Published data prepared by the World Bank and the Malawi Integrated Household Surveys are augmented by analysis of Demographic and Health and Multiple Indicator Cluster Surveys. Inequalities are identified and quantified using asset scores, wealth quintiles and the concentration index – a measure of inequality.
Results

65% of people live below the poverty line. 28% of people are ultra poor. Income inequality as measured by the Gini coefficient is similar to the USA.

Rural life is more disadvantageous than poverty in child mortality. The rural poor report less but probably have more ill health. Full primary education eliminates the unequal fertility rates found between rich and poor. Both education and poverty seem to play a part in malnutrition and there has been a marked reduction in the inequality of severe stunting recently. But child mortality is becoming more inequitable as it improves. Use of health services is inequitable but this is becoming less so. Underlying determinants show a mixed picture – some show inequality, some equality, but the trend is towards a more equitable distribution of these determinants.
Conclusions
Poverty in all its facets is a key underlying cause of ill health in Malawi. Recent efforts to improve access to health care through the Essential Health Package have tended to reduce inequalities. Patience and persistence is required for these to have an effect on the underlying health of the poor