The Commission on Macroeconomics and Health (CMH) was established by former World Health Organization Director-General in January 2000 to assess the place of health in global economic development. In 2001, the Commission released a major report highlighting the link between a country health condition and its socio-economic performance. It is pointed out that extending the coverage of crucial health services, including a relatively small number of specific interventions, to the world’s poor could save millions of lives each year, reduce poverty, spur economic development, and promote global security. Based on the proofs that investing substantially more in health will result in greater economic returns, the CMH proposes to see the health sector not longer as a ‘resources consumer sector’, but as a productive economic sector with a very high returns on investment when resources are effectively used to reach targets of interventions.

The government of Malawi has been one of the first African countries to show interest in the Macroeconomics and Health (M&H) sensitising initiatives held after the publication of the report in 2001. In early February 2004 a first WHO-AFRO mission was organised to advocate for a M&H strategy in Malawi. The MoHP, the national M&H focal point and the AFRO M&H coordinator agreed that a second longer support mission would have taken place to ‘make the ball rolling’. Under this rationale, a second support mission was organised between August and September 2004. Specific objectives of the second support-mission were: collect data and indicate sources on disease burden, poverty, and health financing. Analyse the structure and organization of the health systems and the current health strategy. Review work undertaken by national and international institutions on the national health expenditures and accounts and analyse current investment flows and funds supporting existing health sector and sustainable development initiatives.

The health indicators of Malawi have generally remained poor (see table 2.1). The implementation of the 4th National Health Plan 1999-2004 has not fully achieved all its ambitious objectives and most of them have been kept as a constitutive part of the newly designed Programme of Work 2004-2010 between the Ministry of Health and concerned stakeholders. Infant and child mortality rates are high even for Sub-Saharan standards. While recognising the difficulties of getting a fully comprehensive and reliable picture, the MMR of Malawi is one of the highest in the world and it doubled in the last 10 years. Most deaths are due to lack of quality in services provision, incorrect interventions, omissions and incorrect treatment. Delays in seeking care, poor referral systems, lack of appropriate drugs and equipment, and inadequate number of health staff also play an important role.

Poverty in Malawi is widespread and severe; nearly 60% of Malawians lived below the poverty line in 2000 (table 2.3). During the 1990s, poverty levels in rural areas remained largely unchanged, while urban poverty increased. As a consequence of poverty, most social indicators are very low compared to the rest of Africa. Not only is Malawi among the world’s poorest countries, but it simultaneously suffers from an extremely skewed distribution of income. With a Gini coefficient of 0.62, Malawi has one of the highest income-distribution disparities in the world, lower only than that of Brazil. As a consequence poverty is both widespread and most likely to severely affect the poorest of the poor.