialist infrastructure and support.[19][20][21][22]

The Plan is grounded in a public-health and equity perspective: interventions should reach rural and urban populations, public and private sectors, and poor and marginalised communities, recognising differing risk profiles and the links between non-communicable diseases and poverty.[23][2][9]

Implementation

Implementation uses an integrated, evidence-based, action-oriented and multisectoral model that embeds prevention and care within primary, secondary and tertiary health services rather than relying on fragmented or centralised interventions.[3][9]It combines institutional action, community participation and public policy, while linking prevention with screening, clinical management, rehabilitation and palliative care.[9][24]

• Coordinate national leadership through the Ministry of Health, particularly the Non-Communicable Diseases and Mental Health Unit, which serves as secretariat to a national Non-Communicable Disease Technical Working Group.[24]
• Use thematic steering committees to develop implementation guidelines and monitor progress, alongside district non-communicable disease coordinators, mental health focal persons, District Health Management Teams and zonal health offices.[24]
• Engage government ministries, development partners, academic and research institutions, civil society, communities, professional bodies, private providers and the private sector in delivery and advocacy.[6][4][25]
• Strengthen community structures to promote healthy lifestyles, positive health-seeking behaviour, awareness and participation in prevention and care.[24][26]
• Support implementation through trained personnel, supervision, quality control, guidelines, public education, legislation, regulation, media interventions, research and partnerships.[4][9]

Operationally, the Plan calls for national policies and communication strategies; stronger tobacco, alcohol, food and physical-activity measures; standardised case-management and referral guidelines; expansion of screening and outreach; improved medicine procurement and equipment maintenance; upgraded hospital and primary-care infrastructure; and electronic reporting systems.[5][27][28][29]Specific service actions include nurse-led health-centre clinics, centres of excellence for chronic disease care, emergency medical services, trauma units, one-stop centres for violence survivors, and mental health and epilepsy services in community, hospital and prison settings.[30][29][31][17][21]

Monitoring arrangements include process indicators in intervention matrices, thematic monitoring and evaluation frameworks, annual review of outcome indicators, periodic impact monitoring and a formal Plan evaluation in 2022.[24]Indicators cover policy outputs, trained workers, service readiness, screening coverage, registries, research activity, awareness campaigns and infrastructure development.[7][8][12]National health surveys are planned every five years, the trauma registry annually, and the cancer registry every three years.[8]Transparency and accountability are to be supported through civil-society advocacy, community participation, reports, verification records and designated responsible institutions.[26][32][33]

Financing relies on strengthened programme management, a proposed national budget vote for the non-communicable disease programme, partner resource mobilisation, donor proposals and potential mobilisation of alcohol-levy funds.[7][34]The supplied material does not specify total monetary budgets, costed activities, allocations, funding gaps or economic assumptions.[7][34]

Monitoring & Evaluation

The Action Plan establishes a monitoring, evaluation and research approach intended to track implementation, assess intervention effectiveness and impact, inform advocacy and policy, and strengthen evidence on non-communicable diseases, injuries, violence, epilepsy and mental health.[4][24][8][35]

• Use an intervention matrix with process indicators, and develop thematic monitoring and evaluation frameworks through steering committees during implementation planning.[24]
• Review outcome indicators annually, monitor impact indicators at relevant intervals, and conduct a formal Strategic Plan evaluation in 2022.[24]
• Assign indicators, measures, baselines, targets, data sources, reporting frequencies and responsible entities to strategic objectives, with the non-communicable disease programme identified as a principal reporting body.[36]
• Apply reporting frequencies that vary by activity, including quarterly, annual, once-only, five-year and ten-year cycles.[36][37]
• Integrate non-communicable disease variables into the Disease Surveillance and Response Strategy, the Health Management Information System and electronic medical-record systems.[27][8][29]
• Strengthen cancer, trauma and mental health information systems through national cancer and trauma registries, mental health indicators in district health information systems, and a national mental health database.[8][38][39]
• Conduct national surveys of major risk factors every five years, review the trauma registry annually, update the cancer registry every three years, and undertake research-capacity activities and operational-research budget development every three years.[8]
• Develop coordinated research agendas, research technical working groups and operational studies for non-communicable diseases and mental health.[4][27][35][40]

Existing evidence includes the 2009 Stepwise survey, the 2017 Stepwise survey, Global Burden of Disease estimates, Malawi Epidemiology and Intervention Research Unit studies, the World Health Survey and National NCDI Poverty Commission findings.[41][10][23][42][43]Evidence limitations include outdated or incomplete population studies, inadequate epilepsy data, weak routine information systems, duplicate records, incomplete data and the absence of standard case definitions.[44][3][43]

Priority performance measures cover policy and strategy development, advocacy, workforce training, service availability, screening, medicines, equipment, referral systems, registries, research outputs and community outreach.[5][7][8][12]Examples include annual community education targets, 52 radio programmes per year, 80% completion of planned community forums, one national health event per year and four media review meetings per year.[32][33]Screening targets rise to 80% of district facilities conducting routine outpatient screening and to 29 districts undertaking integrated outreach screening and using screening registers by 2021/2022.[45]

Condition-specific monitoring includes Hepatitis B vaccination coverage among healthcare workers, targeted to rise from 25% in 2017/2018 to 90% in 2020/2021 and 2021/2022; two clean-burning cookstove campaigns and one schistosomiasis campaign annually; and establishment of two non-communicable disease centres of excellence by 2021.[46][47]Trauma and violence monitoring includes audit dissemination, road-safety meetings, training records, Health Management Information System reporting on injury, disability and violence, and National Trauma Register surveillance.[16][48][38]

Accountability mechanisms include technical oversight by a national Non-Communicable Disease Technical Working Group, steering-committee progress monitoring, district coordinators and mental health focal persons, reporting through District Health Management Teams and zonal offices, and transparency supported by civil-society advocacy and community participation.[24][26]The supplied text does not provide a single complete cross-plan accountability framework or a universally specified reporting schedule for every thematic area.[24][29][49]

Costing & Financing

The Action Plan recognises major financing and resource constraints but provides very limited quantified costing information. It calls for national budgeting, resource mobilisation, partner engagement and more equitable alignment between financing and the burden of non-communicable diseases, injuries and mental health conditions.[3][7][34]

• Establish a national budget vote for the non-communicable disease programme and develop donor proposals, mobilise partner resources and mobilise funds through the alcohol levy.[7][34]
• Develop a budget for operational non-communicable disease research.[27][8]
• Advocate for donors to contribute to procurement of chronic non-communicable disease medicines and supplies.[28]
• Consider directing taxes on tobacco, alcohol and unhealthy foods towards prevention and control activities, alongside stronger customs enforcement and tax collection.[25]
• Advocate for 12% of district budgets to be spent on mental health.[35]

Government funding for health, particularly non-communicable diseases, and international support for prevention and management are described as inadequate; limited funds also constrain health promotion, education and research.[25][43]Financial capacity, human resources, infrastructure, diagnostics, medicines, equipment, staff time and political will are repeatedly identified as implementation risks or enabling conditions.[2][30][28][29]UNICEF and Baobab Health Trust provided financial support for meetings to finalise the Action Plan in 2017, while health development partners provided financial and technical support for plan development.[50]

No total programme budget, activity-level costings, expenditure allocations, quantified funding gap, currency-denominated financing commitment or economic analysis is specified in the supplied text.[7][34][28][14]