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

Objectives

Malawi’s National Action Plan for Non-Communicable Diseases and Mental Health, covering 2017 to 2022, seeks to improve quality of life by reducing preventable morbidity, disability and avoidable mortality from non-communicable diseases, injuries and mental health conditions.[1][2]It aims to contribute to a 25% reduction in premature non-communicable disease mortality by 2025 and to raise the priority given to these conditions at national, district and community levels by June 2022.[1][3]

• Prioritise prevention, early detection, treatment, follow-up, rehabilitation and palliative care across cardiovascular diseases, diabetes, chronic respiratory and kidney diseases, cancers, epilepsy, mental illnesses, injuries, trauma and violence.[4][3][5]
• Reduce tobacco use, harmful alcohol use, unhealthy diets and physical inactivity through supportive policies, legislation, public education, healthy-environment measures and community action.[3][6][7]
• Establish and strengthen national policies, plans and regulatory frameworks for prevention and control, including cancer, mental health, tobacco, alcohol and violence-related policies.[2][6][8][9]
• Strengthen surveillance, monitoring, evaluation, research, programme management, health-system capacity and partnerships by June 2022.[3][10][11]
• Promote equitable, culturally and age-sensitive care that reaches rural and urban populations, people using public and private services, and groups disproportionately affected by poverty, young age, disability, stigma or marginalisation.[1][5][12]

The framework is evidence-based and responds to a substantial national burden of non-communicable diseases and injuries, while recognising that many conditions are not explained solely by conventional lifestyle and metabolic risks.[13][14]It therefore combines population-level risk reduction with condition-specific service strengthening, including chronic disease, cancer, trauma, violence, epilepsy and mental health care.[15][16][17]

• Expand chronic disease services through screening, early diagnosis, evidence-based treatment guidelines, referral systems, essential medicines, equipment, laboratory capacity and infrastructure at all levels of care.[10][18][19]
• Improve cancer prevention, diagnosis, treatment, palliative care and access to cytotoxic medicines, including establishment of a national cancer centre.[20][21][22]
• Reduce trauma, injury and violence through safer transport and public environments, public awareness, emergency medical care, rehabilitation, One Stop Centres and multisectoral violence prevention.[23][24][25][26]
• Integrate mental health and epilepsy services into primary and secondary care, expand awareness and rights protection, improve workforce capacity, and strengthen access to medicines, psychosocial support, rehabilitation and specialist services.[27][28][29][30]

Implementation

Implementation uses an integrated, multisectoral and multidisciplinary public-health model rather than disconnected disease-specific projects.[1][5]Care is intended to be integrated across primary, secondary and tertiary services and delivered along a continuum from prevention and screening to treatment, rehabilitation and palliative care.[1][5]Community involvement, public education, policy action, regulation, research, workforce development and service-quality improvement are intended to operate together.[3][5][31]

• Coordinate national implementation through the Ministry of Health’s Non-Communicable Disease and Mental Health Unit, which serves as secretariat to the National Non-Communicable Disease Technical Working Group under the Essential Health Package Technical Working Group.[31]
• Establish thematic steering committees to develop implementation guidance and monitor progress across the plan’s intervention areas.[31]
• Assign district health offices a non-communicable disease coordinator and mental health focal person, working with District Health Management Teams and reporting through zonal health offices to the national unit.[31]
• Engage government ministries, development partners, faith-based providers, private-sector organisations, civil society, professional and patient associations, research institutions, communities and international agencies in implementation and advocacy.[4][32][10]
• Use public-private partnership guidance, resource mobilisation, high-level advocacy and multisectoral advisory structures to support prevention and control.[10][33][34]

Operational delivery combines health promotion with facility and community-based interventions. Planned activities include communication campaigns through radio, television, schools, workplaces, religious and traditional networks; training health workers and community volunteers; developing and distributing guidelines and job aids; strengthening referral pathways; and improving the availability of essential medicines, diagnostics, equipment and specialist support.[35][36][37][38]Community structures are intended to promote healthy lifestyles, positive health-seeking behaviour and participation, while civil society organisations are expected to advocate for service quality, transparency and accountability.[31][32]

• Implement surveillance by integrating non-communicable disease variables into the Disease Surveillance and Response Strategy, Health Management Information System, national surveys, cancer registries and trauma registries.[11][25]
• Develop research agendas and operational research, repeat the STEPwise survey, strengthen data reporting from clinical records, and expand electronic medical records for non-communicable disease services.[39][17]
• Monitor implementation through process, output, outcome and impact indicators, with thematic committees developing detailed frameworks, annual review of outcome indicators, periodic impact monitoring and a formal strategic-plan evaluation scheduled for 2022.[31]
• Track defined outputs such as policies and guidelines produced, workers trained, facilities equipped, services established, campaigns delivered, screenings undertaken and research activities completed.[33][11][18]
• Mobilise resources through a dedicated national budget vote, partner funding proposals, donor engagement and tracking of funds mobilised from an alcohol levy, although no overall budget or costed programme allocation is specified.[10][34]

Implementation is constrained by inadequate and uneven services, high patient costs, shortages and maldistribution of specialised and community health workers, limited diagnostics and commodities, fragmented data systems, limited research capacity, funding uncertainty and variable political commitment.[2][32][40][19]The plan consequently emphasises coordination, supervision, quality control, human-resource planning, affordable access and sustained domestic and partner resource mobilisation.[3][41][10]

Monitoring & Evaluation

The plan establishes a structured monitoring, evaluation and accountability approach for non-communicable diseases, injuries and mental health, combining thematic implementation matrices, process, output, outcome and impact indicators, specified verification sources, assigned responsibilities and periodic review.[31][10][33][36][42]Implementation and monitoring are intended to be integrated across four thematic areas, with thematic steering committees developing detailed monitoring and evaluation frameworks during implementation planning.[4][31]

• Monitor process indicators through intervention matrices, review outcome indicators annually for implementation planning, assess impact indicators at appropriate intervals, and undertake a formal strategic-plan evaluation in 2022.[31]
• Track the overarching outcome of contributing to a 25% reduction in premature mortality from non-communicable diseases by 2025.[1]
• Use frameworks that specify indicators, baselines, targets, data sources, reporting frequencies and responsible institutions, including quarterly, annual, once-off, five-year and ten-year reporting cycles.[33][7]
• Assign principal monitoring responsibility to the non-communicable disease programme, supported by the Ministry of Health, the Community Health and Medical Education Directorate, district structures, thematic committees, partners and other named implementing institutions.[31][7][11][18]
• Strengthen surveillance by incorporating non-communicable disease variables into the Disease Surveillance and Response Strategy, Health Management Information System, national health surveys, cancer registry, trauma registry and district reporting systems.[35][11][17][25]
• Address identified information weaknesses, including incomplete or duplicated data, inconsistent case definitions, fragmented data systems, inadequate comprehensive surveillance, limited population-based research and shortages of up-to-date national survey data.[1][2][35]
• Measure policy, prevention and health-system progress through indicators such as taskforces and advisory structures established, policies and guidelines available, target groups reached, health workers trained, services and medicines available, facilities equipped, screening coverage, referrals, registries and research outputs.[6][10][33][18]
• Monitor research through an operational research agenda, updated priorities, a repeat STEPwise survey, research technical working groups and publications, with five operational research publications targeted annually from 2017/18 to 2021/22.[11][39]
• Use service-specific monitoring for cancer, trauma, violence and mental health, including training records, supervision reports, facility reports, medicine supply reports, curriculum documentation, meeting minutes, activity reports and annual reports.[20][43][44][29][30]
• Promote accountability through civil-society advocacy for transparency, accountability and community participation, while using reports, registers, media records, meeting minutes and other verification materials to substantiate implementation.[32][36][42]

Costing & Financing

Financing is recognised as essential to implementation, but the supplied material provides no comprehensive costed plan, total budget, quantified programme allocation, expenditure estimate, quantified funding gap or detailed economic assumptions.[3][10][34]The plan nevertheless identifies persistent financial constraints, including inadequate government funding for health and non-communicable diseases, limited funding for health promotion, high patient treatment costs, and dependence on funding availability for many service-delivery activities.[32][41][35][40][19]

• Secure a dedicated national budget vote for the non-communicable disease programme and a budget supporting implementation of national policy, strategy and programme activities.[10][34]
• Mobilise partner resources, develop funding proposals, identify donors and monitor the proportion of resources mobilised from an alcohol levy.[10][34]
• Explore resource mobilisation through taxes on tobacco, alcohol and unhealthy foods, strengthen customs and excise collection, and seek international financial and technical support.[41]
• Develop an operational-research budget and monitor its availability, although no value or financing arrangement is specified.[45][11]
• Recognise funding as a recurring prerequisite or implementation risk for campaigns, training, guidelines, supervision, infrastructure, equipment, medicines, supplies, screening, emergency services, cancer care and mental-health interventions.[40][37][19][20][46][24]
• Advocate for large-donor support for chronic non-communicable disease medicines and supplies, with a target of increasing new donors from none in 2017/18 to four by 2021/22.[38]
• Support financial and technical assistance for mental-health partnerships and advocate for 12% of district budgets to be spent on mental health, without specifying whether this target is approved, funded or achieved.[47][48]
• Record development-stage support from health development partners, including financial support from UNICEF and Baobab Health Trust for meetings to finalise the Action Plan.[49]
• Characterise early detection and treatment of chronic kidney disease as relatively inexpensive and cost-effective, while providing no monetary estimate or formal economic analysis.[50]