An evaluation of funding challenges in the Malawian public healthcare delivery sector

Background: Reliable and adequate healthcare funding is crucial in public healthcare service delivery. However, district hospitals in Malawi, face funding challenges as evidenced by poor service delivery. Aim: This study aimed at investigating funding challenges experienced by public district hospitals of Malawi in the provision of healthcare services and proposing strategies for improved funding. Setting: The research presented in this article evaluates funding challenges in the public healthcare sector in Malawi, a developing country. Method: An exploratory sequential mixed method design was used. Qualitative data were collected through semi-structured interviews with 10 purposively selected individuals and were analysed thematically. Quantitative data were collected using questionnaires from 328 respondents. Quantitative data underwent factor and univariate analysis. Results: The study revealed that government funding is received late and is inadequate; donor funding was declining and earmarked for specific health activities; while income generation capacity of hospitals and Councils is weak. The study suggests that hospitals should introduce fees for service, government should be lobbied for increased funding allocations, and revenue–generating capacity of hospitals and Councils should be enhanced. Conclusion: The study concludes that there is an urgent need for government to prioritise the healthcare delivery sector and increase its funding. Hospitals and Councils should be innovative in order to generate additional funding for operations and the revenue generation capacity of hospitals and Councils should thus, be enhanced. Contribution: The study adds to the healthcare funding debate in developing countries by providing a context–specific analysis of healthcare funding challenges and suggesting improvement strategies.