The Malawi National AIDS Spending Assessment (Financial Years 2019/20 - 2021/22)

Abstract

Background: This National AIDS Spending Assessment (NASA) report examines HIV expenditure in Malawi from FY 2019/20 to FY 2021/22, applying a globally recognized methodology to track resource flows.

Key Findings: Total HIV spending increased from MWK275 billion (US$373 million) to MWK376 billion (US$461 million), driven by international donors (PEPFAR, GFATM) and government contributions. Care and treatment accounted for over 55% of expenditure, while prevention spending remained low (7-8%). Personnel and medical supplies were key cost drivers. The public sector managed over 64% of funds, with international sources contributing significantly. HIV care and treatment spending rose from MWK148 billion to MWK210 billion, while prevention spending stagnated below recommended levels (25%). Out-of-pocket expenditure wasn't included due to resource constraints.

Conclusion: The report highlights sustainability risks due to reliance on external funding, threatening long-term HIV response.

Recommendations: Domestic resource mobilization, health insurance, and mainstreaming HIV activities into core budgets are recommended. The government should develop resource mobilization strategies and create budgetary space for HIV costs over the next decade.