Levering Budget Advocacy for TPT Scale-up in Malawi

The Facilitators of Community Transformation (FACT) coordinated and launched the Parliamentary TB Caucus of Malawi on 28th June 2018. In attendance were 180 delegates who included Malawi Parliamentarians, media house representatives, development partners, Ministry of Health officials, NGO representatives, tuberculosis (TB) survivors, civil society representatives and TB entertainment ambassadors. Notable attendees included Hon. Juliana Lunguzi (Member of Parliament), Hon. Mark Botomani (former Minister of Information), Hon. Richard Msowoya (Former Speaker of Parliament) and Hon. Atupele Muluzi (Former Minister of Health).

Globally, the TB Caucuses serve as platforms for the transformation of the global TB response by uniting Members of Parliament to have a shared commitment to end the TB epidemic. Through the efforts of the TB Caucus, there is a potential for increased resource investments to the national TB agenda, while members of the Caucus shape enabling environments through progressive TB policies and legislation, as well as ensuring the collective and collaborative engagement of political leaders and the private sector. The cascade of the national agendas on eradicating TB is effectively shaped through networking.      

A key area which the Caucus focuses on is increasing political will for increased domestic financing of the country’s TB services (e.g., TPT, diagnostic services, human resources etc.).

The Malawi Health Sector spending per capita is 8.2 times lower than the WHO recommended $86, which is considered the minimum necessary per capita investment to provide basic health services. Malawi’s $10.4 per capita public health allocation is just about a third of the Health Sector Strategic Plan II (HSSP II) annual per capita cost requirement estimated at $30. The average per-capita health expenditure for the Southern African Development Community (SADC) region is around $209. As a result, there has been inadequate funding for TB and preventative therapy for TB has not been fully rolled out in Malawi.

Jackeline, a TB survivor, highlighted the importance of increasing funding of TPT during the TB caucus launch

 

As part of the IMPAACT4TB project, in March 2021, FACT and COWHLA conducted a budget assessment to analyze the sufficiency of TPT funding (i.e., INH, 3HP and 3HR) in the country. This assessment aimed to compare funding for TPT against the country’s TPT targets and to assess if Malawi would have sufficient funding to support the procurement of TPT drugs for effective rollout. The findings from the assessment revealed that there is no allocation for 3HP TPT in the current budget in circulation mainly because the health sector budget is consolidated across all directorates and programs within the Ministry of Health (MoH).

 Figure 1: Health Sector Spending Trends

Source: FACT assessment report on analysis of the sufficiency of TPT funding (2021)

 

While CSOs enquired as to having disaggregated data, this information is not forthcoming. The only disaggregated budget information available are donor budgets from PEPFAR and Global Fund. 

In terms of the next steps, partners will continue to advocate on this point. FACT in collaboration with COWHLA will continue to engage with relevant stakeholders to disseminate the findings of the assessment report with parliamentarians, MoH and National TB Control Program officials through the parliamentary TB caucus and advocate for a specific budget line for 3HP TPT. Secondly, strategic engagement will continue with media houses to raise awareness of the importance of TPT and generate demand for TPT among communities. Further, CSOs through the national CSO Forum will continue their engagement with the National TB Control Program and Department of HIV/AIDS under MoH to obtain disaggregated TPT budgetary data.

Through engagement with the TB caucus, MoH and other stakeholders, progress has been made in advocacy for TPT scale up as Malawi’s 2019 Integrated Guidelines and Standard Operating Procedures for Clinical HIV Services were updated to incorporate the rollout of 3HP TPT to all 29 districts. This can only be achieved through increased funding for TPT, which FACT will continue to advocate for and consequently have 343,050 people on TPT by 2022 as declared by the government during the 2018 UN High-Level Meeting on TB.

Malawi is forging ahead with the prevention of tuberculosis, as the country acknowledges that prevention is more affordable than having to diagnose and treat citizens, who often fall through the cracks once they are diagnosed with active TB.