Effects of Public Health Financing on Reproductive Health Service Delivery in Malawi

Modern contraception is critical for achieving global health outcomes, like reducing maternal mortality, maximizing the health benefits of birth spacing, and promoting the economic empowerment of women. Domestic financing remains the most sustainable source of investment that can drive transformative results with strong accountability mechanisms and enabling legislation and policies. Trends in stockout rate for a selected modern contraceptive (DepoProvera), utilization of modern contraceptives, and household expenditure on family planning in comparison to changes in government expenditure on family planning were used. Data was collected between the years 2013 and 2021 in the Open Logistics Information Management System (Open LMIS), District Health Information System 2 (DHIS2), Health Management Information System (HMIS), and National Health Accounts (NHA). Health facilities data reported during FY2013/2014 to FY2020/21 for the Open LMIS and FY2015/16 to FY2017/18 for DHIS 2 and NHA data. Results show that between FY2013/14 and FY2020/21, the country experienced inconsistent availability of Depo-Provera despite the increase in government budgetary allocation since FY2013/14. Between FY2015/16 and FY2017/18, the utilization of modern contraceptives in Malawi had grown tremendously despite the stagnant government expenditure on family planning. Lastly, the study found that the stagnant government expenditure on family planning between FY2015/16 and FY2017/18 coexisted with increased household expenditure on family planning. Funding gaps for family planning commodities coexist with ineffective supply chain systems which affect the availability of commodities in health facilities. An increase in the utilization of modern contraceptives in Malawi exists amidst a high unmet need for modern contraceptives and unintended pregnancies.