1. Strengthening PPPs and inter-faith
partnerships for UHC:
Example from Malawi
Dr. Mwai Makoka
Executive Director, Christian Health Association of Malawi
Presentation at ACHAP 7th Biennual Conference, Nairobi
25 February 2015

2. Background of CHAM
• Christian Health Association of Malawi (CHAM)
was established in 1966
• CHAM is an umbrella association for both
Catholic and Protestant churches’ health facilities
• Current membership includes:
– 12 Christian denominations
– 40 hospitals
– 90 health centres with maternity
– 45 health centres with OPD
– 12 training colleges

3. Service delivery
• Provides 37% of health services
• Trains 80% of mid-level health professionals
• 90% of CHAM health facilities are located in
rural areas, some of which are hard-to-reach
• CHAM is key partner to Government’s delivery
of the Essential Health Package and UHC

4. Memorandum of Understanding
between CHAM and MOH
• CHAM signed an MOU with Government in
2002
• The aim was to support attainment of MDGs
by:
– Expanding access to quality health care
– Promote equity in access to health care
– Expanding pre-service training for health workers

5. Key provisions of the MOU
• Government pays salaries to CHAM staff
• CHAM provides health services (especially EHP)
at minimal user fees
• Government and CHAM should not open new
health facilities within 8km radius of each other
• Government seconds tutors to CHAM colleges
• Graduates are deploys 60% to Government and
40% to CHAM
• Service level agreements (SLAs) are signed at
district level to close specific service delivery gaps

6. Government= Constitutional obligation
Churches= Biblical mandate
Government
• Pays salaries for CHAM
health workers and tutors
• Seconds tutors to colleges
• Provides health care and
training with minimal fiscal
burden (i.e., without
meeting full capital and
recurrent costs
CHAM
• Provides infrastructure and
other assets
• Provides training and health
services
• Provides operational
management
• Receives subvention from
Government (salaries)
• Charges some user fees
Shared responsibility, risk and benefits

7. 0
50
100
150
200
250
Impact of SLAs on service delivery
Antenatal attendance at St Martin's H C (Molere)

8. The need to strengthen PPPs
• Enactment of (a generic) PPP Act in 2010 necessitates
migration from the MOU to a PPP arrangement
• Lack of continuous monitoring of the MOU and SLAs
with timely implementation of corrective measures has
undermined the MOU
• Shrinking fiscal space making the Government look for
an alternative arrangement with even less fiscal
responsibility
• Free services in public facilities reducing people’s
“willingness to pay” in CHAM facilities
• Dwindling direct support to CHAM facilities from
overseas benefactors – more reliance on local
resources

9. Way forward
• Amendment of PPP Act to address specific
public health issues
• Support expansion of funding base for health
care
• Expand Private-Private partnerships with for
for-profit or non-profit organisations
• Support change of mindset on health
financing and PPPs in both faith and public
sector

10. Thank you

11. Dr. Mwai Makoka
Dr. Makoka was appointed Executive Director
of CHAM in January 2014. He previously
worked in the national HIV program in the
Ministry of Health and the National AIDS
Commission; and was also a member of
faculty at the medical school.
He received medical training at the University
of Malawi and did postdoctoral studies in
medical and public health microbiology at the
University of North Carolina, USA.
Dr. Makoka is passionate about access to, and
quality of health care, medical education and
sustainability of Christian health delivery
models.