Malawi: Score Justification Summary

1.1.1a National plan for AMR priority pathogens

Score: 100

Malawi does not have a current Antimicrobial Resistance Plan that covers surveillance, detection, and reporting of priority AMR pathogens but there is evidence of a past plan.

The Public Health Institute of Malawi (PHIM) outlines that in "February 2017, Malawi recognised AMR as a public health risk that needs to be given priority. Following which the country has developed a National AMR Strategy in line with the Global Action Plan that would inform the activities and interventions for AMR". ¹ However, the 'Antimicrobial Resistance Strategy 2017 – 2022' released by the Ministry of Health in January 2017 ² has since lapsed and no evidence of a new or revised national plan was found on the web portals of the Ministry of Health & Population ³, the Ministry of Agriculture, Irrigation & Water Development ⁴, and World Health Organisation (WHO) Library of National Action Plans. ⁵

Additionally, the current 'Health Sector Strategic Plan III 2023-2030' released by the Ministry of Health does not contain any plan targeting AMR. ⁶

1.1.1b Capacity of national lab/lab system to test for AMR priority pathogens

Score: 50

Malawi has a national laboratory which tests for 7 priority AMR pathogens, however testing for Mycobacterium tuberculosis is not available.

The Public Health Institute of Malawi (PHIM) states on its website that the National Micro-Reference Laboratory can conduct testing for E. coli, K. pneumonia, S. aureus, S. pneumoniae, Salmonella spp., Shigella spp. and N. gonorrheae: "The National Micro-Reference Laboratory does a routine check on antibacterial resistance of various pathogens. In the first half of this year( 2025), the lab has reported that 9 pathogens are showing very high resistance to commonly used antibiotics. The pathogens include Methicillin-resistant Staph aureus (MRSA), Neisseria gonorrhoeae, Klebsiella pneumoniae, Escherichia coli, Streptoccus pneumoniae, Pseudomonas aeruginosa, Acinetobacter, salmonella, Typhi and Shigella " ⁷. However, there is no mention of testing for Mycobacterium tuberculosis on the Institute's web portal ⁸

Additionally, no evidence of regular testing for Mycobacterium tuberculosis was found in the 'Malawi Genomic Surveillance Implementation Plan (2023–2030) Second Edition' released by the Ministry of Health in June 2025. ⁹

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

There is insufficient publicly available evidence that Malawi has conducted detection and surveillance activities (e.g. in soil, waterways, etc) for antimicrobial residues or AMR organisms.

A cross-sectional study conducted by Centre for Water, Sanitation, Health, and Appropriate Technology Development (WASHTED), a research centre at the Malawi University of Business and Applied Sciences (MUBAS) and published in December 2024 used the risks, attitudes, norms, abilities, and self-regulation (RANAS) model11 to explore the perception of risk to AMR bacterial infections from environmental pathways (drain water, river water, and animal feces) and to establish the behavioral (i.e., psychosocial) factors that bring people into contact with the environment, at the household level in urban, peri-urban, and rural Malawi.¹⁰

Another study published in October 2024 conducted by researchers from WASHTED, examined transmission pathways across three Malawian study sites using samples from September 2020 to August 2021, and identified potential AMR exposure pathways, including drains, standing water, soil, and areas of communal hand contact. ¹¹

No further evidence of surveillance activities conducted for antimicrobial residues or AMR organisms by the Malawian Government was found through the websites of the Public Health Institute of Malawi ¹², nor Ministry of Health ¹³.

1.1.2a National law(s) requiring prescription for antibiotic use (humans)

Score: 50

Malawi has legislation in place requiring prescriptions for antibiotic use for humans, but there is evidence of gaps in implementation.

The Pharmacy, Medicines and Poisons Act of 1988 (Chapter 35:01) under its Section 35 states that "No person other than a person lawfully carrying on a retail pharmacy business shall sell or supply any medicinal product by way of dispensing except in accordance with a licence granted for that purpose", or unless "the sale or supply or administration of a medicinal product to a patient is by a medical practitioner or dentist who holds a dispensing license (Section 46)" ¹⁴. There is, however, no publicly available list of the medicinal products under this provision ¹⁵¹⁶.

The Pharmacy and Medicines Regulatory Authority Act, enacted in February 2019, provides regulations regarding medicines, allied substances such as Acaricides, Cosmetics, disinfectants, food supplements, feed additives and supplements, traditional medicines, medical and surgical sundries, medical devices etc. and the pharmacy profession in Malawi. ¹⁷ Section 62 of the Act has regulations for pharmacies that regulate marketing, import, and sale of prescription medicines (pg. 36), as well as penalties (Section 116) for the sale of prescription only medicines without proper prescriptions. ¹⁸ However, the Act does not contain specific regulations for antibiotic prescriptions.

According to a news article from 2024, the Pharmacy and Medicines Regulatory Authority (PMRA) had arrested 28 individuals for "allegedly engaging in the illegal vending of medicines, a practice that health experts say is contributing to the alarming rise of antimicrobial resistance (AMR) in Malawi." ¹⁹

Malawi had observed the World Antimicrobial Resistance Awareness Week in December 2024 marked by a series of health education sessions aimed at raising awareness about the dangers of antimicrobial resistance and the importance of using antibiotics responsibly. ²⁰ A press release on the event by the Malawi Liverpool Wellcome Trust stated that "in AMR initiatives across sectors, gaps in consistency and intensity persist. This inconsistency likely stems from limited funding for large-scale campaigns and insufficient political commitment to prioritize AMR advocacy." ²¹

1.1.2b National law(s) requiring prescription for antibiotic use (animals)

Score: 50

There is insufficient evidence that Malawi has legislation in place requiring prescriptions for antibiotic use for animals. However, the Pharmacy, Medicines and Poisons Act 1988 under its Section 35 states that "No person other than a person lawfully carrying on a retail pharmacy business shall sell or supply any medicinal product by way of dispensing except in accordance with a licence granted for that purpose", or unless "the sale or supply or administration of a medicinal product to a patient is by a medical practitioner or dentist who holds a dispensing license (Section 46)" . ²²

The Pharmacy and Medicines Regulatory Authority Act, published in February 2019, contains regulations for prescription medicines for "administration to a person or animal, if the quantity of the imported medicine is based on a prescription" in Section 62. However, no specific regulations for antibiotics were found. ²³

The Joint External Evaluation report (JEE), conducted in February 2019, states that a national committee exists to recommend antibiotic systems for antimicrobial stewardship, and that there are national treatment guidelines, "but no mechanisms to ensure or enforce appropriate prescription and use of antimicrobials in human health, animal health and food production.(pg. 16)" ²⁴ There are no Gazette notices about prescriptions on the Malawi Legal Information Institute website ²⁵

1.2.1a Laws/plans on zoonotic disease

Score: 0

There is no publicly available evidence that Malawi has a national law, plan or strategy document, on zoonotic disease.

The Lilongwe University of Agriculture and Natural Resources (LUANAR) is working with the Capacitating One Health in Eastern and Southern Africa (COHESA) project, and has generated a detailed One Health Baseline Report in April 2023, reviewing governance, national policies, gaps and strategic alignment toward zoonotic disease integration. ²⁶

The Public Health Institute of Malawi (PHIM) is coordinating with national One Health to shape a National One Health Policy, to promote synergy between health, agriculture, and environmental sectors, especially in managing zoonotic diseases. ²⁷ However, no evidence of such a plan or national legislation was found through the Ministry of Health ²⁸ or the Public Health Institute of Malawi (PHIM). ²⁹

1.2.1b Laws/plans on zoonotic disease spillover from animals to humans

Score: 100

Malawi has a national strategy on monitoring and diagnosis of zoonotic diseases.

The One Health Baseline Report released by the Public Health Institute of Malawi (PHIM) in April 2023 on the One Health Malawi webpage, contains human data for only Human African trypanosomiasis and Rabies under Section 'Monitoring and Evaluation. However, the report states that "this database cannot be considered to be representative". ³⁰ No formal government data is available in this report for other zoonotic diseases such as Bovine tuberculosis, Brucellosis, Cysticercosis in humans as well as animals.³¹

In September 2024, Malawi hosted a One Health Zoonotic Disease Prioritization (OHZDP) workshop in collaboration with the Emergency Centre for Transboundary Animal Diseases (ECTAD) programme and Centres for Disease Control and Prevention in Africa (Africa CDC). Outcomes of the workshop included a prioritized list of zoonotic diseases, a comprehensive understanding of roles and responsibilities across sectors, and actionable plans for coordinated multi sectoral engagement in disease prevention and control. ³²

Section 6.2.1.4 of the Strategic Plan III 2023–2030 by the Ministry of Health lays out a strategy for strengthening control of Public Health Zoonotic Disease Emergencies. These include: developing training material and training staff in diagnosis of zoonotic diseases at all levels, and establishing an integrated systematic zoonotic disease surveillance system with the public health, animal healthand environmental sectors (Table 9). ³³ Section 9.2.4 calls for the establishment of the Department of Public Health Zoonotic Disease Emergencies Control, however, no evidence of its existence could be found. Additionally, the Plan acknowledges that "there are no specific programs focusing on zoonotic diseases at the department of animal health and development, primarily because it does not have a specific department to deal with public health events which include zoonoses". ³⁴

No additional evidence of zoonotic disease-related strategy or plans was found via the Public Health Institute of Malawi ³⁵ and the Ministry of Health & Population. ³⁶

1.2.1c Laws/plans for surveillance & control of multiple zoonotic pathogens

Score: 100

There is evidence that Malawi has national plans and guidelines that account for the surveillance and control of multiple zoonotic pathogens of public health concern.

The Public Health Institute of Malawi (PHIM) Strategic Plan (2023-2030) published by Ministry of Health identifies "To strengthen control of Public Health Zoonotic Disease Emergencies" as a dedicated functional component of the Plan, and under Section 6.2.1.4 calls for the establishment of a special department within PHIM to manage zoonotic diseases, in line with the One Health approach. ³⁷ Table 9 lists the key activities of this group which include, improving the access to and use of zoonotic disease surveillance data to inform policy, establishing an integrated systematic zoonotic disease surveillance system with Public health, animal health and environmental sectors, and integrating zoonotic disease surveillance from animal health and environmental sectors into One Health Surveillance Platform (OHSP) (pg. 60). ³⁸

According to the website of Public Health Institute of Malawi (PHIM), PHIM under its Epidemiology and Surveillance Division has a Department of Surveillance and Epidemiology whose function is described as "responsible for detecting outbreaks, and guiding on the response to the outbreaks and other public health emergencies of national and international concern (PHENICs) for outbreak control." This Department also oversees the development of preparedness and response plans, including contingency plans for the country’s high-risk hazards. ³⁹

According to a June 2023 'Malawi Deep Dive study' from the International Association of National Public Health Institutes (IANPHI), Malawi has adopted the Integrated Disease Surveillance and Response (IDSR) strategy developed by the World Health Organization's Regional Office for Africa as its national surveillance system. The implementation of the IDSR strategy is supervised by the Public Health Institute of Malawi (PHIM). ⁴⁰

Malawi also follows the third edition of the 'Technical Guidelines for Integrated Disease Surveillance and Response (IDSR) in the African Region' for its surveillance program, which includes zoonotic diseases as 'Priority diseases' (Table 1) requiring surveillance and immediate reporting (pg. 23). ⁴¹

1.2.1d Cross-ministerial department/agency/unit for zoonotic disease

Score: 100

Malawi has a dedicated Department of Surveillance and Epidemiology with a focus on zoonotic diseases.

The Public Health Institute of Malawi (PHIM) is responsible for the implementation of the Public Health Institute of Malawi (PHIM) Strategic Plan (2023-2030) published by the Ministry of Health. Section 6.2.1.4 of that plan calls for the establishment of a special department within PHIM to manage zoonotic diseases, in line with the One Health approach. ⁴² Table 9 lists the key activities of this group which include, improving the access to and use of zoonotic disease surveillance data to inform policy, establishing an integrated systematic zoonotic disease surveillance system with Public health, animal health and environmental sectors, and integrating zoonotic disease surveillance from animal health and environmental sectors into One Health Surveillance Platform (OHSP). ⁴³

This OHSP is executed through the Department of Surveillance and Epidemiology, under the Epidemiology and Surveillance Division of PHIM. ⁴⁴ According to Section 1.1.3 of Public Health Institute of Malawi (PHIM) Strategic Plan (2023-2030), the Epidemiology and Surveillance Division implements the following interventions: integrated disease surveillance and response, which includes communicable and non-communicable disease surveillance; emergency preparedness and response; Field Epidemiology Training Program (FETP) and HIV and STI surveillance and Event Based Surveillance among others. As part of the disease surveillance, the unit is responsible for detecting outbreaks, and guiding the response to the outbreaks and other public health emergencies of national and international concern (PHENICs) for outbreak control. The framework of response is provided through a multi-hazard emergency response plan as guided by strategic risk assessment, which the unit coordinates. Additionally, the unit oversees development of preparedness and response plans, including contingency plans for the country’s high-risk hazards. The Public Health Emergency Operation Centre (PHEOC) which sits within the unit, is expected to be functional at all times and respond to emergencies as they happen (pg. 11). ⁴⁵
The Department of Surveillance and Epidemiology and National Public Health Emergency Operations Centre (NPHEOC) do not have their own websites, however, they are embedded within the Public Health Institute of Malawi's website, which confirms that both NPHEOC and Deptartment of Surveillance and Epidemiology are currently functional. ⁴⁶

1.2.1e Presence of One Health strategic plan

Score: 0

Malawi does not have a One Health strategy but is in the process of developing one. In August 2025, Malawi hosted a National Bridging Workshop to strengthen its One Health approach. ⁴⁷ Hosted by the Government of Malawi, in collaboration with the World Health Organization (WHO), the World Organisation for Animal Health (WOAH), the Food and Agriculture Organization of the United Nations (FAO), and the UN Environment Programme, the workshop aimed to enhance the country’s “One Health” multi sectoral approach by improving collaboration among human, animal, and environmental health sectors to prevent and respond to public health threats. During the workshop Dr. Martias Joshua, Chief of Services-Reforms at the Ministry of Health highlighted Malawi’s commitment to One Health, noting that the country has already initiated a One Health Policy and prioritized zoonotic diseases for urgent multi sectoral action. ⁴⁸

1.2.2a Surveillance/reporting mechanism for zoonotic disease for livestock owners

Score: 0

There is no publicly available evidence that Malawi has a national mechanism (either voluntary or mandatory) for owners of livestock to conduct and report on disease surveillance to a central government agency.

There is no evidence of such a mechanism through the Public Health Institute of Malawi (PHIM) Strategic Plan (2023-2030), the Ministry of Health and Population, the Ministry of Agriculture, the Public Health Institute of Malawi (PHIM), or the 2019 Joint External Evaluation report (JEE). ^49505152

1.2.2b Laws/regulations on data confidentiality to protect livestock owners

Score: 0

Malawi does not have laws or regulations that safeguard the confidentiality of information generated through surveillance activities for animals (for owners).

The Malawi Genomic Surveillance Implementation Plan (2023-2030), developed by the Public Health Institute of Malawi (PHIM) with technical support from Africa Pathogen Genomics Initiative (Africa PGI) and published in June 2023, explicitly notes that genomic surveillance raises significant ethical concerns regarding privacy, data ownership, and the responsible use of genetic information (Section 2.6.6). ⁵³

To address this, the National Health Sciences Research Committee (NHSRC) and other local Institutional Review Boards (IRBs) will review and update guidelines on the ethical collection, storage, and use of genomic surveillance data. These IRBs are mandated to consult with stakeholders, including patient advocacy groups, healthcare providers, and government agencies, to ensure that the guidelines reflect a diverse range of perspectives (pg 26-27). ⁵⁴ However, the Plan does not include any specific regulations for safeguarding the confidentiality of information generated through surveillance activities for animals and their owners.

Malawi's Data Protection Act 2024 which commenced on May 2024, does not make any reference to any safeguards for data collected on animals. ⁵⁵

1.2.2c Wildlife zoonotic disease surveillance

Score: 0

There is insufficient evidence that Malawi conducts surveillance of zoonotic disease in wildlife.

The Health Sector Strategic Plan III (HSSP III) (2023-2030) published in January 2023, in Strategy 2.4, calls for "strengthening vector and vermin control, pandemic, disaster preparedness response and surveillance of diseases". It further includes activities to "conduct coordination and surveillance meetings with the Ministry of Agriculture’s Animal Health Department on surveillance and response of zoonotic diseases" throughout the eight years of the Strategy's implementation period. ⁵⁶

In January 2024, the Food and Agriculture Organization, through its Emergency Centre for Transboundary Animal Diseases program launched the 'Enhancing Animal Health & One Health Capacities to Mitigate Zoonotic Diseases and Antimicrobial Resistance Risks & Threats' project with the United States Agency for International Development (USAID) Malawi, and the Malawian Government. ⁵⁷

As per the latest available 'T3 One Health Baseline Report' (2023) by One Health Malawi, although there is a clear structure for reporting zoonotic diseases that includes the assignment of animal health officers in communities and area supervisors overseeing a wider geographic area; however, "in reality, reporting/surveillance is patchy at best due to lack of human resources, poor infrastructure, and inadequate data management systems" and "no regular surveillance bulletins exist for zoonotic diseases". ⁵⁸

No further evidence of conduction of zoonotic disease surveillance was found through the websites of Ministry of Health ⁵⁹, and Public Health Institute of Malawi. ⁶⁰

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

There is publicly available evidence that Malawi has a mechanism for reporting notifiable diseases to The World Organisation for Animal Health (WOAH).

According to the World Organisation for Animal Health (WOAH) website, Malawi is a member state of the WOAH World Assembly, with a delegate from the Department of Animal Health and Livestock Development representing Malawi in the World Assembly. ⁶¹

There is evidence of Malawi reporting notifiable diseases to the WOAH, with the most recent notification being sent by Malawi on 27 May 2025 for Aphanomyces invadans (Epizootic ulcerative syndrome) outbreak. ⁶²

1.2.4a Number of veterinarians per 100,000 people

Score: 0.16

1.2.4b Number of veterinary para-professionals per 100,000 people

Score: 7.41

1.2.5a Inclusion of private sector in national plan/law on zoonotic disease

Score: 0

There is no publicly available evidence that Malawi has a national plan on zoonotic disease or other legislation, regulations, or plans that include mechanisms for working with the private sector in controlling or responding to zoonoses.

Section 2.5.7 of the Malawi Genomic Surveillance Implementation Plan (2023-2030) titled 'Collaboration with private sector, research, and higher learning institutions' states that the Government of Malawi will "collaborate with both the private sector and research institutions to maximize the use of available resources for genomic surveillance". ⁶³ However, the Implementation Plan does not include any explicit mechanism for working with the private sector.

The Public Health Institute of Malawi (PHIM) Strategic Plan (2023-2030) identifies 'Private corporations' as key stakeholders (Table 4) and "potential collaborators to improve health through sharing resources and enhancing opportunities". This includes specific entities like "private health institutions (hospitals, pharmacies and laboratories), manufacturers" (pg. 39). ⁶⁴ However, the Strategic Plan does not include a mechanism for working with 'Private corporations' in responding to zoonotic diseases.

No further information could be found through the 2019 Joint External Evaluation report (JEE) ⁶⁵, the Ministry of Health and Population ⁶⁶, the Public Health Institute ⁶⁷ or the Health Reference Laboratory. ⁶⁸

1.3.1a Updated national records of especially dangerous pathogen/toxin inventories

Score: 0

There is no publicly available evidence that Malawi has in place a record, updated within the past 5 years, of the facilities in which especially dangerous pathogens and toxins are stored or processed, including details on inventories and inventory management systems of those facilities.

The 2019 Joint External Evaluation report (JEE) notes, as an area that needs strengthening, that "there is no mechanism to monitor and develop an updated record and inventory of pathogens within facilities that store or process dangerous pathogens and toxins." ⁶⁹ The April 2020 national COVID-19 Preparedness and Response Plan lists "Renovate Microbiology laboratory to Biosafety Level 3" and "Construct All Pathogen BSL3 laboratory" as priority tasks ⁷⁰ However, there is no further public evidence of such a record through the Ministries of Health or Agriculture, the Public Health Institute, the Health Reference Laboratory or the VERTIC database. ^{71 72 73 74 75}.

Malawi has not submitted a Confidence Building Measure Return (CBM), a reporting mechanism set by the Biological Weapons Convention, to the United Nations Office at Geneva (UNOG) since 2016 ⁷⁶.

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 50

There is evidence of a plan and regulations in Malawi related to biosecurity, but there is insufficient information that it outlines specific requirements such as physical containment, operation practices, failure reporting systems, and/or cybersecurity of facilities.

According to the Malawi Genomic Surveillance Implementation Plan (2023-2030) developed by the Ministry of Health, the Public Health Institute of Malawi acts as Secretariat of the National Genomics Committee, and coordinates national genome sequencing of pathogens that are critical to public health, particularly those with pandemic and epidemic potential. The National Genomics Committee (NGC) is the central body specifically tasked with coordinating, guiding, and supervising the national response regarding the application of genomics. As part of disease surveillance, the institution is responsible for detecting outbreaks and guiding responses as well as other public health events of national and international concern related to outbreak control and management (Section 2.6.1). ⁷⁷ Under the Plan's Section 2.6.8 titled 'Biosafety and biosecurity', it states that the "Government of Malawi will adhere to stringent international biosafety and biosecurity guidelines on the management of pathogens. This will ensure the protection of laboratory staff and containment of pathogens." (pg. 27) ⁷⁸ The Plan also acknowledges the need for genomic sequencing and surveillance facilities to "develop comprehensive emergency plans that encompass various scenarios, including natural disasters, accidental releases of hazardous or infectious materials, cyber-attacks, and other emergencies" (pg. 20). However, no further evidence of operational practices, guidelines for failure reporting systems, containment, or cyber-attacks was found in the Plan.

Malawi also has a Biosafety Act (Commenced on 20 August 2007) and was revised and consolidated by 31 December 2014, which applies to the genetic modification of organisms, as well as the importation, development, production, testing, release, use, application of genetically modified organisms, and the use of gene therapy in animals, including human beings. ⁷⁹
Similarly, the Biosafety (Management of Genetically Modified Organisms) Regulations' (2007) scope includes licensing GMOs and applying risk assessments, and have established a National Biosafety Regulatory Committee. However, neither focuses on the storage and processing of pathogens nor biosecurity in this context. ⁸⁰

The 2019 Joint External Evaluation report (JEE) states that "a number of public health laws either already exist or are in draft form but there remain gaps in legislation in the areas of biosafety and biosecurity" and "There is no comprehensive national biosafety and biosecurity regulatory framework or legislation". ⁸¹

No further evidence of laws/acts/bills pertaining to biosecurity was found through the Malawi Legal Information Institute's web portal. ⁸²

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 0

There is insufficient publicly available evidence that Malawi has established National Committees which is responsible for the enforcement of security regulations.

According to the Malawi Genomic Surveillance Implementation Plan (2023-2030) developed by the Ministry of Health, the Public Health Institute of Malawi acts as Secretariat of the National Genomics Committee, and coordinates national genome sequencing of pathogens that are critical to public health, particularly those with pandemic and epidemic potential. The National Genomics Committee (NGC) is the central body specifically tasked with coordinating, guiding, and supervising the national response regarding the application of genomics. As part of disease surveillance, the institution is responsible for detecting outbreaks and guiding responses as well as other public health events of national and international concern related to outbreak control and management (Section 2.6.1). ⁸³ Appendix 11 of the Implementation Plan outlines the organizational structure of the NGC which includes a Steering Committee, Laboratory Networking Committee, and an Advisory Committee; along with the roles and functions of each one of them. ⁸⁴ However, it does not explicitly cover biosecurity.

The Plant Protection Act 2018 (Act No. 19 of 2018) further establishes a framework of control measures governing plant protection and phytosanitary control, including the classification in Section 18 of plant pathogens (among others) as quarantine objects under phytosanitary control. ⁸⁵

Regulations 37-38 and 40-42 of the Environment Management (Waste Management and Sanitation) Regulations 2008 (Chapter 60:02) (as amended) provide specific measures for the safety of the environment in the management of infectious waste. Penalties for violation of these provisions may include a fine and imprisonment. ⁸⁶

The 2019 Joint External Evaluation report (JEE) states that "a number of public health laws either already exist or are in draft form but there remain gaps in legislation in the areas of biosafety and biosecurity" and "There is no comprehensive national biosafety and biosecurity regulatory framework or legislation". ⁸⁷

No further evidence of laws/acts pertaining to biosecurity was found through the Malawi Legal Information Institute's web portal ⁸⁸, nor any evidence of a biosecurity committe was found through the websites of Public Health Institute of Malawi ⁸⁹, Ministry of Health ⁹⁰.

1.3.1d Consolidation of especially dangerous pathogens into minimum # of facilities

Score: 0

There is no publicly available evidence that Malawi has taken action to consolidate its inventories of especially dangerous pathogens and toxins into a minimum number of facilities.

The Public Health Institute of Malawi (PHIM)'s Strategic Plan (2023-2030) under its Strategy 2 aims to "Strengthening Laboratory Biosecurity, Biosafety and Bio-risk management system" (Table 7). This includes conducting risk assessments in biosafety, pathogen mapping, and instituting biosecurity programmes and also commits to adhering to "stringent international biosafety and biosecurity guidelines on the management of pathogens" to ensure the protection of laboratory staff and containment. ⁹¹

The Malawi Genomic Surveillance Implementation Plan identifies a "lack of a centralized biobank for different samples" as a weakness and proposes to "increase and centralize the storage capacity of biorepositories" in its key strategy (pg. 31). However, the Implementation Plan does not explicitly focus on consolidating all dangerous pathogens and toxins into fewer facilities.

1.3.1e Capacity to conduct tests for anthrax/Ebola without culturing live pathogens

Score: 0

There is no publicly available evidence of Malawi's capacity to conduct Polymerase Chain Reaction (PCR)–based diagnostic testing for anthrax and/or Ebola.

Malawi has a National Public Health Laboratory (NPHL) under the Public Health Institute of Malawi (PHIM). ⁹² According to PHIM's website, the laboratory comprises the following sections: HIV/, Tuberculosis (TB), Parasitology, Microbiology, Biochemistry Nutrition Influenza Haematology, and Genomic Sequencing. The PHRL’s main goal is to develop a robust and sustainable public health reference laboratory capacity to address national public health concerns through the performance of specific activities that ensure one health laboratory testing functions are successfully implemented. ⁹³ There is no explicit evidence of the Laboratory's capacity for Polymerase Chain Reaction (PCR)-based diagnostic testing for anthrax and/or Ebola.

A 2022 study conducted in collaboration with Malawi's Ministry of Health indicates existing pathogen control programs for human immunodeficiency virus and tuberculosis that use Abbott and GeneXpert machines and reagents. The study focused on training of laboratory officers in SARS-CoV-2 testing to scale-up testing capacity, and supporting initial training of 25,000 health workers trained in sample collection for Polymerase Chain Reaction (PCR) testing. ⁹⁴
However, no evidence for PCR-based diagnostic testing for anthrax and/or Ebola was found.

1.3.2a Biosecurity training using a standardised, required approach

Score: 33.33

There is evidence of biosecurity and biosafety training being provided in Malawi on an ad hoc basis.

In October 2023, Malawi hosted a biosafety and biosecurity training program, organized under the World Organisation for Animal Health (WOAH) Fortifying Institutional Resilience Against Biological Threats (FIRABioT) Project. Participants included staff from the Central and Regional Veterinary Laboratories, the Public Health Institute of Malawi, and representatives from the Malawi Police Service. Experts from WOAH reference labs, the Africa Center for Disease Control, and regional institutions led the training. Topics included biorisk assessment, biocontainment, and security measures, and participants engaged in hands-on exercises in hazard identification and risk mitigation. ⁹⁵

In continuation of the FIRABioT Project, a validation workshop was held in April 2025 with a multi sectoral audience to finalize a National Biological Risk Management Manual that includes risk assessments, standardized operations, emergency response plans, and strategies for biohazardous waste management. ⁹⁶ The Manual is yet to be published.

According to a 2023 research paper published in the Journal of Global Security: Health, Science and Policy, Malawi, along with 14 other Regional Assessors, were trained as trainers of the Regulatory and Certification Framework by the Africa Center for Disease Control (CDC). ⁹⁷ The Framework officially launched at the African Union Headquarters in August 2022 has three components (Figure 5): (i) a set of minimum standards for biosafety and biosecurity that institutions handling high-risk pathogens must comply with, (ii) a standard evaluation checklist that AU Member States can use to check for continued compliance with the agreed minimum standards and (iii) a framework for certifying and authorising institutions that comply with the minimum standards to perform various activities with high-risk pathogens based on their compliance levels (Africa CDC). ⁹⁸

1.3.3a Personnel checks for permission to access to especially dangerous pathogens

Score: 0

There is no publicly available evidence that Malawi requires security and other personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential to be subjected to drug testing, background checks, and psychological or mental fitness checks.

The Public Health Institute of Malawi (PHIM) Strategic Plan (2023-2030), released by the Ministry of Health, includes objectives to enhance Public Health Human Resources Development and Management, focusing on attracting and retaining skilled and motivated staff. This involves job analyses, staff establishment development, and filling positions based on skill mix and equity. For surge staff during emergencies, there is a standard operating procedure (SOP) for selection, engagement, and deployment based on expertise, competence, developed skills, and attitudes. ⁹⁹ However, it does not include drug testing, criminal background checks, or psychological assessments for staff members.

Additionally, no evidence of personnel screening requirements such as drug testing, criminal background checks, or psychological assessments was found in the Malawi Genomic Surveillance Implementation Plan (2023-2030) ¹⁰⁰, Biosafety Act (2002) ¹⁰¹, Biosafety (Management of Genetically Modified Organisms) Regulations (2007) ¹⁰², and the PHIM website ¹⁰³

1.3.4a National transport regulations for Category A and B infectious substances

Score: 100

Malawi has publicly available information on national regulations on the safe and secure transport of infectious substances, which include Categories A and B.

The Pharmacy, Medicines and Poisons Board has published the "Regulatory Requirements on Storage and Export of Samples/Specimens Collected from Participants/Clinical Trial Subjects during Clinical Trials for Testing" which comprehensively outlines the requirements for packing, marking, labelling, refrigeration and transportation of infectious substances, including Categories A and B. ¹⁰⁴¹⁰⁵. The document, under Section 5.1 & 5.2 includes specific guidelines for packaging, labelling and documentation requirements for infectious substances in both Category A and B. For Category A, dangerous goods are assigned United Nations numbers and proper shipping names according to their hazard classification and their composition. For Category B, Infectious substances shall be assigned to UN 3373 along with a shipping label “BIOLOGICAL SUBSTANCE, CATEGORY B”. ¹⁰⁶.

The 2019 Joint External Evaluation report (JEE) further confirms that "National legislation covers the transport of infectious substances in Categories A and B". ¹⁰⁷

Additionally, the Malawi Genomic Surveillance Implementation Plan (2023-2030), which guides the handling of "pathogens of pandemic and epidemic potential" outlines efforts for 'Sample collection, transportation, and storage' under its Section 2.2.6. calls for ministries involved in One Health to develop standardized processes by adopting advanced logistics for a safe and efficient sample transportation system, along with appropriate monitoring mechanisms that enhance efficiency. The Plan includes training requirements for the staff who collect samples at all genomic surveillance sentinel sites, and the training of couriers on the transportation and safety of samples. All sentinel sites need to be equipped with adequate sample collection materials and storage equipment, along with regular monitoring of couriers' adherence to the sample transportation procedures (pg. 22). ¹⁰⁸

Section 2.4.4 of the Plan states that the Government of Malawi will develop a framework that provides guidance and consensus on data and metadata standards. These standards shall uphold privacy, security, and national sovereignty, and regulate the sharing of contextual information to accompany genomics data. However, there is no evidence that these standards are/will be ISO qualified or based on external standards. Appendix 3 calls for conducting staff training "on sample management (collection, packaging, transportation, storage, retrieval and disposal)" with a goal of 100% of facilities to be trained on sample management by 2030. ¹⁰⁹

1.3.5a Laws/regulations on cross-border transfer and end-user screening

Score: 0

Malawi has regulations in place to oversee the cross-border transfer of dangerous pathogens and toxins with pandemic potential; however, it does not have regulations for end-user screening.

Malawi is a State Party to the International Health Regulations 2005 (IHR), with the Public Health Institute of Malawi (PHIM) being the organization responsible for strengthening the implementation of the IHR through an integrated disease surveillance and response strategy.

In line with the IHR, the National Public Health Emergency Operations Centre (NPHEOC) Handbook was released by the Public Health Institute of Malawi in August 2024. According to its Risk Characterization Matrix (Table 11), the Handbook shall be deployed for high-to-very high risk scenarios, such as if "the agent is highly pathogenic, highly transmittable, new or emerging, or has significant potential to disrupt travel/trade" (pg 85). Under Section 7.3.2, it lists the activation criteria, and allows the Secretary for Health to declare a public health emergency in case of: "Infectious incident(s) with high potential of cross border spreading or involving neighboring countries" and "mass returnees from epidemic affected countries". ¹¹⁰

The handbook also includes strategies with a focus on intensifying Cross Border Collaboration Activities, which include monitoring "cross border Zones," conducting joint meetings with neighbouring countries, strengthening " Points of Entry (PoE) surveillance activities," and establishing "ONE-STOP clinics at all PoEs" (pg. 56). ¹¹¹

Additionally, the NPHEOC in line with the One Health approach, has established a One Health Surveillance Platform (OHSP) aimed at collecting, analyzing and providing feedback on data in real time to provide a coordinated and effective surveillance and response system to a Public Health Emergency (pg. 20). ¹¹² According to Section 6.4, the NPHEOC information system is integrated with the Health Management Information System with District Health Information System-2 (HMIS/DHIS-2)1, One Health Surveillance Platform (OHSP2)/DHIS-2 and Laboratory Information Management System (LIMS). The event-specific data, Event management information and Context data are routinely captured, processed, and displayed in the NPHEOC. ¹¹³

1.4.1a Biosafety laws/regulations

Score: 100

Malawi has national biosafety regulations in place.

Malawi has a Genomic Surveillance Implementation Plan (2023–2030), led by the Public Health Institute of Malawi (PHIM) and aligned with the Africa Center for Disease Control, is designed to strengthen detection, monitoring, and response to infectious diseases through genomic sequencing. It focuses on pathogen surveillance, data management, laboratory capacity, and policy frameworks to support public health interventions. ¹¹⁴

Additionally, the Biosafety Act, which commenced on 20 August 2007 and was revised and consolidated by 31 December 2014, applies to the genetic modification of organisms, as well as the importation, development, production, testing, release, use, application of genetically modified organisms, and the use of gene therapy in animals, including human beings. ¹¹⁵ Similarly, the Biosafety (Management of Genetically Modified Organisms) Regulations' (2007) scope includes licensing GMOs and applying risk assessments, however only within GMO context.¹¹⁶

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 100

Malawi has established a National Genomics Committee responsible for the enforcement of biosafety regulations.

The National Genomics Committee (NGC) is the central body specifically tasked with coordinating, guiding, and overseeing the national response regarding the application of genomics. According to the Malawi Genomic Surveillance Implementation Plan (2023-2030) developed by the Ministry of Health, the Public Health Institute of Malawi acts as Secretariat of the National Genomics Committee and coordinates national genome sequencing of pathogens that are critical to public health, particularly those with pandemic and epidemic potential. As part of disease surveillance, the institution is responsible for detecting outbreaks and guiding responses, as well as other public health events of national and international concern related to outbreak control and management (Section 2.6.1). ¹¹⁷ Appendix 11 of the Implementation Plan outlines the organizational structure of the NGC which includes a Steering Committee, Laboratory Networking Committee, and an Advisory Committee. The Steering Committee is the highest committee in the hierarchy, composed of the Minister of Health and the Minister of Agriculture, is responsible for supporting national coordination, partnerships, collaboration, and resource mobilization. The Advisory Committee is the section of the hierarchy that presents issues to the Steering Committee and provides advice to laboratories. The Advisory Committee is composed of institutions or individuals that have technical expertise in genome sequencing, and is responsible for guiding laboratories on the selection of equipment, assays, and technologies for genomics, as well as advising on operational activities that directly impact or overlap with member institutions. The Laboratory Networking Committee is a subgroup of the larger national genomics committee that facilitates collaboration and resource sharing among genomics laboratories, researchers, and professionals under the One Health framework (pg. 66). ¹¹⁸

1.4.2a Biosafety training using a standardised, required approach

Score: 33.33

There is evidence of biosafety training being provided in Malawi on an ad hoc basis.

In October 2023, Malawi hosted a biosafety and biosecurity training program, organized under the World Organisation for Animal Health (WOAH) Fortifying Institutional Resilience Against Biological Threats (FIRABioT) Project. Participants included staff from the Central and Regional Veterinary Laboratories, the Public Health Institute of Malawi, and representatives from the Malawi Police Service. Experts from WOAH reference labs, Africa Center for Disease Control, and regional institutions led the training. Topics included biorisk assessment, biocontainment, and security measures, and participants engaged in hands-on exercises in hazard identification and risk mitigation. ¹¹⁹

In continuation of the FIRABioT Project, a validation workshop was held in April 2025 with a multi sectoral audience to finalize a National Biological Risk Management Manual that includes risk assessments, standardized operations, emergency response plans, and strategies for biohazardous waste management. ¹²⁰ The Manual is yet to be published.

According to 2023 research paper published in the Journal of Global Security: Health, Science and Policy, Malawi along with 14 other Regional Assessors were trained as trainers of the Regulatory and Certification Framework by Africa Center for Disease Control (CDC). ¹²¹ The Framework officially launched at the African Union Headquarters in August 2022 has three components (Figure 5): (i) a set of minimum standards for biosafety and biosecurity that institutions handling high-risk pathogens must comply with, (ii) a standard evaluation checklist that AU Member States can use to check for continued compliance with the agreed minimum standards and (iii) a framework for certifying and authorising institutions that comply with the minimum standards to perform various activities with high-risk pathogens based on their compliance levels (Africa CDC). ¹²²

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is no publicly available evidence that Malawi has conducted a comprehensive national assessment to determine whether ongoing research involves especially dangerous pathogens, toxins, pathogens with pandemic potential, or other dual-use research.

In March 2025, the World Organisation for Animal Health (WOAH) supported Malawi in drafting biological risk management manuals for veterinary laboratories, which included field visits and workshops to identify gaps and propose mitigation measures. However, these activities were centered on improving laboratory practices and safety protocols rather than assessing ongoing research involving dangerous pathogens. ¹²³

No evidence of a national assessment to determine whether ongoing research involves especially dangerous pathogens was found on the Public Health Institute of Malawi (PHIM) website ¹²⁴, the Malawi Data Portal ¹²⁵, VERTIC database ¹²⁶, WHO website ¹²⁷.

1.5.1b National law/regulation on oversight of dual-use research

Score: 0

There is insufficient evidence of regulation in Malawi requiring oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential, and it does not cover dual-use research.

The Genomic Surveillance Implementation Plan (2023–2030), led by the Public Health Institute of Malawi (PHIM) and aligned with the Africa Center for Disease Control, is designed to strengthen detection, monitoring, and response to infectious diseases through genomic sequencing. It focuses on pathogen surveillance, data management, laboratory capacity, and policy frameworks to support public health interventions. ¹²⁸ The Plan under Section 2.1.3 acknowledges that genomic research and surveillance "come with risks and challenges," including "the possibility of the release of hazardous/infectious materials, breaches of privacy, and ethical concerns about genetic data collection and use". Therefore, genomic sequencing and surveillance facilities are required to develop and regularly update comprehensive emergency plans that cover scenarios such as accidental releases of hazardous or infectious materials. Additionally, these facilities must also conduct regular risk assessments to identify potential hazards and vulnerabilities (pg. 20). ¹²⁹

The Biosafety Act (2002) which applies primarily to biotechnology and genetically modified organisms (GMO)-related activities, affords regulatory control over importation, development, testing, general release, and contained use of genetically modified organisms. It establishes licensing, inspection, and accident reporting requirements, but does not encompass oversight for dangerous pathogens or dual-use research. ¹³⁰ Similarly, the scope of the Biosafety (GMO) Regulations(2007) includes licensing GMOs and applying risk assessments, however, only within the GMO context. ¹³¹

1.5.1c Existence of agency responsible for oversight of dual-use research

Score: 100

Malawi has a committee responsible for oversight of research with pathogens of pandemic potential.

According to the Malawi Genomic Surveillance Implementation Plan (2023-2030) developed by the Ministry of Health, the Public Health Institute of Malawi acts as Secretariat of the National Genomics Committee and coordinates national genome sequencing of pathogens that are critical to public health, particularly those with pandemic and epidemic potential. The National Genomics Committee (NGC) is the central body specifically tasked with coordinating, guiding, and supervising the national response regarding the application of genomics. As part of disease surveillance, the institution is responsible for detecting outbreaks and guiding responses as well as other public health events of national and international concern related to outbreak control and management (Section 2.6.1). ¹³²

Additionally, the Biosafety Act (2014), in Section 6, has established the National Biosafety Regulatory Committee (NBRC), which is responsible for evaluating all applications concerning genetically modified organisms and their products, making recommendations to the Minister of Health. It also advises on all aspects relating to the introduction of GMOs into the environment, contained use, and proposed regulations and guidelines. ¹³³

The website of the National Commission for Science and Technology (NCST) confirms that NBRC is hosted within its supervision. Additionally, the Department of Environmental Affairs is responsible for the regulation of biotechnology and holds NBRC meetings which entails receiving and reviewing applications for activities with genetically modified organisms and issuing licenses or permits. ¹³⁴
The National Biosafety Regulatory Committee does not have its own website and no further information on the Committee's recent activities was found through the latest available Annual Report 2022/23 released by the National Commission for Science and Technology in May 2024. ¹³⁵

1.5.2a Requirement to screen synthesised DNA against list prior to sale

Score: 0

There is no publicly available evidence that Malawi currently has legislation or regulations mandating screening of synthesized DNA against known pathogen or toxin sequences before being sold.

No evidence of specific regulations on sale of synthesized DNA was found in the Biosafety Act ¹³⁶, Biosafety (Management of Genetically Modified Organisms) Regulations ¹³⁷, Malawi Genomic Surveillance Implementation Plan (2023-2030) ¹³⁸, VERTIC database ¹³⁹, nor via the Malawi Legal Information Institute database. ¹⁴⁰

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 0

1.6.1b Availability of vaccination figures for livestock (FMD) through OIE database

Score: 100

Malawi's official foot-and-mouth disease (FMD) vaccination figures for livestock publicly available through the OIE database.

The World Organisation for Animal Health (WOAH) WAHIS database on 'Surveillance and control measures' contains data on Malawi, with the most recently reported data on foot-and-mouth disease (FMD) vaccination figures for livestock (both domestic and wild) being from July to December 2023. ¹⁴¹

1.6.1c Equitablenature of national immunization strategy/plan

Score: 100

Malawi has a national immunization strategy that includes a plan to ensure equitable distribution.

In April 2025, the Government of Malawi, through the Ministry of Health, officially launched the National Immunization Strategy (NIS) 2025–2030. The Strategy's key priority is to increase vaccine coverage, combat preventable diseases, and support the country’s commitment to Universal Health Coverage (UHC). ¹⁴²

According to the World Health Organization (WHO) news reporting from May 2025, the NIS contains a six-pillar framework to guide national immunization efforts. The NIS focuses on strengthening programme management, planning, and financing to ensure better coordination and long-term sustainability. It also aims to reduce zero-dose and under-immunized populations by 95% from 2022 levels through improved service delivery, particularly in remote areas. ¹⁴³ The news report further states that "World Health Organization highlighted the plan’s focus on equity and quality as a model for immunization progress." ¹⁴⁴

The NIS document is not yet publicly available through the Malawi Monitoring platform ¹⁴⁵ or through the National Planning Commission database. ¹⁴⁶ Therefore, no further details could be obtained on strategies specifically aimed at overcoming socioeconomic inequalities, geography, cultural/linguistic differences and/or gender barriers to vaccination.

1.6.1d Vaccine hesitancy and build public trust coverage in vaccines in national immunization strategy/plans

Score: 100

Malawi has a national immunization strategy that includes measures to address vaccine hesitancy and build public trust in vaccines.

In April 2025, the Government of Malawi, through the Ministry of Health, officially launched the National Immunization Strategy (NIS) 2025–2030. The Strategy's key priority is to increase vaccine coverage, combat preventable diseases, and support the country’s commitment to Universal Health Coverage (UHC). ¹⁴⁷ The NIS document is not yet publicly available through the Malawi Monitoring platform ¹⁴⁸ nor through the National Planning Commission database. ¹⁴⁹

However, according to the World Health Organization (WHO) reporting from May 2025, "the NIS prioritizes robust disease surveillance and vaccine safety monitoring to maintain public trust. It addresses vaccine hesitancy through targeted advocacy and communication, while enhancing data systems for better tracking, evaluation, and decision-making." ¹⁵⁰

1.6.1e National advisory group for immunization strategy/plan

Score: 100

There is evidence that Malawi has a national advisory group that provides technical guidance and advice on the immunization strategy/plan to the government.

According to the World Health Organization's (WHO) web portal, Malawi has a standing technical advisory group on immunization, as part of WHO's National Immunization Advisory Mechanism (NITAG) called Malawi Immunization Technical Advisory Group (MAITAG), operating under Malawi's Ministry of Health. National Immunization Technical Advisory Groups (NITAGs) are multidisciplinary groups of national experts responsible for providing independent, evidence-informed advice to policy makers and programme managers on policy issues related to immunization and vaccines. According to the latest 2024 data on the website of the WHO, there are 5+ areas of expertise represented in the NITAG's core membership, and the latest NITAG assessment was conducted by the group in 2024. ¹⁵¹

According to a news update from July 2025 on the WHO website, the Malawi Immunization Technical Advisory Group (MAITAG), the Ministry of Health introduced the second dose of the Inactivated Polio Vaccine (IPV2) into the national immunization schedule during December 2024. Through this initiative, 17,000 health workers were trained across all districts of Malawi, and IPV2 was rolled out in every health facility, including outreach posts in remote areas. ¹⁵²

1.6.1f Presence of an immunization programme for influenza

Score: 0

Malawi does not have an immunization programme for influenza.

According to the World Health Organization's web portal, Malawi does not have an immunization program for influenza. ¹⁵³ No evidence of an immunization programme for influenza, nor seasonal flu vaccines, were found via Gavi ¹⁵⁴ nor on the Public Health Institute of Malawi website. ¹⁵⁵

1.7.1a Strategy/plan for resilience of health system

Score: 50

Malawi has plans to develop a strategy to develop a health system that is resilient to the challenges that climate change and changing seasonal weather patterns, but there is insufficient evidence that it includes considerations that specifically address the threat of infectious diseases.

Malawi’s National Adaptation Plan (NAP) Framework (2020), in Section 5.1, identifies 'human health' as one of the main sectors to be affected by climate change and calls for "developing and implementing measures to protect human health from the changing climate." ¹⁵⁶

The National Climate Change Management Policy (NCCMP), published in 2012 by the Ministry of Environment and Climate Change Management, in Section 3.1 'Policy Priority Areas', includes "endemicity to climate sensitive vector-borne and water-associated diseases, such as malaria, Schistosomiasis, cholera and other diarrhoeal diseases". These Policy Priority Areas aim to reduce vulnerabilities and promote community and ecosystem resilience to the impacts of climate change through "promoting practices that prevent and limit the spread of vector-borne and water-borne diseases". It also seeks to integrate population dynamics, reproductive health, and family planning in national climate change and development plans (pg 10). ¹⁵⁷

According to the World Health Organization's (WHO) website, in 2014, Malawi implemented a climate change and health program under the "Adaptation for Africa" project, supported by the Global Framework for Climate Services. This initiative established a Health and Climate Change Core Team (HCCCT) to guide adaptation planning, and conducted a Vulnerability & Adaptation (V&A) assessment to pinpoint climate-sensitive health risks. ¹⁵⁸ In 2016, the Ministry of Health was assisted by WHO post a severe drought and food insecurity experienced throughout the country due to climate change, to enhance its capacity in 4 districts on EWARS (Early Warning, Alert and Response System) for predicting vector -borne disease outbreaks and trained district field staff on data synthesis, modelling and interpretation of the early warning system. ¹⁵⁹

No evidence of strategies for building climate change resilience was found in the Public Health Institute of Malawi (PHIM) Strategic Plan (2023-2030). ¹⁶⁰

2.1.1a Capacity of national lab system to conduct 5 or more WHO core tests

Score: 0

There is insufficient publicly available evidence to confirm that Malawi's national laboratory system has the capacity to conduct diagnostic tests for at least 5 of the 10 WHO-defined core tests.

According to the website of the Ministry of Health, the "Diagnostic Services Unit is responsible for ensuring provision of quality diagnostic, monitoring drug efficacy, and patient management services" but there is no mention of which specific diagnostic tests can be conducted. ¹⁶¹ The University of North Carolina ProjectMalawi (UNC Project) is a collaboration between the University and the Malawi Ministry of Health. The UNC Project Laboratory, "is a state-of-the-art clinical and research laboratory" that offers a range of services; "The laboratory has one of the most extensive diagnostic menus in Malawi". Although the UNC has been doing research in infectious diseases and vaccine trials, there is no mention of which diagnostic tests can be conducted. ¹⁶² The 2019 Joint External Evaluation report (JEE) recommends, as a priority action, "Develop one list of priority diseases and core tests that is agreed jointly by the human and animal sectors." ¹⁶³

The Malawi National Strategic Plan for HIV and AIDS 2020–2025, developed by the National AIDS Commission, includes in Section 5.8.10, the objective that "central hospitals be brought up to speed to provide tests for improved care for PLHIV, such as CD4 count, biochemistry and hematology" but does not confirm the current capacity to conduct such tests. ¹⁶⁴ There is no further evidence available on the websites of the Ministry of Health ¹⁶⁵ or the Public Health Institute of Malawi's website ¹⁶⁶ to support Malawi's capacity to conduct such tests.

2.1.1b Plan to conduct testing during a public health emergency

Score: 50

Malawi has an implementation plan for conducting testing during a public health emergency but there is insufficient evidence on consideration for scaling capacity and defined goals for testing.

The Malawi Genomic Surveillance Implementation Plan includes a "Genomic surveillance algorithm for Disease X", defining "Disease X" as a hypothetical scenario for an unknown pathogen with epidemic potential. This algorithm (in Appendix 9) outlines the approach for molecular testing at national reference laboratories, assuming they are equipped to handle high-risk samples and advanced molecular diagnostic tools like broad-spectrum polymerase chain reaction (PCR) and next-generation sequencing (NGS). ¹⁶⁷

Additionally, the National Public Health Emergency Operations Centre Handbook for Malawi (2024), developed by the Public Health Institute of Malawi acknowledges the need for "Surge staff/Service corps" to support Public Health Emergency Operation Center (PHEOC) functions in case of a surge in emergencies in its Section 6. It mentions developing Memoranda of Understanding (MoUs) with relevant public health staff resources and maintaining a roster of candidates for rapid deployment; however, the Handbook does not include details on testing for novel pathogens. ¹⁶⁸

2.1.2a Existence of an accredited national lab serving as a reference facility

Score: 100

Malawi has national laboratories that serve as a reference facility and which hold ISO 15189 accreditation.

The National Microbiology Reference Laboratory, recognized as a national reference lab for microbiology in Malawi, holds ISO 15189 accreditation from the Southern African Development Community Accreditation Service (SADCAS). The approval was issued on March 28, 2023, with validity extending through December 5, 2025 according to the SADCAS website. ¹⁶⁹

Additionally, the National HIV Reference Laboratory, a national-level reference facility specialising in HIV-related diagnostics, received ISO 15189 accreditation via the SADCAS in February 2021.¹⁷⁰

2.1.2b External quality assurance of a national lab serving as a reference facility

Score: 100

Malawi does not have a dedicated national laboratory that serves as a reference facility, which is subject to external quality assurance review. However, according to Section 2.2.4 of the Malawi Genomic Surveillance Implementation Plan (2023-2030), "all genomic sequencing laboratories shall be required to implement a quality management system, including mandatory participation in external quality assurance (EQA) programs coordinated by PHIM. The EQA programs shall include software validation and evaluation." ¹⁷¹ The ministries involved in One Health are tasked with identifying local, regional, or international EQA providers that offer EQA programs, as well as ongoing monitoring of EQA results and participant feedback (pg. 21). ¹⁷²

Additionally, the Public Health Laboratory Service (PHLS), a cluster of laboratory systems operating under the Public Health Institute of Malawi, on its webpage states that "PHRL has a quality assurance section responsible for the implementation of a Quality Management System, Coordination of Proficiency Testing Schemes and championing accreditation services, across the entire laboratory network." ¹⁷³

However, there is no dedicated national laboratory that serves as a reference facility, which is subject to external quality assurance review.

2.2.1a Nationwide specimen transport system

Score: 100

Malawi has a nationwide specimen transport system.

The primary operator of Malawi's specimen transport system is Riders for Health (R4H), a non-profit organization that manages a national network of motorcycle couriers. ¹⁷⁴ In collaboration with the Malawi Ministry of Health and other partners, R4H has also implemented an Optimized Sample Transportation (OST) system. This system includes a data-sharing platform that allows healthcare facilities to report sample volumes via Unstructured Supplementary Service Data (USSD) technology. An optimization model then generates daily transportation schedules and courier routes, reducing unnecessary trips and improving turnaround times for diagnostic results. ¹⁷⁵ As of 2021, R4H operated a fleet of 86 vehicles, predominantly motorcycles, covering over 2 million kilometers annually to transport medical samples and test results across the country.¹⁷⁶

2.2.2a Plan to rapidly authorize/license laboratories to scale-up testing during an outbreak

Score: 0

There is no evidence of a plan to rapidly authorize or license laboratories to supplement the capacity of the national public health laboratory system to scale-up testing during an outbreak.

No evidence of a plan to authorize or license laboratories was found through the websites of Pharmacy and Medicine Regulatory Authority ¹⁷⁷, Malawi Bureau of Standards ¹⁷⁸, Public Health Institute of Malawi ¹⁷⁹, nor in Malawi Multi-Hazard Emergency Response Plan 2023-2025 ¹⁸⁰

2.3.1a Evidence of ongoing event-based and indicator-based surveillance and analysis

Score: 50

Malawi is actively conducting both event-based and indicator-based surveillance for notifiable and novel infectious diseases on a weekly basis.

Malawi's government, through the Public Health Institute of Malawi (PHIM) under the Ministry of Health, regularly publishes de-identified event-based and indicator-based health surveillance data on infectious diseases. These reports are publicly accessible on the PHIM website and provide detailed weekly and monthly updates on disease trends, outbreaks, and surveillance performance. ¹⁸¹

The latest available Weekly Integrated Disease Surveillance and Response (IDSR) Epidemiological Bulletin is from Epidemiological Week 31 (28 July – 3 August 2025) which includes updates on performance of the Integrated Disease Surveillance and Response, Reported Event Based Surveillance (EBS) signals, Reported Diseases/Conditions of Public Health Importance diseases/conditions of public health importance, and ongoing outbreaks and emergencies in Malawi. ¹⁸²

2.3.1b Evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline

Score: 100

There is publicly available evidence of Malawi having an IHR focal point for reporting notifiable diseases to the WHO.

According to the International Health Regulations (2005) by the World Health Organization (WHO), Malawi is a State Party, with the Public Health Institute of Malawi (PHIM) serving as the National IHR Focal Point, a designation that ensures 24/7 communication with WHO under the International Health Regulations (IHR) (Appendix 1) ¹⁸³

The webpage of Epidemiology and Surveillance Division operating under the Public Health Institute of Malawi confirms that as per WHO and Africa Center for Disease Control's recommendation, Malawi's National Public Health Emergency Operation Centre (NPHEOC) is functional all the time (24/7) and operates in three modes: Watch, Alert and Response. ¹⁸⁴

The National Public Health Emergency Operations Centre Handbook for Malawi, published in 2024 by PHIM, in its Section 38, describes the steps of activation for NPHEOC in response to a certain public health emergency. This goes as follows: when an incident is reported to the NPHEOC Manager by a watch staff ie. 24/7 duty officer, the Manager alerts the National IHR Focal Point (NFP), which involves the relevant IHR focal persons and Subject Matter Experts (SMEs). SMEs work with the NPHEOC Manager to gather facts and recommend that the National Rapid Response Team assess the incident. The NPHEOC Manager then convenes a preliminary assessment team of SMEs to recommend the level of response and expertise required. If needed, the NPHEOC Manager also calls in additional personnel. The NPHEOC Manager keeps the Director of PHIM informed with situation updates. Once the incident is confirmed, the NPHEOC Manager, in consultation with the PHIM Director (or delegate) and the Secretary for Health, decides on activating the NPHEOC and sets the activation level (pg. 38). ¹⁸⁵

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 100

Malawi operates an electronic reporting surveillance system at both the national and the sub-national level.

According to the Malawi Multi-Hazard Emergency Response Plan 2023-2025, developed by the Ministry of Health, Malawi utilizes the District Health Information System 2 (DHIS2), a widely adopted open-source health management information system and is implemented across all 28 districts in Malawi. It is used for routine data collection to support planning, management, and decision-making in health service provision, gathering data on diseases, events, conditions, and other administrative/service provision information (pg. 29). Data is extracted from health facility registers and compiled into reporting forms for submission to the district, and then from districts to the national level via DHIS2. ¹⁸⁶

Additionally, One Health Surveillance Platform (OHSP) platform is used to capture human, animal, and environmental health surveillance data. The OHSP is linked to DHIS2 and is optimised for reporting all priority diseases and events in Malawi. Data collected at Points of Entry (PoEs) are submitted to the respective ministries using designated reporting forms, with the Ministry of Health (MoH) using OHSP for reporting surveillance data from PoEs to the national level (pg. 32). ¹⁸⁷

2.3.2b Collection of ongoing/real-time lab data by electronic surveillance system

Score: 0

There is insufficient evidence that Malawi has an electronic reporting surveillance system collecting disaggregated ongoing or real-time laboratory data.

According to Malawi Multi-Hazard Emergency Response Plan 2023-2025, developed by the Ministry of Health, the One Health Surveillance Platform (OHSP) is used to capture human, animal, and environmental health surveillance data and is linked to DHIS2 for reporting all priority diseases and events in Malawi. ¹⁸⁸ However, there is no evidence of real-time laboratory data integration within this system. No further information is available on disaggregation of data by age, ethnicity, etc.

The Health Sector Strategic Plan III 2023-2030, under Section 8.3 aims to integrate the National Public Health Emergency Operations Centre (NPHEOC) information system with Laboratory Information Management System (LIMS), to enable the routine capture, processing, and display of event-specific, event management, and contextual data. ¹⁸⁹ The National Public Health Emergency Operations Centre Handbook for Malawi (2024) reinforces the need for data-integration from common surveillance/laboratory/operational datasets such as OHSP/DHIS-2, HMIS/DHIS-2, LIMS, Human Resources Information system (HRIS), Logistic Management Information System (LMIS, data on stockpiles of medicines and commodities), other health facilities data, reports from district PHEOCs and coordination structures, and financial data. ¹⁹⁰

However, no evidence of its implementation was found on the website of the Public Health Institute of Malawi ¹⁹¹ nor the Ministry of Health ¹⁹²

2.3.3a National wastewater surveillance programme or initiative

Score: 100

There is evidence that Malawi has ongoing national environmental or wastewater surveillance programmes.

Following the case of wild poliovirus reported in Malawi in February 2022, the country managed to set up an ES system for poliovirus in 11 cities, including Lilongwe where the case was detected, by mid-April 2022.¹⁹³

Malawi reported circulating vaccine-derived poliovirus type 2 (cVDPV2) on 27 Jan 2026, following detection in environmental samples collected through routine sewage surveillance at two sites in Blantyre, the country's commercial city. According to the Ministry of Health, the detection was part of routine surveillance collections, which were sent to WHO and collected on 08 Dec 2025. The Global Polio Eradication Initiative (GPEI) reports that the isolates are linked, with "final emergence group classification pending additional analysis."¹⁹⁴

2.4.1a Common usage of electronic health records

Score: 50

There is limited evidence that electronic health records are commonly in use in Malawi.

The Health Sector Strategic Plan III (HSSP III) 2024 aims to lead efforts to ensure that longitudinal and cross-sectional patient health records are accessible at the point of service delivery through a comprehensive and integrated, user-centred, and secure EHR system. Under Strategy 6.6, it calls for "implementation of a comprehensive and integrated, user centred and secure Electronic Health Record (EHR) system."¹⁹⁵ The HSSP also calls for the establishment of a Central Data Repository (CDR) and Master Patient Index for patient-level data, which, along with the Master Patient Index, will serve as a starting point for a Shared Health Record (pg. 40). This will allow a patient's electronic health record to move between different health facilities, with the aim to link it with the National Registration and Identification System (NRIS), requiring Malawians to present their national ID or birth registration to access publicly funded healthcare. ¹⁹⁶ The National Tuberculosis Program has been using an e-health application since 2017 for real-time tracking of sample status and diagnostic test outcomes, with the system functional in 33 sites, including 7 mobile units, by 2020 (pg. 29). ¹⁹⁷

According to a 2023 German Federal Ministry for Economic Cooperation and Development (BMZ) ecosystem mapping assessment of Malawi, there are 10 digital systems operating in the health sector: Malawi Healthcare Information System (MaHIS), Civil Registration and Vital Statistics (CRVS) and National Registration and Identification System (NRIS), Demographics Data Exchange (DDE), Integrated Community Health Information System (iCHIS), One Health Surveillance Platform (OHSP), Master Health Facility Registry (MHFR), OpenLMIS, Electronic Health Information Network (eHIN), Project Catalog Management Tool (PCMT). ¹⁹⁸ However, the assessment notes that there are inefficiencies due to duplicate data entry across systems and a lack of interoperability between existing systems (pg. 39). ¹⁹⁹

Additionally, as of 2024, Malawi has implemented an Electronic Medical Records System (EMRS) in 758 clinics providing antiretroviral therapy (ART) services. This system captures and allows real-time access to patient care and treatment information, including modules for ART, HIV testing services, outpatient departments, and antenatal care. ²⁰⁰

The DHIS 2 website further confirms that Malawi has established an interoperability layer to bring data from OpenLMIS into DHIS2 to facilitate composite analysis of stock and health data to support effective logistics planning. ²⁰¹ The integrated HMIS-eLMIS system, in line with ISO standards, can be used to access the following data: caseload to commodity consumption ratio, caseload to stock on hand, average monthly commodity consumption, and estimate of adequate stock levels per facility (to show which facilities are adequately, under- or overstocked). ²⁰²

2.4.1b Public health system access to individual electronic health records

Score: 100

There is publicly available evidence that national public health system have access to electronic health records of individuals in their country.

According to a 2023 German Federal Ministry for Economic Cooperation and Development (BMZ) ecosystem mapping assessment of Malawi, there are 10 digital systems operating in the health sector: Malawi Healthcare Information System (MaHIS), Civil Registration and Vital Statistics (CRVS) and National Registration and Identification System (NRIS), Demographics Data Exchange (DDE), Integrated Community Health Information System (iCHIS), One Health Surveillance Platform (OHSP), Master Health Facility Registry (MHFR), OpenLMIS, Electronic Health Information Network (eHIN), Project Catalog Management Tool (PCMT). ²⁰³ However, the assessment notes that there are inefficiencies due to duplicate data entry across systems and lack of interoperability between existing systems (pg. 39). ²⁰⁴

A key goal of the Malawi Health Sector Strategic Plan III (2023-2030) is to build an interoperability architecture. As per Section 2.5.4.1, the Interoperability Architecture is currently facilitating the sharing of data between HMIS DHIS 2 and OpenLMIS (Drugs and Essential Medicines data platform), HMIS DHIS 2 and DHA MIS, and Integrated Supportive Supervision System.²⁰⁵

The DHIS 2 website, further confirms that Malawi has established an interoperability layer, to bring data from OpenLMIS into DHIS2 to facilitate composite analysis of stock and health data to support effective logistics planning. ²⁰⁶ The integrated HMIS-eLMIS system, in line with ISO standards, can be used to access the following data: caseload to commodity consumption ratio, caseload to stock on hand, average monthly commodity consumption, and estimate of adequate stock levels per facility (to show which facilities are adequately, under- or overstocked).²⁰⁷

Additionally, as of 2024, Malawi has implemented an Electronic Medical Records System (EMRS) in 758 clinics providing antiretroviral therapy (ART) services. This system captures and allows real-time access to patient care and treatment information, including modules for ART, HIV testing services, outpatient departments, and antenatal care. ²⁰⁸

2.4.1c Existence of data standards for health record data comparability

Score: 100

There is publicly available evidence that Malawi's health data is interoperable.

Malawi's health data was initially captured in two systems and lacked interoperability: {1) OpenLMIS used as an electronic Logistics Management Information System (eLMIS) for collecting and managing data on medical stocks down to the facility level, and (2) DHIS2-based HMIS which includes data from more than 60 health programs, with a large portion being data on HIV, Tuberculosis, and Malaria. ²⁰⁹

According to a 2021 update on the DHIS 2 website, Malawi has established an interoperability layer, to bring data from OpenLMIS into DHIS2 to facilitate composite analysis of stock and health data to support effective logistics planning. ²¹⁰ The integrated HMIS-eLMIS system, in line with ISO standards, can be used to access the following data: caseload to commodity consumption ratio, caseload to stock on hand, average monthly commodity consumption, and estimate of adequate stock levels per facility (to show which facilities are adequately, under- or overstocked). ²¹¹

2.4.2a Data sharing mechanisms

Score: 100

There is evidence of established mechanisms at the relevant ministries responsible for animal, human, and wildlife surveillance to share data.

Malawi has adopted the One Health Approach, with the Public Health Institute of Malawi (PHIM) being the coordinating authority for all One Health activities in Malawi, according to Malawi's One Health Platform. Specifically, Capacitating One Health in Eastern and Southern Africa (COHESA) collaborates with the Lilongwe University of Agriculture and Natural Resources (LUANAR) for the implementation of the project activities. ²¹²

The latest One Health Joint Plan of Action (2022-26) lists its activities Table 6, such as to "develop operational tools and resources to conduct targeted One Health surveillance at human-animal-ecosystem interfaces and a mechanism for multi sectoral data sharing, per Quadripartite guidance". ²¹³ It further sets a deliverable of "supporting countries in collecting and reporting disaggregated data on endemic zoonotic, neglected tropical and vector-borne diseases as relevant; and providing guidance for standardized indicators and tools, harmonized protocols with data shared across sectors in a timely manner" (pg 37). ²¹⁴

Malawi also participates in the WHO's Weekly Epidemiological Record (WER), which serves as an essential instrument for the rapid and accurate dissemination of epidemiological information on cases and outbreaks of diseases under the International Health Regulations and on other communicable diseases of public health importance, including emerging or re-emerging infections. ²¹⁵

2.4.3a Availability of de-identified health surveillance data on disease outbreaks

Score: 100

Malawi makes de-identified health surveillance data on infectious diseases publicly available via weekly bulletins on the government website.

Malawi's government, through the Public Health Institute of Malawi (PHIM) under the Ministry of Health, regularly publishes de-identified health surveillance data on infectious diseases. These reports are publicly accessible on the PHIM website and provide detailed weekly and monthly updates on disease trends, outbreaks, and surveillance performance. ²¹⁶
The latest available Weekly IDSR Epidemiological Bulletin is from Epidemiological Week 31 (28 July – 3 August 2025), which includes updates on performance of the Integrated Disease Surveillance and Response, diseases/conditions of public health importance, and ongoing outbreaks and emergencies in Malawi. ²¹⁷

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

Malawi has legislation and regulations in place that safeguard the confidentiality of identifiable health information for individuals.

Malawi's Data Protection Act (2024) under its Section 16 states that "a data controller and data processor shall not process sensitive personal data such as 'health status data' of a subject unless the processing of the data is in the interest of public health. Section 13 ' Data integrity and data confidentiality' states that "a data controller and data processor shall ensure that the appropriate technical or organizational security measures are implemented to guarantee the security of personal data, including protection against unauthorized or unlawful processing and accidental loss, destruction, or damage of the data". ²¹⁸ Additionally, if a person/data controller commits 'breach of confidentiality, shall, upon conviction, be liable to a fine of K20,000,000 (USD 11,500) and imprisonment for five years. ²¹⁹

The Malawi Health Sector Strategic Plan III 2023-2030, published in 2024, under Strategy 6.5, calls for improving the security of information and Information Communication Technology (ICT) Systems. ²²⁰ Under Annex 1, it further lays out actionable intervention plans which include: protection of digital health information and users from undesirable threats including physical threats (fraud and theft), malwares, breach of privacy, misuse of information, and development and deployment standardized security management process in health sector to promote acceptable use of data and related tools, including hardware and software (pg 99). ²²¹

2.4.4b Inclusion of cyber protections in health data confidentiality law/regulation

Score: 100

Malawi has legislation and regulations for safeguarding the confidentiality of identifiable health information for individuals, and protection from cyber attacks.

The Malawi Health Sector Strategic Plan III 2023-2030 published in 2024, under Strategy 6.5 calls for improving the security of information and ICT Systems. ²²² Under Annex 1, it further lays out actionable intervention plans which include: protection of digital health information and users from undesirable threats including physical threats (fraud and theft), malwares, breach of privacy, misuse of information, and development and deployment standardized security management process in health sector to promote acceptable use of data and related tools, including hardware and software (pg 99). ²²³

Additionally, the Access to Information Act (2016) under its Section 32 titled 'Protection of legally privileged information' ²²⁴, and the Electronic Transactions and Cyber Security Act (2016) under its Section 33 ²²⁵ provide a legal framework for the protection of medical information and health information security.

2.4.5a Cooperative commitments or agreements within regions

Score: 0

Malawi has made a commitment via a cooperative agreement to share surveillance data during a public health emergency with other countries for one disease.

According to the Africa Centres for Diseases Control and Prevention, Malawi is one of 12 countries that have joined together in collaboration to respond, prevent and control disease outbreaks, especially the recent monkeypox outbreaks, which includes "data-sharing mechanisms". It is unclear whether this is just for one or multiple diseases, and there is no evidence of any implementation of mechanisms. ²²⁶ The press release explicitly establishes data sharing for monkeypox, however, no further details are available on the "other health emergencies".

The country's adherence to the International Health Regulations (IHR 2005) serves as a primary legal and operational commitment. As a signatory, Malawi is obligated to notify the World Health Organization (WHO) of public health events that may constitute a public health emergency of international concern. This legally binding framework necessitates the sharing of surveillance data with the WHO but does not specify provisions to share with other countries. .

No further evidence was found on the website of the Public Health Institute of Malawi ²²⁷ nor the Ministry of Health ²²⁸.

2.5.1a National support to conduct contact tracing in the event of a public health emergency

Score: 100

There is evidence of a national system in place to provide support to prepare for future public health emergencies.

The Malawi Multi-Hazard Emergency Response Plan has established Laboratory Based Surveillance for "successful detection, characterization and tracing of disease transmission for prevention and control of public health events" (pg 26). ²²⁹ The purpose of this surveillance is to monitor "existing, emerging and re-emerging pathogens", with a special focus on antimicrobial resistance, HIV, Malaria and TB drug resistance, to provide early warning signals for public health events. Table 6 lists all laboratories across the country that are a part of this surveillance system. ²³⁰

According to the Malawi Health Sector Strategic Plan III 2023-2030, during the COVID-19 pandemic, capacity building was undertaken for health care workers and other point of entry workers for case detection, specimen collection, contact tracing and reporting, and producing regular epidemiological reports (pg. 30). ²³¹

2.5.1b Provision of wraparound services to enable self-isolation/quarantine as recommended

Score: 0

There is insufficient evidence that Malawi provides wraparound services, such as economic support and medical attention to infected people and their contacts.

Malawi has a seven-year 'Social Support for Resilient Livelihoods Project' (2020-2027), funded by the World Bank, which is designed to improve resilience and build human capital among poor and vulnerable populations through social cash transfers (SCTs), livelihoods support, Enhanced Climate Smart Public Works, as well as an option for scalable financing for SCTs reach more disaster-affected households in times of weather-related disasters. ²³² In 2021, nearly 140,000 households benefited from the project’s special COVID-19 Urban Cash Intervention (CUCI) designed to help the urban poor population cope with the health and economic effects of the pandemic. However, it is not explicitly aimed at supporting self-isolation or quarantine during a public health emergency. ²³³

According to the Malawi COVID-19 Emergency Response And Health Systems Preparedness Project (2020), guidelines are provided for "training health workers in case management and clinical care, and provision of rehabilitation and renovation of existing facilities including quarantine facilities, and provision of tents and equipment for temporary isolation and quarantine, particularly at Points of Entry”(pg. 14-15). ²³⁴ However, these are applicable only for individuals employed in the Project.

No further evidence of wraparound services for quarantine or self-isolate or quarantine was found via the Public Health Institute of Malawi ²³⁵ or on the website of the Ministry of Health. ²³⁶

2.5.2a Strategy for tracing and quarantining international travelers

Score: 100

Malawi has a plan in place to identify suspected and potential cases in international travelers and trace and quarantine their contacts in the event of a public health emergency.

According to the Malawi Multi-Hazard Emergency Response Plan 2023-2025 developed by the Ministry of Health, Malawi has 36 official points of entry (POE) which include ground crossings, water (lake) port and two international airports. The Port Health Officers from the Ministry of Health, and Plant and Animal Health Officers from the Ministry of Agriculture at selected points of entry are responsible for conducting screening of travellers entering the country, and screening of animals and plants being imported into the country respectively for detection of public health conditions/animal diseases reportable under Integrated Disease Surveillance and Response (2005) developed by World Health Organization for the African Region (AFRO) (pg. 30). ²³⁷ The Ministry of Health uses the One Health Surveillance Platform (OHSP) for reporting surveillance data from PoEs to the national level. Events requiring attention are investigated by the Rapid Response Teams (RRTs) from both ministries deployed by the district health office. Additionally, there is provision of quarantine facilities at some selected POEs, which are used to support investigation by Rapid Response Teams, and samples can be collected for confirmation in laboratories. ²³⁸

2.6.1a Access to field epidemiology training program in country and/or abroad

Score: 100

There is evidence of Malawi conducting Frontline Field Epidemiology Training Programs (FETP) and it has provided resources for its citizens to participate in FETP in other countries.

According to the website of the Public Health Institute of Malawi (PHIM), a Frontline Field Epidemiology Training Program (FETP) was established in 2016 with technical and financial support from the Africa Centre for Disease Control (CDC). The program aims to strengthen the epidemiological capacity of the country’s ministries of health, agriculture, and environment in detecting and responding to diseases with epidemic potential or international significance. As of June 2025, Malawi’s Frontline FETP has completed 22 cohorts and trained 301 personnel. ²³⁹

As per the 2024 Annual Report published by Malawi Epidemiology and Intervention Research Unit, "all central support expenditure for the scientific work of MEIRU is initially charged to Core costs. Operational projects, however, benefit from those central support costs, and the approved share payable by these projects in their budgets is charged to them through an internal journal, crediting Core costs as a recovery. Total internal charges and recoveries therefore offset each other in the Income and Expenditure Statement." ²⁴⁰ However, no further information on a dedicated budget for FETP or for international travel of epidemiologists to participate in an applied epidemiology training program was found.

In June 2025, Malawi participated in a five-day Curriculum Trainer of Trainers (TOT) workshop held in Johannesburg, South Africa, under the One Health Field Epidemiology Training Program (FETP) organized by the African Epidemiology Network (AFENET) in June 2025. The primary objective of this workshop was to update mentors on the new One Health FETP curriculum contents and identify gaps to improve its implementation across the continent. ²⁴¹

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 100

There is sufficient evidence of field epidemiology training programs in Malawi explicitly inclusive of animal health professionals.

According to the website of Public Health Institute of Malawi, Malawi participated in a Curriculum Trainer of Trainers (TOT) workshop under One Health Field Epidemiology Training Program (FETP) organized by the African Epidemiology Network (AFENET) in June 2025. The FETP, a three-tier training approach comprising of basic, intermediate, and advanced levels, and is currently being implemented at the basic and intermediate levels in Malawi, targeting animal and human health practitioners. ²⁴²

According to the website of the Public Health Institute of Malawi (PHIM), a Frontline Field Epidemiology Training Program (FETP) was established in 2016 with technical and financial support from the Africa Centre for Disease Control (CDC). The program aims to strengthen the epidemiological capacity of the country’s ministries of health, agriculture, and environment in detecting and responding to diseases with epidemic potential or international significance. ²⁴³

The country webpage of Malawi on the website of Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) further confirms that "all cohorts have included at least one trainee from the Department of Animal Health to embrace the One Health approach."²⁴⁴

2.6.2a Evidence of at least 1 trained field epidemiologist per 200,000 people

Score: 100

There is sufficient evidence that Malawi has at least 1 trained field epidemiologist per 200,000 people.

According to the website of the Public Health Institute of Malawi (PHIM), a Frontline Field Epidemiology Training Program (FETP) was established in 2016 with technical and financial support from the Centre for Disease Control (CDC). The program aims to strengthen the epidemiological capacity of the country’s ministries of health, agriculture, and environment in detecting and responding to diseases with epidemic potential or international significance. As of June 2025, Malawi’s Frontline FETP has completed 22 cohorts and trained 301 personnel. ²⁴⁵

Additionally, according to the website of the Public Health Institute of Malawi, Malawi participated in a Curriculum Trainer of Trainers (TOT) workshop under the One Health Field Epidemiology Training Program (FETP) organized by the African Epidemiology Network (AFENET) in June 2025. The FETP, a three-tier training approach comprising basic, intermediate, and advanced levels, and is currently being implemented at the basic and intermediate levels in Malawi, targeting animal and human health practitioners.²⁴⁶ However, data on the total number of Malawian epidemiologists trained during this workshop is unavailable.

Considering Malawi has a total population of 21,655,286 (as per 2024 Population data by the World Bank) ²⁴⁷, Malawi currently has ~2.78 epidemiologists per 200,000 people.

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 66.67

Malawi has an overarching national public health emergency response plan in place, which addresses planning for multiple communicable diseases with epidemic or pandemic potential, but there is no evidence of funding.

The Malawi Multi-Hazard Emergency Response Plan 2023-2025, developed by the Ministry of Health, is aimed at defining the processes for preparedness, response, and recovery to public health emergencies in Malawi. It further outlines the organizational structure of how emergencies will be managed and the roles and responsibilities of the relevant stakeholders. The Plan is intended to be used by all sectors involved in responding to public health emergencies, including epidemics, disease outbreaks, public health conditions and events at all levels in Malawi (Section 1.3). ²⁴⁸

In line with the decentralised architecture of Malawi's Health Systems Structure (Figure 1), all District Councils are responsible for overseeing the management, planning, execution, and evaluation of the health District Implementation Plans (DIPs) and budgets. A committee of councillors, ie. the District Development Committee (DDC), provides oversight to the District Executive Committee (DEC). In turn, DEC, headed by the District Commissioner and composed of heads of different government institutions, is responsible for all aspects of Public Financing Management (PFM) (pg. 6). ²⁴⁹ However, no evidence of a budget allocation or explicit funding mechanism was found in the Plan.

Malawi Health Equity Network (MHEN), in a news report from March 2024, has expressed concern over the lack of a budget allocation to the public health emergency response in the 2024/2025 national budget. ²⁵⁰

3.1.1b National public health emergency response plan published in past 3 years

Score: 100

There is evidence of an overarching plan for Malawi and it has it been updated in the last 3 years.

The Malawi Multi-Hazard Emergency Response Plan 2023-2025 which contains overarching plan is in place for national public health emergencies, was launched in 2023 by the Ministry of Health. ²⁵¹

3.1.1c One health principles by covering multiple threat types

Score: 100

Malawi has an overarching national public health emergency response plan in place and it follows one health principles by covering multiple threat types.

The Malawi Multi-Hazard Emergency Response Plan 2023-2025 is strategically aligned with the principles of the International Health Regulations (IHR, 2005), and contains comprehensive guidelines for stakeholders engaged in One Health and public health emergencies. The Plan, as per its National Risk Assessment (Table 3), has categorized 'Antimicrobial resistant microorganisms' as a 'High Risk' hazard in its public health risk profile, alongside other 'Very High Risk' threats like floods, cholera, and transportation accidents (pg. 8).

It further assigns the Department of Animal Health and livestock development under the Ministry of Agriculture to conduct animal health surveillance for early detection and monitoring of trends in improvements of animal health welfare for conditions which include: Rabies, Anthrax, Foot and Mouth Disease, African Swine Fever, Rift Valley Fever, Brucellosis, Highly Pathogenic Avian Influenza (HPAI) and Antimicrobial Resistance. ²⁵²

Under its passive surveillance strategy, Animal Health Surveillance Assistants (AHSAs) report to the District Animal Health and Livestock Development Officer (DAHLDO), who in turn reports to the national level for action, and the 'important events' are reported to the ONE HEALTH platform (pg. 29). ²⁵³

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 100

Malawi's overarching national public health emergency response plan includes considerations and needs of vulnerable populations, however it does not include a mechanisms for identifying their needs.

Malawi Multi-Hazard Emergency Response Plan 2023-2025, under Section 3.4.4, focuses on Risk Communication and Community Engagement (RCCE), and puts emphasis on considerations for vulnerable populations. It recommends translating communication materials into local languages, and involving community leaders such as religious and traditional leaders, media and health workers to facilitate dissemination of information to the general public (pg. 45). ²⁵⁴ No further information on mechanisms for identifying and considering the needs of vulnerable populations nor consideration of the impact of health equity was found in the Plan.

3.1.2a Mechanism to engage private sector in outbreak preparedness/response

Score: 0

Malawi does not have a specific mechanism for engaging with the private sector to assist with outbreak emergency preparedness and response.

According to the Malawi Multi-Hazard Emergency Response Plan 2023-2025, health services are delivered through a network of Public Faith-Based Facilities (Christian Health Association of Malawi and Islamic Health Association of Malawi, Non-Governmental Organisations (NGOs), Private-not for-Profit (PNFP), and Private-for-Profit (PFP) providers (pg. 4). Table 2 shows the distribution of health facilities by type and ownership, with Private for-profits owning 248 facilities, and Private not-for-profits owning 62 health facilities across Malawi. The PFP sector consists of private hospitals, clinics, laboratories and the PNFP sector comprises of religious institutions, non-governmental organisations (NGOs), statutory corporations and companies. ²⁵⁵

Additionally, the Malawi Laboratory network incorporates government laboratories, academic institutions, faith-based institutions and private-owned laboratories (pg. 20). All health facilities, both public and private, are obliged to report to the district surveillance office using tools from the Integrated Disease Surveillance and Response (IDSR) technical guidelines (pg. 31). ²⁵⁶

Malawi National Logistics Preparedness Action Plan, developed in 2020, has identified potential bottlenecks in stakeholder engagement from both public and private sectors (pg. 8). For private sector stakeholders, it recommends "exploring ways to involve and raise awareness with the private sector on humanitarian preparedness and response strategies (i.e. by inviting them to national logistics cluster meetings)". ²⁵⁷

3.1.3a Policy/plan/guidelines in place to implement non-pharmaceutical interventions (NPIs)

Score: 100

Malawi has a policy and guidelines in place to implement non-pharmaceutical interventions (NPIs) during an epidemic or pandemic.

Malawi Multi-Hazard Emergency Response Plan 2023-2025, developed by the Ministry of Health, in Section 2.3.1, has identified key hazards or scenarios, and calls for development of contingency plans for diseases like Cholera, Measles/Rubella, COVID-19, Typhoid Fever, Ebola (EVD), Rabies, and Poliomyelitis. ²⁵⁸ Table 3 ranks each of these 'hazards' based on their risk level for Malawi. For example, Rabies is marked as a 'High Risk' Hazard and the contingency plan for it calls for increasing vaccine coverage to 70% of dogs in order to protect more than 16.4 million people in Malawi from dog-mediated rabies (pg. 9). ²⁵⁹

Additionally, Port Health Officers from the Ministry of Health and Plant and Animal Health Officers from the Ministry of Agriculture are stationed at selected PoEs to conduct screening of travellers entering the country, as well as animals and plants being imported, for public health conditions or animal diseases reportable under IDSR/IHR (2005) (pg. 30) ²⁶⁰

The National Public Health Emergency Operations Centre Handbook for Malawi (2024) includes strategies for non-pharmaceutical interventions (NPIs) such as: public risk communications (pg. 27) as a key technical area within the Operations Section during emergency response, alongside surveillance, laboratory, multi-sectoral rapid response teams (pg. 50), as well as active & passive human health data surveillance (pg. 21-22). ²⁶¹

3.2.1a Completion of biological-focused IHR exercise with the WHO in past year

Score: 100

There is publicly available evidence that Malawi has activated its national emergency response plan for an infectious disease outbreak in the past year and has also completed a national-level biological threat-focused exercise in the past year.

According to the Public Health Institute of Malawi's (PHIM) website, there is an ongoing Mpox outbreak in the country as of July 2025. ²⁶² In response, the Ministry of Health, through PHIM, has activated its Incident Management System (IMS) for Mpox and is working with various sectors, including animal health, civic education, and disaster management, using One Health Approach ²⁶³, as outlined in the Malawi Multi-Hazard Emergency Response Plan 2023-2025. ²⁶⁴

As per the latest update on the PHIM website from August 16, 2025, Malawi's Rapid Response Teams (RRTs) have been deployed to conduct contact tracing and investigate cases; surveillance systems have been enhanced at the community level, health facilities, and points of entry (PoEs); Case management guidelines have been developed and distributed, and isolation facilities have been identified. ²⁶⁵

In April 2025, Malawi participated in a specialised train-the-trainer workshop, organized by the European Union, on biological waste management and incident response in Lilongwe, Malawi. The training focused on managing infectious waste across laboratories, hospitals, and other high-risk facilities, an often-overlooked but vital component of biosafety systems. ²⁶⁶

On April 29-20 2025, the Government of Malawi hosted a national awareness-raising workshop on the risks related to Chemical, Biological, Radiological and Nuclear (CBRN) hazards. The event was co-organised by the European Union CBRN Risk Mitigation Centres of Excellence Initiative (EU CBRN CoE), which Malawi has been a partner of since 2015, the United Nations Office on Disarmament Affairs (UNODA) and the United Nations Interregional Crime and Justice Research Institute (UNICRI). ²⁶⁷

3.2.1b Evidence of bio-focused exercise to identify gaps/best practices

Score: 50

There is publicly available evidence that Malawi has conducted gap analysis activity and developed a plan to improve response capacity, but has not published the plan.

According to the Public Health Institute of Malawi's (PHIM) website, in February 2025, PHIM with support from The Global Fund, conducted a comprehensive assessment of District Public Health Emergency Operations Centres (PHEOCs) across the country. The assessments involved a thorough evaluation of several key areas of PHEOC functionality, including: Infrastructure and Equipment – a review of the adequacy of facilities, communication-systems, and essential equipment; Staffing and Training – assessment of the availability of trained personnel and their preparedness to respond to emergency situations; Plans and Protocols: an examination of the existence and efficacy of emergency response plans and standard operating procedures; and Coordination and Communication: an evaluation of the mechanisms for inter-agency collaboration and information sharing. ²⁶⁸ The findings from this assessment are intended to inform the development of targeted interventions and training programs to reinforce the preparedness and responsiveness of District PHEOCs nationwide. ²⁶⁹ No evidence of these improved targeted interventions and training programs was currently found on the PHIM website.

In May 2024, as per the website of PHIM, the research division in the Public Health Institute of Malawi, the Ministry of Health conducted a gap analysis exercise with the aim of analyzing the gaps that the old National Health Science Research Committee (NHSRC) guidelines have, informed by time, experiences and recent studies. According to the PHIM website, a gap analysis document was produced that compiled all gaps observed in the old guidelines which is to be used in the formulation of the updated guidelines. ²⁷⁰ No evidence of these updated/revised guidelines was found on the website of the National Commission For Science And Technology ²⁷¹, under which the National Health Science Research Committee operates. ²⁷²

3.2.2a Evidence of national-level biological threat-focused exercise that includes private sector

Score: 0

There is no publicly available evidence that Malawi in the past year has undergone a national-level biological threat-focused exercise that has included private sector representatives.

In April 2025, Malawi participated in a specialised train-the-trainer workshop, organized by the European Union, on biological waste management and incident response in Lilongwe, Malawi. The training focused on managing infectious waste across laboratories, hospitals, and other high-risk facilities, an often-overlooked but vital component of biosafety systems. However, there is no evidence of private sector participation in this workshop. ²⁷³

From April 29-20, 2025, the Government of Malawi hosted a national awareness-raising workshop on the risks related to Chemical, Biological, Radiological and Nuclear (CBRN) hazards. The event was co-organised by the European Union CBRN Risk Mitigation Centres of Excellence Initiative (EU CBRN CoE), which Malawi has been a partner of since 2015, the United Nations Office on Disarmament Affairs (UNODA) and the United Nations Interregional Crime and Justice Research Institute (UNICRI). However, there is no evidence of private sector participation in this workshop. ²⁷⁴

No further evidence of inclusion of private sector representatives in biological-threat-focuses exercise was found through the website of the Public Health Institute of Malawi ²⁷⁵, nor the Malawi Epidemiology and Intervention Research Unit. ²⁷⁶

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

Malawi has a National Public Health Emergency Operations Centre in place.

According to the National Public Health Emergency Operations Centre Handbook for Malawi, published by the Public Health Institute of Malawi in August 2024, Malawi has established a National Public Health Emergency Operations Centre Malawi (NPHEOC), that serves as the country’s main coordination hub for Public Health Emergencies (PHE). The NPHEOC acts as the central incident management location for coordinating the response to a PHE. The NPHEOC coordinates the allocation of resources and field investigations; receives analyses and maintains up-to-date information; provides reliable health information to the public, and brings decision-makers and Subject Matter Experts (SMEs) to a central point to coordinate the response to a PHE (pg. 3). ²⁷⁷

The National Public Health Emergency Management Committee is the steering committee responsible for the effective implementation of NPHEOC's functions (pg. 48). ²⁷⁸

3.3.1b Requirement for EOC to conduct/evidence EOC conducts at least annual drills

Score: 0

The National Public Health Emergency Operations Centre of Malawi is required to conduct a drill for a public health emergency scenario, and there is evidence of a drill/simulation exercise being conducted this year. However, there is no mandate to conduct a drill at least once per year.

Section 10.2 of the National Public Health Emergency Operations Centre Handbook for Malawi, published by the Public Health Institute of Malawi in August 2024, states that the NPHEOC Manager is responsible for the conduct and coordination of 'Simulation Exercises' to test skills acquired, functionality of plans and procedures and systems. ²⁷⁹ However, it does not mandate the conduction of simulation exercises/drills every year.

The training plan should cover types of exercise to be conducted, frequency of exercise per year, persons to be involved in the exercise in a One Health approach, ie. it needs to be multi-disciplinary/ multi-sectoral including response partners. The Malawi National Public Health Emergency Operations Centre (NPHEOC) will use standard procedures from the World Health Organization to conduct these simulation exercises. Additionally, the Public Health Emergency Operations Center (PHEOC) manager will also plan on how to build the capacity of PHEOC staff from gaps that would be identified during the Simulation Exercises (pg. 67). ²⁸⁰

However, the number of Simulation Exercises/drills for a public health emergency scenario is up to the discretion of the NPHEOC Manager. The NPHEOC Handbook does not explicitly mandate a minimum of one simulation exercise/ drill per year. ²⁸¹

The latest available evidence of a Simulation Exercise being conducted is from a 28 July 2025 Facebook post by World Food Programme Malawi. ²⁸²

3.3.1c EOC activation within 120 minutes of identification of emergency/scenario

Score: 0

There is no public evidence to show that the National Public Health Emergency Operations Centre has conducted a coordinated emergency response or emergency response exercise activated within 120 minutes of the identification of the public health emergency/scenario within the last year.

According to Section 7.1.2. of the National Public Health Emergency Operations Centre Handbook for Malawi, published in August 2024 by the Public Health Institute of Malawi, the National Public Health Emergency Operations Centre (NPHEOC) "should be capable of activation within 120 minutes of the identification of a Public Health Emergency, as required by International Health Regulations (IHR) 2005" (pg. 22). ²⁸³

However, no evidence of a National Public Health Emergency Operation was found on the website of the Public Health Institute of Malawi, nor specifically under the Epidemiology and Surveillance Division webpage. ²⁸⁴ The National Public Health Emergency Operations Centre does not have a website.

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There is no publicly available evidence of Malawi's public health and national security authorities carrying out an exercise to respond to a potential deliberate biological event or that there are publicly available standard operating procedures between the public health and security authorities to respond to a potential deliberate biological event.

The 2019 Joint External Evaluation report (JEE) states that "A proper coordination mechanism to detect and respond to deliberate or accidental events is absent". (pg. 14) ²⁸⁵ There is no further evidence of such an agreement or exercise through the Ministries of Health or Justice, the Public Health Institute or the Department of Disaster Management Affairs; those sites also do not contain evidence of an MOU or other agreements between the public health, animal health, the private sector and security authorities to respond to a potential deliberate biological event ^{286 287 288 289}.

3.5.1a Risk communication plan for specific use during a public health emergency

Score: 100

Malawi has a National Public Health Emergency Operations Centre Handbook with a section detailing the risk communication plan that is specifically intended for use during a public health emergency.

The National Public Health Emergency Operations Centre Handbook for Malawi (2024), developed by the Public Health Institute of Malawi, contains Section 3.4.1 'Emergency Risk Communication (ERC) Plans' which includes an ERC Communication Management Plan (Table 10) along with response timelines.

As per Section 3.4.2, the protocol for activating ERC is as follows: in case of an emerging health threat, Public Health Institute of Malawi (PHIM) will investigate and issue a report on the threat to the Secretary for Health (SH). The SH reports to the Minister of Health, who announces the emerging health threat within 24 to 48 hours of its confirmation through a press briefing/statement. The statement is then shared through print, social and electronic media (pg. 44). ²⁹⁰

3.5.1b Inclusion of different population & sector needs in risk communication plan

Score: 100

Malawi has a National Public Health Emergency Operations Centre Handbook which outlines how messages will reach populations and sectors with different communications needs.

The National Public Health Emergency Operations Centre Handbook for Malawi (2024), developed by the Public Health Institute of Malawi, contains an 'Emergency Risk Communication (ERC) Plan'. ²⁹¹

For public communication during a public health emergency, according to Section 3.4.3, Health Education Services (HES) is responsible for leading the Risk Communication and Community Engagement (RCCE) response Pillar which consists of different stakeholders, including International, national and community based organizations. RCCE at the national and district level {Health Promotion Technical Working Group (HP TWG)} are responsible for the dissemination of information on the threat, rumour management, coordination of RCCE response activities and also sharing of daily or weekly situation updates to different platforms, including health journalist WhatsApp groups. ²⁹²

The RCCE aims to ensure audience segmentation for effective social and behaviour change communication, with a focus on vulnerable populations. Community leaders such as religious and traditional leaders, media and health workers are to be included to facilitate dissemination of information to the general public (pg. 45).²⁹³

Additionally, under Section 3.4.4, the Handbook states that "the communication materials shall be translated into local languages such as Chichewa and Tumbuka to ensure maximum reach to intended audiences", and the "RCCE should ensure that the communication materials are inclusive and adapted to literacy levels of the targeted audience". ²⁹⁴

3.5.1c Designation of a specific government spokesperson during a public health emergency

Score: 100

There is evidence that Malawi's risk communication plan designates a specific position within the government to serve as the primary spokesperson to the public during a public health emergency.

The National Public Health Emergency Operations Centre Handbook for Malawi (2024), developed by the Public Health Institute of Malawi, contains an 'Emergency Risk Communication (ERC) Plan'. As per its Section 3.4.2, the protocol for activating ERC is as follows: in case of an emerging health threat, the Public Health Institute of Malawi (PHIM) will investigate and issue a report on the threat to the Secretary for Health (SH). The SH reports to the Minister of Ministry of Health, who announces the emerging health threat within 24 to 48 hours of its confirmation through a press briefing/statement. The statement is then shared through print, social and electronic media (pg. 44). ²⁹⁵ Therefore, the current Minister of Health acts as the spokesperson during public health emergencies.

3.5.2a Government use of media platforms to share info on public health emergencies

Score: 100

There is public evidence that Malawi's public health system has actively shared messages via online media platforms to inform the public about ongoing public health concerns and dispel rumors.

The Public Health Institute of Malawi has an active Facebook page ²⁹⁶ through which it is currently sharing updates on the ongoing Mpox outbreak in Malawi, with the latest Mpox update Facebook post being from 27 July 2025. These Facebook posts include updates on the number of cases identified, the steps being taken to address the outbreak, and Mpox awareness videos in local languages. ²⁹⁷

During a Cholera outbreak in 2023 in Malawi, World Health Organization (WHO)-led media trainings have been running since February 2023, reaching over 120 journalists, alongside significant efforts to engage communities online and offline, including videos on social media, to help mitigate the spread of harmful misinformation in order to bring the outbreak under control. The videos were produced in multiple languages, and were viewed nearly 23 million times on WHO Africa’s Facebook account. ²⁹⁸

3.5.2b Evidence that senior leaders have shared mis/disinformation on infectious diseases

Score: 100

There is no public evidence that Malawi’s President or Ministers have shared misinformation or disinformation about infectious diseases in the past 24 months.

According to a World Health Organization news report from May 2023, during a cholera outbreak in 2022-2023, misinformation and rumours had been circulating that "health workers were harvesting the body parts of patients who had died of cholera" causing mistrust, and contributing to patients failing to seek timely treatment, raising their risk for rapid onset of severe dehydration, and even death. ²⁹⁹ However, there is no evidence of senior leaders (president or ministers) spreading these rumours.

No further evidence of misinformation or disinformation sharing by senior leaders was found through the local news website ³⁰⁰

3.6.1a Percentage of households with Internet

Score: 18.39

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 33.04

3.6.3a Gender gap in access to a mobile phone (percentage points)

Score: 73.33

3.6.4a Gender gap in access to the Internet (percentage points)

Score: 50

3.7.1a Restrictions on export/import of medical goods due to an infectious disease outbreak

Score: 100

There is no publicly available evidence that Malawi has in the past year has implemented restrictions on the export/import of medical goods.

No evidence of a restriction on export/import of medical goods in the past year was found through the website of Malawi Trade Portal ³⁰¹, Malawi Revenue Authority (MRA) ³⁰², nor the Ministry of Trade and Industry. ³⁰³

3.7.1b Restrictions on movement and/or exports/imports due to disease outbreak

Score: 100

There is no publicly available evidence that Malawi has in the past year has implemented restrictions on export/import of non-medical goods due to an infectious disease outbreak.

According to news report from March 2025, through a government gazette dated March 13, 2025, Minister of Trade and Industry Vitumbiko Mumba announced an import ban on maize flour, fresh milk, rice and fruits, except those that do not grow in Malawi. However, the ban is aimed at incentivising production to meet the deficit created by this import ban, not due to an infectious disease outbreak. ³⁰⁴

No further evidence of a restriction on export/import of non-medical goods (e.g. food, textiles, etc) in the past year was found through the website of Malawi Trade Portal ³⁰⁵, Malawi Revenue Authority (MRA) ³⁰⁶, nor the Ministry of Trade and Industry. ³⁰⁷

3.7.2a Evidence of travel ban due to an infectious disease outbreak

Score: 100

There is no public evidence that Malawi has, in the past year, implemented inbound or outbound travel restrictions due to an infectious disease outbreak.

As per the Public Health Institute of Malawi's (PHIM) website, there is an ongoing Mpox outbreak in the country. In response, the Ministry of Health, through PHIM, has implemented a multi-faceted response strategy, in line with the One-Health Approach. This includes an intensified surveillance and awareness campaign for travelers at all Points of Entry. ³⁰⁸ However, no ban or restrictions on inbound or outbound travel have yet been announced on the PHIM website. ³⁰⁹

The International SOS does not recommend implementation of travel restrictions to the public health authorities of affected countries in case of Mpox. ³¹⁰

No further evidence of travel restrictions due to an infectious disease outbreak was found through the website of the Public Health Institute of Malawi ³¹¹ and the Department of Immigration. ³¹²

3.7.2b Risk-based approach to international travel-related measures

Score: 100

There is public evidence that Malawi uses a risk-based approach to international travel-related measures.

Malawi is a State Party to the International Health Regulations (IHR) of 2005, which obligates member states to develop and maintain capacities to respond to public health emergencies of international concern, including at points of entry. ³¹³

The Public Health Institute of Malawi (PHIM) Strategic Plan (2023-2030) highlights that Points of Entry (PoEs) are often the main entry route for infectious diseases and have historically been neglected in the region (pg. 30). ³¹⁴ Malawi has 36 official points of entry, including ground crossings, water (lake) ports, and two international airports, where Port Health Officers from the Ministry of Health and Plant and Animal Health Officers from the Ministry of Agriculture are stationed at selected PoEs to conduct screening of travellers entering the country, as well as animals and plants being imported, for public health conditions or animal diseases reportable under IDSR/IHR (2005). These are routine screenings being conducted at all 36 PoEs. ³¹⁵ Table 10 lists strategic activities to be undertaken in order to 'Intensify Cross Border Collaboration Activities' as part of the Strategy 5 under PHIM Strategic Plan. These activities include: training PoE staff in One-Health approach (IHR) prioritizing the designated PoEs, establishing/strengthening collaboration of neighboring PoEs by conducting joint response to public health emergencies (pg. 63). ³¹⁶

4.1.1a Doctors per 100,000 people

Score: 0.24

4.1.1b Nurses and midwives per 100,000 people

Score: 5.45

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 0

There is insufficient evidence that Malawi has a health workforce strategy in place to identify fields where there is an insufficient workforce and strategies to address these shortcomings.

The Malawi Emergency Preparedness and Response Roadmap 2023-2025, developed in collaboration with World Health Organization Africa and Africa Center for Disease Control (CDC) provides a 2-year roadmap after conduction of a gap analysis by Malawi government’s multi sectoral technical teams together with partners, with support
from World Health Organization. Under Section 1 'Workforce Development' it calls for establishment of a committee to expand the availability of trained workforce, and to map out existing specialized experts in relation to Public Health Emergencies (PMEs) in various health institutions across Malawi. ³¹⁷

It also calls for establishment of an inter-ministerial taskforce for mobilizing resources,and convene meetings to elect the leadership and map-out potential sources of funding for surge in the workforce. It further lays out a strategy for 'Building Outbreak Response Capacity' through the training and evaluation of 200 multi sectoral and trans-disciplinary experts across five health sectors. A total budget of USD 1,594,170 has been allocated for resources needed in PMEs, including surge in workforce. ³¹⁸

Additionally, Malawi is a participant of the Global Health Workforce Programme (GHWP) (2025-26), funded by the United Kingdom Department of Health and Social Care. ³¹⁹ For Malawi, GHWP's project goal for 2025-26 is to "strengthen capacity and capability of faculty and Healthcare worker trainers to deliver high quality pre- and in-service education and training in ear and hearing care and trauma and orthopaedics, leading to improved quality and accessibility of healthcare services in Malawi." ³²⁰

The Malawi Health Sector Strategic Plan III 2023-2030 under Section 2.5.2.2 lists 'Bottlenecks in Human Resources for Health' including high vacancy rates with poor absorption, partly due to challenges with aligning interministerial and intersectoral partners on increasing financing of remuneration and benefits (pg. 37). Under Table 6 details the projected workforce and workforce gaps in 2030, if the prioritized health workforce investment package is funded as proposed. However, the Plan does not include a mechanism to identify. ³²¹ However, the Plan does not explicilty include strategies to identify and address workforce shortages.

The 2019 Joint External Evaluation report (JEE) recommends that Malawi should "conduct a comprehensive human resource mapping and revise the national human resource strategy and HR information system to include other staff such as epidemiologists, laboratory specialists, public health specialists, biostatisticians and staff in animal health in oth the public and private sector. This should incorporate mechanisms for regular updates and tracking of the IHR workforce in particular, such as public health specialists (epidemiologists), clinicians, biostatisticians and laboratory scientists." ³²² However, no evidence of its inculcation was found in the current Malawi Health Sector Strategic Plan III 2023-2030 ³²³

4.1.1d Health system capacity for essential health services

Score: 0

Malawi does not have sufficient capacity within the health system to deliver essential health services.

The Joint external evaluation of IHR core capacities of the Republic of Malawi (2019) gives the country a score of 1, the lowest possible, on this measure. It says that, while the country has guidelines in place for servise delivery, the country has no plan for sending and receiving health personnel during a public health emergency; there are no plans for surge staffing, including triggers for requesting personnel from other countries; and there is no involvement in regional and international personnel deployment agreements, such as the WHO Global Outbreak Alert and Response Network.³²⁴

Moreover, according to the latest available Annual Report 2023 by the World Health Organization, Malawi needs to strengthen its essential care services by conducting capacity building for frontline workers, supportive supervision, strengthening of data management, including the deployment of the Vigimobile app for surveillance data tracking and enhancement of cross- border surveillance (p. 73). ³²⁵ The report further states that "Malawi faces significant risks in terms of public health emergencies, as its capacity for pandemic preparedness and response is inadequate."(pg. 73) ³²⁶

As per the 2023 Climate and Health Vulnerability Assessment conducted by the World Bank, there are significant staffing gaps in the number of skilled health workers and their geographical distribution throughout the country. According to the WHO’s recommended Sustainable Development Goals (SDG) index threshold of 4.45 skilled health workers (physicians, nurses, and midwives) per 1,000 population, Malawi is in the critical shortage zone: it has just 0.019 doctors and 0.283 nurses and midwives per 1,000 population (pg. 40). ³²⁷

Additionally, as per the Malawi National Strategic Plan for HIV and AIDS 2020-2025, developed by the National AIDS Commission, Malawi faces severe health worker shortages, with a 48% vacancy rate for established clinical and nursing positions. Current staffing levels are only 33% of the World Health Organization's recommended minimum ratio of 4.45 health workers per 1,000 population (pg. 69-70). ³²⁸

4.1.1e Essential health services continuity plan for public health emergencies

Score: 0

There is insufficient evidence that Malawi has national plans in place to ensure continuity of essential health services during a public health emergency.

The Health Sector Strategic Plan III (2023-2030) outlines objectives, strategies, and activities to build strong and holistic health systems, placing joint processes for planning, budgeting, and reporting at its centre. It has explicitly accounted for "other health determinants such as poverty, climate change, natural disasters and disease pandemics and defined priorities for multi sectoral and inter-sectoral collaboration". (pg. 10). ³²⁹

Additionally, the Malawi Multi-Hazard Emergency Response Plan (2023-2025), developed by the Ministry of Health, defines processes for preparedness, response, and recovery to public health emergencies. It further outlines the organizational structure and responsibilities of relevant stakeholders (Chapter 1). ³³⁰ The Plan under Chapter 3 contains dedicated Indicator-Based Surveillance (IBS) & Event-Based Surveillance (EBS) surveillance and early warning systems, along with their implementation strategies, to be used during public health emergencies. ³³¹

Public Health Institute of Malawi, in August 2024, has also developed a 'National Public Health Emergency Operations Centre Handbook', which under Section 6, lists Standard Operating Procedures to be followed by the Public Health Emergency Operations Centre to execute its duties and maintain continuity of operations during public health emergencies. ³³²

However, the above Health Sector Strategic Plan III (2023-2030), Malawi Multi-Hazard Emergency Response Plan (2023-2025), and National Public Health Emergency Operations Centre Handbook do not explicitly contain a strategy/plan to ensure continuity of essential health services during a public health emergency. ^{333 334 335}

4.1.2a Hospital beds per 100,000 people

Score: 31.4

4.1.2b In-country capacity to isolate patients with highly communicable diseases

Score: 100

There is publicly available evidence that Malawi has the capacity to isolate patients with highly communicable diseases in patient isolation shelters located within the country.

According to the website of the Public Health Institute of Malawi, with funding from the World Bank through the National Aids Commission (NAC)for an Ebola Project, the Public Health Institute of Malawi (PHIM) constructed 6 isolation shelters in Karonga, Mzuzu, Mchinji, Dedza, Mwanza and Blantyre. ³³⁶ As of April 2021, a seventh isolation shelter is being constructed at Kamuzu Central Hospital, funded by the Government of Malawi. ³³⁷ No further updates are available on the PHIM website. ³³⁸

4.1.2c Demonstrated capacity / evidence of plan to expand isolation capacity

Score: 0

There is no publicly available evidence that Malawi has expanded or has developed/updated or tested a plan its isolation capacity in response to an infectious disease outbreak in the past two years.

According to the website of the Public Health Institute of Malawi, as of April 2021, a seventh isolation shelter is being constructed at Kamuzu Central Hospital, funded by the Government of Malawi. ³³⁹ As per a 2021 brochure by the World Food Programme (WFP), the WFP has deployed Mobile Units at border posts for screening and isolation, in health centres for testing and vaccination, and in Dzaleka Refugee Camp (for testing and isolation)." ³⁴⁰

No further evidence of expansion in isolation capacity in response to an infectious disease outbreak was found through the websites of the Public Health Institute of Malawi ³⁴¹ or the Ministry of Health ³⁴²

No explicit evidence of plans/strategy/goal to expand isolation capacity in response to an infectious disease outbreak was found in the Malawi Multi-Hazard Emergency Response Plan 2023-2025 ³⁴³, and Malawi Health Sector Strategic Plan III 2023-2030 ³⁴⁴

4.2.1a National procurement protocol for the acquisition of routine laboratory/medical supplies

Score: 0

There is inadequate publicly available evidence to show that there is a national or international procurement protocol in place which can be utilized by the Ministries of Health and Agriculture for the acquisition of laboratory supplies (such as equipment, reagents and media) and medical supplies (equipment, PPE) for routine needs.

The Public Procurement Act (2003), which the Director of Public Procurement is responsible for enforcing, outlines the procurement protocols for "goods" which include "objects of every kind and description, including raw materials, products and equipment, and objects in solid, liquid or gaseous form, and electricity" (Section 2), but no specific mention is made of the Ministries of Health or Agriculture, nor are laboratory or medical supplies mentioned. ³⁴⁵.

In addition, according to the Ministry of Health, although "the public health sector has continued to follow procedures for procuring goods, works and services as laid down in the Public Procurement Act (2003) and elaborated in the Public Procurement Regulations of 2004", there are "major challenges in procurement". These include lack of capacity; poor coordination between the Procurement Unit and other departments; lack of well documented procurement procedures; unclear role of the central level in procurements undertaken at the district level, and excessive emergency procurements. ³⁴⁶

The Central Medical Stores Trust (CMST) a not-for-profit, autonomous organization with the Government of Malawi being its primary stakeholder. CMST is responsible for procuring and supplying medicines, medical consumables and equipment to health facilities ³⁴⁷. CMST runs International Competitive Bidding (ICB) in line with Public Procurement and Disposal of Assets Authority (PPDA) rules for routine needs. ³⁴⁸ No specific mention is made of either the Ministry of Agriculture or of laboratory supplies.

No further information could be found through the Public Health Institute of Malawi (PHIM), including the page for the National Public Health Laboratory ³⁴⁹, or the Ministry of Agriculture. ³⁵⁰

4.2.2a Stockpile of medical supplies for national use during a public health emergency

Score: 66.67

Malawi has a stockpile of medical supplies for national use during a public health emergency defined by a national public health emergency response plan, with limited evidence for equitable distribution of medical supplies.

According to the Malawi Multi-Hazard Emergency Response Plan 2023-2025 developed by the Ministry of Health, Health Technical Support Services (HTSS) in the Ministry of Health is responsible for effective and sustainable stockpiling of medical supplies, which includes "medicines, vaccines, antidotes, protective equipment and other medical supplies"(Section 2.5.8) to be made available for use during the national response to public health emergencies. ³⁵¹ Under Section 2.5.9, the Plan states that the Government of Malawi, through the Ministry of Health has successfully established a National Blood Service in the name of the Malawi Blood Transfusion Service to be the key driver in ensuring availability of adequate supplies of safe blood and blood products for use during a public health emergency. ³⁵²

Section 2.5.9.1 further details the criteria for quantities of stockpiles per product group to be determined by how the equipment will be used (e.g., PPE, syringes), as well as the shelf life of the supplies. ³⁵³ The Plan under its Section 2.5.9 only explicitly ensures equitable distribution of donated blood during a public health emergency, stating "(blood) must equitably be made available to all in need without favour or prejudice". ³⁵⁴

4.2.2b Stockpile of laboratory supplies for national use during a public health emergency

Score: 0

There is insufficient evidence that Malawi has a stockpile of laboratory supplies for national use during a public health emergency.

Malawi Multi-Hazard Emergency Response Plan 2023-2025 developed by the Ministry of Health, under Section 2.5.9.1 'Strategic Health Stockpiles' states that the stockpile includes "strategic reserve of medicines, vaccines, antidotes, protective equipment and other medical supplies available for use during the national response to public health emergencies". However, no further evidence of the stockpile explicitly including laboratory supplies was found in the Plan. ³⁵⁵

According to a 2022 National Medical Equipment Baseline Inventory Report published by PATH, most health facilities in Malawi do not meet the national minimum set in the Standard Equipment List and have an overall 81% gap in device availability (pg. 12). ³⁵⁶

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

There is no publicly available evidence that Malawi conducts or requires an annual review of the national stockpile to ensure the supply is sufficient for a public health emergency.

The Malawi Multi-Hazard Emergency Response Plan 2023-2025 developed by the Ministry of Health, under its Section 2.5.9.1 'Strategic Health Stockpiles' calls for a periodic review of the stockpile, stating, "the periodic review should be foreseen to stress test various elements; content of the stockpile, maintenance and validity of the products, evolution of needs and innovations". ³⁵⁷ However, no evidence of an annual review of the national stockpile was found through the websites of Public Health Institute of Malawi ³⁵⁸ nor Ministry of Health. ³⁵⁹

4.2.3a Plan/agreement to produce/procure medical supplies during a public health emergency

Score: 100

Malawi has legislation in place to allow for procurement of medicines during a public health emergency, however there is insufficient evidence of a plan/agreement to leverage public and/or private sector domestic manufacturing capacity to produce medical supplies, or expedite medical supplies through points of entry.

The Public Procurement and Disposal of Public Assets Act (2025), under Section 49 titled 'Emergency procurement ' allows a procuring and disposing entity, in case of an emergency to use any of the following approaches: request for quotations, restricted tender, open tender, and single source. The Act defines 'emergency' as "a situation which poses an imminent threat to the physical safety of a population or damage to property", and does not explicitly mention public health emergencies. ³⁶⁰

The Pharmacy and Medicines Regulatory Authority (PMRA) Act (2019) under Part 6 titled 'Regulation and Registration of Medicines and Allied Substances', contains an exception for medicine imported or exported in response to a declared health emergency, ie. such medicines can be placed on the market, advertised, marketed, manufactured, sold, imported, supplied, administered or dealt any manner without a marketing authorization issued by the PMRA. ³⁶¹

The Health Sector Strategic Plan III 2023-2030 highlights "building local manufacturing capabilities" as a key strategy for enhancing resilience based on lessons learned from past pandemics. ³⁶² Within the emergency preparedness and response strategies of the Malawi Genomic Surveillance Implementation Plan (2023-2030), there is an activity to "Consider the value of onshoring local manufacturing of some essential commodities, e.g., PPE". ³⁶³ Section 2.5.8 further states that "the Government of Malawi will strengthen public-private partnerships to benefit genomic surveillance, and will negotiate pricing agreements with manufacturers and suppliers of reagents, laboratory equipment, ICT equipment, software, and other resources."³⁶⁴

According to the website of management4health, Malawi has allocated approximately USD 2.5 million from the Health Services Joint Fund (HSJF) under the Ministry of Health to procure emergency medical supplies through UNICEF during COVID-19. These included PPE, medicines (e.g., paracetamol, antibiotics), laboratory consumables, and equipment for treatment and quarantine centers. ³⁶⁵ Management4Health supported the needs assessment, technical specifications, costing, freight logistics, risk mitigation, and procedural documentation for approval. ³⁶⁶

No further evidence of a mechanism/plan to produce/procure/ or expedite medical supplies through points of entry during PHEs was found through the Malawi Multi-Hazard Emergency Response Plan 2023-2025. ³⁶⁷, websites of Malawi Trade Portal ³⁶⁸, Malawi Revenue Authority ³⁶⁹, and Ministry of Trade and Industry ³⁷⁰.

4.2.3b Plan/agreement to produce/procure lab supplies during a public health emergency

Score: 0

There is no publicly available evidence of a plan/agreement to leverage public and/or private sector domestic manufacturing to produce laboratory supplies, procure or expedite laboratory supplies through points of entry during a public health emergency.

No evidence of such a plan/policy or agreement was found through the Pharmacy and Medicines Regulatory Authority (PMRA) Act ³⁷¹, Public Procurement and Disposal of Public Assets Act ³⁷², Malawi Multi-Hazard Emergency Response Plan 2023-2025 ³⁷³, Malawi Trade Portal ³⁷⁴, Malawi Revenue Authority ³⁷⁵, Ministry of Trade and Industry ³⁷⁶.

4.2.3c Mechanism emergency logistics and supply chain management

Score: 100

Malawi has action plans and systems in place for national and subnational levels for emergency logistics and supply chain management, which covers the public and private sectors as well as cold chain management for vaccines.

Malawi National Logistics Preparedness Action Plan, developed in 2020, lists potential gaps and bottlenecks as well as targeted actions along with designated implementation authority for each component in the logistics chain: air/water/road transport, warehousing, customs, information management, etc. It also identifies potential bottlenecks in stakeholder engagement from both public and private sectors (pg. 8). For private sector stakeholders, it recommends "exploring ways to involve and raise awareness with the private sector on humanitarian preparedness and response strategies (i.e. by inviting them to national logistics cluster meetings)". For public sector stakeholders such as academic institutions, it recommends "identifying areas of expertise and capacity of relevant academic institutions in Malawi, that could contribute to enhancing humanitarian logistics operations". ³⁷⁷ However, no evidence of the Action Plan's evaluation or regular update was found.

In 2021, Malawi, with support from the World Food Programme, had established a Humanitarian Staging Area in Nsanje District, southern Malawi, as part of the emergency supply chain project to increase access, ensure operational continuity, and enhance national resilience during crisis. ³⁷⁸

As per an August 2024 update on the DHSIS website, Malawi’s Ministry of Health is using DHIS2 Tracker to register and manage its vaccine cold chain equipment. An 'eVax Cold Chain Guard system' has been developed which features dashboards for data on equipment functionality by site, equipment distribution by funding source, equipment distribution by manufacturer, etc. ³⁷⁹ However, there is no evidence that the mechanism includes private sector stakeholders.

A July 2024 report by the World Food Programme on the impact of the Supply Chain Simulation Exercises conducted in 2022 and 2023 to strengthen logistics capacities in Malawi reported improvements towards "more efficient crisis management practices, including timely response, better resource allocation, and enhanced collaboration among stakeholders".³⁸⁰

4.3.1a Plan/program/guidelines for dispensing MCMs during a public health emergency

Score: 0

There is insufficient evidence that Malawi has a national plan and guidelines in place for dispensing medical countermeasures (MCM) for national use during a public health emergency.

According to the Malawi Multi-Hazard Emergency Response Plan 2023-2025 developed by the Ministry of Health, Health Technical Support Services (HTSS) in the Ministry of Health is responsible for effective and sustainable stockpiling of medical supplies to availability of needed services along the continuum of care where needed for patients and any (unforeseeable) place and point in time. ³⁸¹ Section 2.5.9.1 further details the criteria for quantities of stockpiles per product group to be determined by how the equipment will be used (e.g., PPE, syringes), as well as the shelf life of the supplies. ³⁸²

Additionally, Malawi's Health Sector Strategic Plan III 2023-2030 is guided by a National Supply Chain Transformation Plan, which includes strategies for procuring sufficient medicines and commodities to prevent stock-outs and ensure rational utilisation. ³⁸³ However, the Malawi national supply chain transformation plan (MNSCTP 2023-2030) is not publicly accessible, therefore no further information on how the supplies will be handed-out could be determined. ³⁸⁴

According to the National Public Health Emergency Operations Centre Handbook (2024) developed by the Public Health Institute of Malawi, the National Public Health Emergency Operations Centre (NPHEOC) serves as the central hub for coordinating information and resources during public health emergencies, including the "mobilisation and deployment of resources, including surge capacity, services and supplies" (pg. 4). ³⁸⁵

4.3.2a Plan to receive foreign health personnel during a public health emergency

Score: 100

There is evidence that Malawi has a public plan in place to facilitate a workforce surge in an emergency.

The Malawi Emergency Preparedness and Response Roadmap 2023-2025, developed in collaboration with World Health Organization Africa and Africa Center for Disease Control (CDC) under Section 1 'Workforce Development' calls for establishment of a committee to expand the availability of trained workforce, and to map out existing specialized experts in relation to Public Health Emergencies (PMEs) in various health institutions across Malawi. ³⁸⁶

It also calls for the establishment of an inter-ministerial task force for mobilizing resources, convening meetings to elect the leadership and mapping out potential sources of funding for a surge in the workforce. It further lays out a strategy for 'Building Outbreak Response Capacity' through the training and evaluation of 200 multi sectoral and trans-disciplinary experts across five health sectors. A total budget of USD 1,594,170 has been allocated for resources needed in PMEs, including a surge in workforce. ³⁸⁷

Malawi Multi-Hazard Emergency Response Plan 2023-2025, developed by the Ministry of Health, under its Section 2.5.4, states plans to increase the capacity of National Emergency Medical Teams (N-EMT). The goal of N-EMT's is to enhance the capacity of the district health systems in leading the activation and coordination of the rapid response capacities in the immediate aftermath of a disaster, outbreak or other emergencies. The N-EMT teams are composed of health professionals (doctors, nurses, paramedics etc.) with proven experience in humanitarian crises (emergency and trauma care, control of communicable diseases) and are familiar with the national operation procedures in emergency (pg. 17-18). ³⁸⁸

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 100

Malawi has a public plan to receive health personnel from other countries to respond to a public health emergency.

Malawi Multi-Hazard Emergency Response Plan 2023-2025, developed by the Ministry of Health under Section 2.5.4, indicates the presence of an International Medical Emergency Team (I-MET) in the country. According to the Plan, I-METs are intended to help improve the timeliness and quality of health services provided by the National Emergency Medical Teams (N-MET). It enhances the capacity of the national health systems in leading the activation and coordination of the rapid response capacities in the immediate aftermath of a disaster, outbreak or other emergencies. In accordance to WHO requirements, an International Emergency Medical Team (I-EMT) provides immediate basic outpatient and in-patients clinical services focused on basic trauma care, communicable and non-communicable diseases and preventive care.³⁸⁹

The most recently available evidence of an I-EMT deployment by WHO in Malawi is from a cholera outbreak in 2023. ³⁹⁰

4.3.2c Plan to redeploy existing health personnel within the country

Score: 100

There is publicly available evidence that Malawi has a public plan in place to facilitate a workforce surge in an emergency, including redeploying existing health personnel within the country.

According to the National Public Health Emergency Operations Centre Handbook (2024) developed by the Public Health Institute of Malawi (PHIM), the National Public Health Emergency Operations Centre (NPHEOC) serves as the central hub for coordinating information and resources during public health emergencies, including the "mobilisation and deployment of resources, including surge capacity, services and supplies" (pg. 4). ³⁹¹ Under Section 6 titled 'Standard Operating Procedures' (SOP), there are procedures for carrying out surge staffing and integration of Service Corps during a public health emergency. ³⁹² The Secretary for Health is responsible for the Memorandum of Understanding between the Ministry of Health and other agencies, partners that provide surge staff/ service corps (pg. 71-74).

The NPHEOC maintains MoUs with relevant public health staff resources (internal and external) and a roster of multidisciplinary and multi-sectoral experts who can be deployed at short notice. The Human Resource Unit of the NPHEOC is responsible for maintaining this roster and implementing the surge staffing SOP. During the 'Response' stage ie. when NPHEOC is activated, the NPHEOC Manager conducts a human resource needs analysis to determine the number, type, and expertise of surge staff required. The NPHEOC Manager then advises the Secretary for Health through the Director of PHIM on staffing needs. Subsequently, the identified surge staff are mobilized, oriented on the public health emergency, and deployed to support operations. ³⁹³ However, the exact departments/specializations that the staff is mobilized for is not stated.

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 50

Malawi has an aspirational or subject to progressive realization approach towards right to medical care.

The Constitution of the Republic of Malawi, last amended in 2021, under its 'Principles of national policy' states that the "State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals" which among others include: "to provide adequate health care, commensurate with the health needs of Malawian society and international standards of health care." ³⁹⁴ However, these are non-binding Directive Principles, not entitlements entrenched as enforceable rights in the Constitution. ^{395 396}

Additionally, the World Policy Analysis Center classifies Malawi’s constitutional approach to healthcare as "aspirational or subject to progressive realization", rather than an explicit, enforceable right. ³⁹⁷

4.4.1b Access to skilled birth attendants (% of population)

Score: 94.12

4.4.1c Out-of-pocket health expenditures per capita, PPP (current international $)

Score: 99.27

4.4.1d Coverage of essential health services through universal health coverage

Score: 43.75

4.4.1e Total population pushed below a relative poverty line by household health expenditure (60% of media daily per capita consumption or income)

Score: 87.87

4.4.1f Rate of mortality amenable to health care

Score: 74.1

4.4.2a Guaranteed paid sick leave

Score: 66.67

Malawi offers guaranteed paid sick leave to employees; however, paid sick leave for mental health problems is not explicitly covered.

According to the Malawi Employment Act No. 6 of 2000 under Section 46, an employee who has completed 12 months of continuous service is entitled to 4 weeks of sick leave on full pay, and 8 additional weeks of sick leave on half pay for each year of service. During sick leave, the employee must be paid their normal rate of wages. ³⁹⁸ The employer is not obliged to grant such leave unless the employee provides a medical certificate from a registered medical practitioner stating the nature of the incapacity. However, the Act does not explicitly cover mental health problems. No further evidence of paid sick leave for mental health problems was found in the Occupational Safety, Health and Welfare Act of 1997. ³⁹⁹

As per a 3 July 2025 notification on the Parliament of Malawi's website, Bill No. 17 of 2025 'Mental Health' has been passed by the President, which replaces the outdated Mental Treatment Act of 1948, and establishes a Mental Health Board for promoting and protecting the rights of persons with mental health conditions, and oversees treatment, rehabilitation, and protection.⁴⁰⁰ The bill includes the rights of Persons with Mental Health Conditions, including the right to recognition before the law, employment, fair treatment, access to information, and the highest attainable standard of mental health care. ⁴⁰¹ The Bill is not yet publicly available through the Parliament's website; therefore no further information could be obtained. ⁴⁰²

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is insufficient evidence that Malawi has a policy or a public statement committing to provide prioritized healthcare services to healthcare workers who become sick as a result of responding to a public health emergency.

Malawi's National Infection Prevention and Control Policy (2024) developed by Ministry of Health under its specific objectives states "maintaining healthcare worker and patient safety" as one of its key priorities (pg. 19). Under Section 3.8, it mandates "all health facilities should provide healthcare workers with adequate and appropriate PPE, including gloves, masks, gowns, and face shields, to protect them from infection risks." Additionally, isolation structures/rooms should be established in health facilities to allow for the safe management and treatment of infected patients while protecting other patients and healthcare workers (pg. 25-26). ⁴⁰³ However, it does not include prioritized healthcare services to healthcare workers who become sick as a result of responding to a public health emergency.

The Malawi Public Health Emergency Operations Centre (PHEOC) Handbook outlines protocols for hospitalization in case of "severe illness of a healthcare worker after exposure to patients with similar symptoms" (pg. 82). However, it does not explicitly prioritize healthcare workers during a public health emergency. ⁴⁰⁴

4.5.1a Existence of system for communication during a public health emergency

Score: 100

Malawi has a system in place for public health officials and healthcare workers to communicate during a public health emergency.

The National Public Health Emergency Operations Centre Handbook for Malawi developed by Public Health Institute of Malawi in August 2024, establishes a PHEOC information system which is integrated with the Health Management Information System, District Health Information System-2 (HMIS/DHIS-2)1, One Health Surveillance Platform (OHSP2)/DHIS-2, and Laboratory Information Management System (LIMS) (pg. 20-21). ⁴⁰⁵ As per Section 6.6, the PHEOC information system also includes a 929 toll free hotlines to conduct Event Based Surveillance (EBS) that help to receive public health alerts or rumors, provide health education and public awareness creation. ⁴⁰⁶

In April 2021, the World Bank had supported Malawi in deploying digital health tools to enhance its COVID-19 response. These tools include systems for case management, contact tracing, coordination, diagnostics, and event-based surveillance. For example, RapidSMS, an SMS-based system developed by UNICEF, is utilized for disease surveillance and drug tracking. It enables healthcare workers to report cases and receive updates, even in remote areas with limited internet connectivity. ⁴⁰⁷

The deployment of these digital tools aims to improve data collection, analysis, and decision-making processes. ⁴⁰⁸ The World Bank also identified opportunities for existing digital tools to be adapted to pandemic use case needs for the COVID-19 response and potential future epidemics. ⁴⁰⁹

4.5.1b Inclusion of public and private sector in healthcare communication system

Score: 0

There is insufficient evidence that Malawi has a system for public health officials and healthcare workers to communicate during an emergency, encompassing healthcare workers in both the public and private sectors.

The National Public Health Emergency Operations Centre Handbook published by the Ministry of Health in August 2024 is built on a multi-stakeholder context unde the 'One Health' Approach. Section 7.7 describes how and when to engage different branches and levels of government, the private sector, as well as other partners (including international agencies) in the Incident Management System (IMS). IMS is an emergency management structure and set of protocols that provides an approach to guiding government agencies, the private sector, non-governmental organizations and other actors to work in a coordinated manner primarily to respond to and mitigate the effects of all types of emergencies. ⁴¹⁰

As per the IMS, during an emergency response, Situation reports (SITREPs) are prepared by Operations Section staff, approved by the IM, and submitted in electronic form. They should be disseminated widely to the National Public Health Emergency Operations Centre (NPHEOC) members, all levels of the health system delivery (district, health facilities, etc.), relevant government and private sector agencies and partners, and displayed in the NPHEOC. ⁴¹¹

According to Section 9.2, the National Public Health Emergency Operations Centre (NPHEOC) communicates externally with key development partners (WHO, UNICEF, CDC), government, private sectors, Civil Society, and the media by sharing Situation Reports. The communications include situation updates, actions taken and areas that need support. ⁴¹²

However, no evidence of a system was found through the Handbook ⁴¹³, nor the Public Health Institute of Malawi's website ⁴¹⁴, that enables public health officials and healthcare workers to communicate during an emergency, encompassing healthcare workers in both the public and private sector.

4.6.1a Evidence of national public health system monitoring and tracking of HCAIs

Score: 0

There is insufficient evidence that the national public health system in Malawi is monitoring for and tracking the number of healthcare associated infections (HCAI) that take place in healthcare facilities.

The National Infection Prevention and Control Policy, published by the Ministry of Health in August 2024, states that its main objective is "to reduce the occurrence of healthcare-associated infections (HAIs) and the emergence of antimicrobial resistance (AMR) in Malawi". ⁴¹⁵ As part of its Priority Area 6, the government will "ensure that all health facilities conduct regular audits of IPC implementation, HAI Surveillance, and AMR according to national and local guidelines (pg. 43). Section 3.4.2 lists strategies for development of appropriate reporting tools for HAIs and AMR and their integration into the routine disease surveillance, and procurement of infrastructure and equipment for HAI and AMR surveillance for all healthcare levels. Under Section 3.6.2, it calls for integrating monitoring and evaluation tools for healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) into the MoH’s routine M&E framework and incorporating HAI and AMR indicators into the national indicators matrix.⁴¹⁶ No evidence of its implementation was found on the Ministry of Health's website ⁴¹⁷

Parallely, a 2024 assessment in collaboration with Kamuzu University of Health Sciences, Ministry of Health, Malawi Infection Prevention and Control Association of Malawi (IPCAM), using the IPC Assessment Framework tool revealed that while 76% of healthcare facilities had an infection prevention and control (IPC) program, only 10% conducted regular monitoring, audits, or feedback. The median score for HCAI surveillance was 40/100. ⁴¹⁸

4.6.1b Infection prevention and control programme

Score: 100

Malawi has a national infection prevention and control programme in place.

The National Infection Prevention and Control Policy published by the Ministry of Health in August 2024 outlines a comprehensive strategy to strengthen Infection Prevention and Control (IPC) practices within the healthcare system, addressing challenges such as healthcare-associated infections (HAIs) and antimicrobial resistance (AMR).

Under its Chapter 3, the Policy lists its key priority areas along with their implementation strategies. The priority areas are: infection prevention and control programme, evidence based IPC guidelines, infection prevention and control education and training, health care-associated infection surveillance, multimodal strategies for implementing infection prevention and control activities, monitoring/audit of infection prevention and control practices/activities and feedback, workload, staffing, and bed occupancy at the facility level, built environment, materials, and equipment for IPC at the facility level. ⁴¹⁹

The Ministry of Health is responsible for overseeing IPC implementation and standards development. Healthcare facilities conduct planning, coordination, implementation, and monitoring of the IPC programme at the facility level through their IPC committees (pg. 13). ⁴²⁰

Malawi has also developed National Quality of Care (QOC) Standards guidance (Section 1.4.1.) by aligning them with already existing standards in Malawi, such as the Safe Care, QOC standards, to ensure there is consistency in the provision of quality of health services across the country. ⁴²¹

4.6.1c National plan to ensure a safe environment in health facilities

Score: 100

Malawi has a national plan to ensure a safe environment in health facilities.

The National Infection Prevention and Control Policy published by the Ministry of Health in August 2024 outlines a comprehensive framework for promoting essential practices such as hand hygiene, environmental hygiene, and proper waste management, along with other standard precautions. Under Section 3.8, it sets out minimum protection and safety standards for patients, healthcare workers, and visitors at both national and health facility levels, based on the WHO core components for Infection Prevention and Control (IPC) programmes. ⁴²²

IPC structural indicators include the provision for facilities to provide an enabling environment for handwashing, which helps to prevent the spread of microorganisms, and segregation of waste facilitates safe and efficient handling of waste in a manner that minimises transmission of infectious agents and environmental contamination (pg. 45-46). ⁴²³

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 100

Malawi has a national requirement for ethical review (e.g., from an ethics committee or via Institutional Review Board approval) before beginning a clinical trials.

Malawi's National Health Sciences Research Committee (NHSRC) General Guidelines were developed and published by the National Health Sciences Research Committee in December 2007. ⁴²⁴ According to these guidelines, a sponsor or principal investigator (PI) must obtain full ethical approval from either the National Health Sciences Research Committee (NHSRC) or the College of Medicine Research and Ethics Committee (COMREC) before submitting a clinical trial application to the Pharmacy and Medicines Regulatory Authority (PMRA) (pg. 1-2).^{425 426 427}

Subsequently, the Pharmacy and Medicines Regulatory Authority (PMRA), established under the Pharmacy and Medicines Regulatory Authority Act of 2019 ⁴²⁸, under its Section 74 mandates the PMRA to authorize the conduct of clinical trials (for both humans and animals) in accordance with the principles of Good Clinical Practice (GCP). This is done through the review of clinical trials applications (CTAs) and issuance of clinical trial certificates (pg. 43-44). ⁴²⁹

4.7.1b Expedited approval for clinical trials of unregistered MCMs during epidemics

Score: 0

Malawi does not have an expedited process for approving clinical trials for unregistered medical countermeasures (MCM) or mutual recognition of clinical trial results taking place elsewhere to treat ongoing pandemics or epidemics.

The Pharmacy and Medicines Regulatory Authority (PMRA), established under the Pharmacy and Medicines Regulatory Authority Act of 2019. Section 74 of the PMRA Act mandates the PMRA to authorize the conduct of clinical trials for both humans and animals (pg. 43). ⁴³⁰ However, no expedited process for approving clinical trials for ongoing pandemics or epidemics was found on the PMRA website ⁴³¹

A country report on Malawi by National Institute of Allergy and Infectious Diseases on their web portal, indicates that an expedited review by either the National Health Sciences Research Committee (NHSRC) and the College of Medicine Research and Ethics Committee (COMREC) is possible "for continuing review of research previously approved by NHSRC where no subjects have been enrolled and no additional risks have been identified, or where the remaining research activities are limited to data analysis and report writing." Expedited review can also be considered for continuing review of research previously approved by the NHSRC or COMREC, where the research is permanently closed to the enrollment of new subjects, and all subjects have completed all research-related interventions. ⁴³² However, no explicit expedited review process or mutual recognition of clinical trial results taking place elsewhere in case of ongoing epidemic/pandemic was found. ^{433 434 435}

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 100

Malawi has a government agency responsible for approving new medical countermeasures (MCM) for humans.

The Pharmacy and Medicines Regulatory Authority (PMRA), established under the Pharmacy and Medicines Regulatory Authority Act of 2019 (replacing the older Pharmacy, Medicines and Poisons Board) ⁴³⁶, is the primary government agency responsible for the oversight of medicines and related products in Malawi, according to their website. ⁴³⁷ Although the term 'medical countermeasures' is not explicitly stated, Section 74 of the PMRA Act mandates the PMRA to authorize the conduct of clinical trials (for both humans and animals) in accordance with the principles of Good Clinical Practice (GCP). This is done through the review of clinical trial applications (CTAs) and issuance of clinical trial certificates. ⁴³⁸ The PMRA Board of Directors approves the licensing and registration of CTA upon recommendation from the Clinical Trial Review Committee (CTRC). The approval granted may be full or conditional, depending on the nature of the findings of CTRC. Post authorization GCP inspection is done for selected implemented clinical trials, depending on the risk profile of the study. ⁴³⁹

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 0

There is no publicly available evidence that there is an expedited process for approving medical countermeasures or recognition of approval decisions taking place elsewhere during public health emergencies in Malawi.

There is no evidence of such a process through the 2019 Joint External Evaluation report (JEE), the 2020 national COVID-19 Preparedness and Response Plan, the Ministry of Health, the Public Health Institute, the Department of Disaster Management Affairs, the Pharmacy, Medicines and Poisons Board (PMPB) or the Disaster Preparedness and Relief Act, adopted in 1991. ^{440 441 442 443 444 445 446}

5.1.1a Submission of IHR reports to the WHO in past year

Score: 100

Malawi has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁴⁴⁷

5.1.2a Existence of specific risk reduction strategies for epidemics and pandemics

Score: 100

There is evidence of epidemics and pandemics being integrated into the national risk reduction strategy of Malawi.

Malawi has a Multi-Hazard Emergency Response Plan 2023-2025, developed by the Ministry of Health. ⁴⁴⁸ It includes dedicated contingency plans targeting epidemics and pandemic scenarios, with Chapter 5 listing 11 hazard-specific contingency plans, including COVID-19 Transition Plan, Ebola (EVD) Contingency Plan, Monkeypox Contingency Plan, Cholera, Measles/Rubella, Polio, Rabies, and Typhoid Fever contingency plans. ⁴⁴⁹ Section 3.3 outlines a mechanism for grading of emergencies, and their subsequent response tiers, and the logistics and finance mechanisms needed to manage them. The plan under Section 3.1.2.3 details surveillance systems, both indicator-based and event-based, under the Integrated Disease Surveillance and Response (IDSR) framework, with a focus on 'priority epidemic-prone diseases' such as dengue, cholera, plague, COVID-19, SARI, etc. ⁴⁵⁰

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 50

Malawi has a cross-border agreement with neighboring countries with regards to public health emergencies.

According to a May 2025 press release by the Africa Center for Disease Control and Prevention (CDC), Malawi, along with 11 other African countries, has joined a Cross-Border Collaboration to respond, prevent and control disease outbreaks of Mpox, and other health emergencies. ⁴⁵¹ The collaboration is intended to help streamline cross-border transmission challenges, data-sharing mechanisms among countries, movement of affected populations, as well as aid in financial and technical resources for sustainable mpox response strategies. ⁴⁵² Further details & evidence of its implementation are not yet available.

In March 2023, Malawi, as a member of the Southern African Development Community (SADC), hosted a ministerial meeting inviting 12 African Union members to collaborate on outbreak responses, such as for cholera and climate-related public health emergencies. ⁴⁵³

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 50

There is evidence of Malawi having cross-border agreements, protocols, or MOUs with neighboring countries, or as part of a regional group, with regards to animal health emergencies.

A Memorandum of Understanding between the Southern African Development Community (SADC), of which Malawi is a member, and the World Organisation for Animal Health (WOAH) signed in March 2024 under its Article 2 states that both parties agree to "cooperate in the following areas: animal health, including transboundary animal diseases, zoonoses, emerging infectious diseases, etc; animal Welfare2; Antimicrobial Resistance (AMR); and aquatic animal health and biosecurity (including fisheries)" (pg. 7). ⁴⁵⁴

According to a May 2025 report by Market Access Africa, Malawi participates only as an observer in the Veterinary Medicines Zazibona, the Southern African Development Community (SADC) Veterinary Medicinal Products (VMPs) Collaborative Procedure, a regional platform that enables joint assessment of veterinary medicinal products. ⁴⁵⁵

Malawi, as a member of the Southern African Development Community (SADC), is party to the SADC Protocol on Trade 'Annex VIII: Sanitary and Phytosanitary Measures'. This protocol establishes regional cooperation and harmonized sanitary practices to protect animal, plant, and human health, and provides a mechanism for technical assistance and dispute resolution among member states. ⁴⁵⁶ Under Section 6.17 of its Regional Guidelines for the Regulation of Vet Drugs in SADC Member States, it calls for "confiscation of banned, illegal, counterfeit and expired veterinary drugs and disposal of these products according to the Guidelines for Safe Disposal of Unwanted Pharmaceuticals in and after Emergencies Interagency Guidelines, (WHO, 1999) and the Recommended International Code of Practice for Control of the Use of Veterinary Drugs (FAO, CAC/RCP 38-1993)". ⁴⁵⁷ However, no evidence of its implementation nor additional MOUs/ protocols/agreements was found on the Public Health Institute of Malawi ⁴⁵⁸, and the Ministry of Agriculture's website was inaccessible at the time of research. ⁴⁵⁹

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

Malawi has a ratified the Biological Weapons Convention.

According to the Biological Weapons Convention National Implementation Measures Database, Malawi has ratification/accession status to the Biological Weapons Convention since 2 April 2013. ⁴⁶⁰

5.3.1b Submission of CBMs to the Biological and Toxin Weapons Convention

Score: 100

There is public evidence that Malawi has submitted confidence building measures for the Biological Weapons Convention in the past three years.

According the Electronic Confidence Building Measures Portal operated by Biological Weapons Convention Implementation Support Unit, Malawi has submitted its latest report on 17 July 2025. ⁴⁶¹

5.3.1c Submission of UNSCR 1540 reports

Score: 100

Malawi has submitted the required United Nations Security Council Resolution (UNSCR) 1540 report to the Security Council Committee established pursuant to resolution 1540 (1540 Committee).

The Report (S/AC.44/2014/8) was submitted on 3 September 2014 and is publicly available on the United Nations Security Council web portal.⁴⁶²

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 0

5.3.2a Membership in global health security and/or biological weapons agreements

Score: 0

Malawi is not a member of any of the listed groups.

Malawi is not a member of the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction ⁴⁶³, the Australia Group (AG) ⁴⁶⁴ or the Proliferation Security Initiative (PSI). ⁴⁶⁵

5.4.1a Completion and publication of JEE (or GHSA pilot external assessment) report

Score: 0

Malawi has not completed a Joint External Evaluation (JEE) or precursor external evaluation, and published a full public report in the last five years.

Malawi underwent its first Joint External Evaluation (JEE) from February 11 to 15, 2019. The final report, titled Joint External Evaluation of the Republic of Malawi, was published by the World Health Organization (WHO) in 2019. ⁴⁶⁶

According to a Facebook post from December 2024 by the Nation Publications Limited, Malawi has begun its second Joint External Evaluation (JEE) to assess public health capacities under the International Health Regulations (IHR). ⁴⁶⁷

No evidence of a published or ongoing GHSA pilot external assessment was found on the Global Health Security Agenda's website.⁴⁶⁸

5.4.2a Completion and publication of PVS report (past five years)

Score: 0

Malawi has not completed and/or published a Performance of Veterinary Services (PVS) assessment in the last five years.

The latest OIE PVS Evaluation was conducted from January 20-31, 2014 by a OIE PVS Evaluation Team authorised by the World Organisation for Animal Health. ⁴⁶⁹

5.4.2b Completion and publication of PVS gap analysis (past five years)

Score: 0

Malawi has not conducted a Performance of Veterinary Services (PVS) gap analysis in the last five years.

No evidence of a Performance of Veterinary Services (PVS) gap analysis being conducted was found on the web portal of World Organization for Animal Health ⁴⁷⁰

5.5.1a Evidence of allocated national funds to improve capacity to address epidemic threats

Score: 100

There is evidence that Malawi has allocated national funds to improve capacity to address pandemic or epidemic threats within the past three years.

According to a UNICEF Budget Brief, in the 2024/25 fiscal year, Malawi allocated MK550 billion (USD 316.8 million) to the health sector, marking a 50% nominal increase from MK368 billion in the previous year. This allocation represents 9.2% of the total national budget, positioning health as the second-largest sector after education. ⁴⁷¹

As per Table 1, the Pandemic and Disaster Preparedness sub-programme received MK160 million (USD 92,160) in 2024/25 (pg. 7). ⁴⁷²

5.5.2a National budget to address gaps identified in JEE, NAPHS or GHSA roadmap

Score: 0

There is no public evidence that Malawi has allocated or described specific funding from the national budget (covering a time-period either in the future or within the past five years) to address the gaps identified through the Joint External Evaluation (JEE) report.

The National Public Health Emergency Operations Centre (NPHEOC) has a "budget line secured through Public Health Institute of Malawi to support Public Health Emergency Operations Centre's (PHEOC) operation and management," which is mobilised from government, and partner agencies. ⁴⁷³ However, there is no explicit allocation of budget to address the gaps identified through the Joint External Evaluation (JEE) report. ⁴⁷⁴

Although the 2019 JEE report sets a target for "States Parties (to) ensure provision of adequate funding for IHR implementation through the national budget or other mechanisms. Country has access to financial resources for the implementation of IHR capacities" (pg. 10). No description of specific funding for addressing gaps was found in the report itself. ⁴⁷⁵

Ministry of Health and Population has been allocated a budget of 103,359 million MK (USD 60 million) for the financial year 2025/26, however, no evidence of explicit budget allocation to address gaps identified through the Joint External Evaluation (JEE) report was found. ⁴⁷⁶

5.5.2b National budget to address gaps identified in PVS assessment or gap analysis

Score: 0

Malawi has not conducted a Performance of Veterinary Services (PVS) gap analysis.

The 2014 OIE PVS Evaluation Follow-Up mission recommends that "DVS should submit a request to the OIE to conduct a PVS GAP Analysis mission that will allow to establish the requirements for veterinarians at headquarters, ADDs, laboratories, Districts and abattoirs based on program priorities and future workload" (pg. 33). ⁴⁷⁷

The latest 2016 Veterinary Legislation Identification Mission Report further acknowledges that "A (OIE) PVS Gap Analysis would help to identify the resources required by the DAHLD for prioritized areas of intervention for investment in the livestock sub-sector."⁴⁷⁸

However, no evidence of a PVS Evaluation being conducted was found on the web portal of the World Organization for Animal Health ⁴⁷⁹, nor is the OIE PVS Evaluation publicly available. ⁴⁸⁰ Therefore no budget allocation can be determined.

5.5.3a Emergency public financing during a public health emergency

Score: 100

There is evidence of a publicly identified special emergency public financing mechanism and funds which the country can access in the face of a public health emergency.

Malawi has a National Disaster Preparedness and Relief Fund, established through the Disaster Preparedness and Relief Act (1991) under Part 10, to manage funds during emergencies and disasters. It consists of funds appropriated by the treasury, along with voluntary contributions and donations from foreign governments and international agencies. The Department of Disaster Management Affairs (DODMA), through the Office of the President and Cabinet (OPC), is responsible for coordinating emergencies and managing this fund. ⁴⁸¹ However, according to the National Public Health Emergency Operations Centre Handbook for Malawi (2024), there is a significant challenge due to a lack of adequate and readily available funds within this mechanism, often operating as an indicative budget rather than a readily accessible reserve. ⁴⁸²

Additionally, Malawi's Emergency Preparedness and Response Roadmap (2023–2025) outlines the establishment of a contingency fund to support a timely response to public health emergencies. According to the Roadmap, WHO has committed to support the Ministry of Health and partners to mobilize the initial seed funding that is required to start implementation of the priority interventions. This roadmap is part of the country's broader strategy to enhance its emergency preparedness and response capabilities. ⁴⁸³

According to the website of International Development Association (IDA) under the World Bank Group, Malawi is eligible for IDA support, as Malawi’s relative poverty, defined as GNI per capita below an established threshold. ⁴⁸⁴

5.5.4a Commitments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is publicly available evidence that senior leaders (president or ministers) of Malawi, in the past three years have made a public commitment either to support other countries to improve capacity to address epidemic threats by providing financing or support or to improve its own domestic capacity to address epidemic threats by expanding financing or requesting support to improve capacity.

The Global Health Security (GHSA) Funding Tracker Dashboard confirms that Malawi has not invested finances or technical support to support other countries to improve their capacity to address epidemic threats in the past three years. ⁴⁸⁵

According to an April 2020 press release from the World Bank Group, the World Bank approved USD 7 million in immediate funding to support Malawi’s response to the global COVID-19 (coronavirus) pandemic under the Malawi COVID-19 Emergency Response and Health Systems Preparedness project. In addition to this, USD 30 million was made available from the Disaster Risk Management Development Policy Financing with a Catastrophe Deferred Drawdown Option (Cat-DDO) to strengthen the country’s response to the pandemic. ⁴⁸⁶

In 2021, President Chakwera launched the Malawi COVID-19 Socio-Economic Recovery Plan (SERP) (2021-2023), emphasizing the need for international support to strengthen health systems, calling for mobilizing resources to support this roadmap, as well as indicating an openness to external assistance, along with dedicated budget allocation across its four focus areas. ⁴⁸⁷

No further evidence of expanding financing or requesting support was found in the press releases by the Parliament of Malawi, ⁴⁸⁸, Public Health Institute of Malawi ⁴⁸⁹, nor Ministry of Health's ⁴⁹⁰ news webpages.

5.5.4b Investments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is evidence that Malawi has requested financing and technical support from donors to improve the country’s domestic capacity to address epidemic threats.

According to an April 2020 press release from the World Bank Group, the World Bank approved USD 7 million in immediate funding to support Malawi’s response to the global COVID-19 (coronavirus) pandemic under the Malawi COVID-19 Emergency Response and Health Systems Preparedness project. In addition to this, USD 30 million was made available from the Disaster Risk Management Development Policy Financing with a Catastrophe Deferred Drawdown Option (Cat-DDO) to strengthen the country’s response to the pandemic. ⁴⁹¹

Additionally, in April 2021, the World Bank supported Malawi in deploying digital health tools to enhance its COVID-19 response. These tools include systems for case management, contact tracing, coordination, diagnostics, and event-based surveillance. The deployment of these digital tools aims to improve data collection, analysis, and decision-making processes. ⁴⁹²

However, no evidence was found of Malawi providing other countries with financing or technical support to improve capacity to address epidemic threats through the websites of the Public Health Institute of Malawi. ⁴⁹³

According to a April 2025 article from HealthCare Middle East & Africa Magazine, Malawi’s Ministry of Health launched a five-year Health Emergency Preparedness, Response, and Resilience Program, with a US$60 million investment from the World Bank. The aim of this Program is to improve laboratory capacity, expand access to innovative technologies, and create a more inclusive and resilient framework for managing future health challenges by incorporating climate adaptation measures".⁴⁹⁴

5.5.4c Evidence that the country has fulfilled its full WHO contribution within the past two years

Score: 100

There is publicly available evidence that Malawi has fulfilled its full contribution to the WHO within the past two years.

According to the latest Assessed contributions overview published by the World Health Organization on 9 May 2024, Malawi does not have any outstanding balance for the year 2023. ⁴⁹⁵

5.6.1a Sharing of genetic/biological data and materials beyond influenza

Score: 100

Malawi has a publicly available plan for sharing genetic data and specimens with international organizations and/or other countries that goes beyond influenza.

The Malawi Genomic Surveillance Implementation Plan (2023-2030) states in Section 2.4.4 that "the Government of Malawi (GoM) will create and implement a data-sharing platform designed to facilitate the exchange of genomic data among public health agencies and researchers" (p. 24). Additionally, the GoM aims to develop a framework that provides guidance and consensus on data and metadata standards. These standards will uphold privacy, security, and national sovereignty. The GoM will also regulate the sharing of contextual information to accompany genomics data (pg. 24). Appendix 3 lists strategies and objectives under 'Data Management' including, "establishing explicit data sharing and access principles that are widely agreed upon to promote transparency and rapid and equitable dissemination." ⁴⁹⁶ It further sets a goal of 100% data and specimen sharing with the international scientific community by 2030 (pg. 54). ⁴⁹⁷

5.6.1b Evidence of non-compliance with sample sharing element of PIP framework

Score: 100

There is no public evidence that Malawi has not shared samples in accordance with the PIP Framework in the past two years.

There was no evidence of this through the Ministry of Health ⁴⁹⁸, the World Health Organisations' "News Room"⁴⁹⁹, country page for Malawi ⁵⁰⁰ or "Disease Outbreak News (DON)" ⁵⁰¹, or local and international media outlets. ^{502 503 504}

5.6.1c Evidence of non-sharing of pandemic pathogen samples during an outbreak

Score: 100

There is no publicly available evidence that Malawi has failed to share pandemic pathogen samples.

There is no evidence on this through the Ministry of Health, the World Health Organisation (WHO) country page for Malawi or either international or local media outlets. ^{505 506 507 508 509}

6.1.1a Policy formation

Score: 25

6.1.1b Quality of bureaucracy

Score: 0

6.1.1c Excessive bureaucracy/red tape

Score: 25

6.1.1d Vested interests/cronyism

Score: 0

6.1.1e Corruption

Score: 34

6.1.1f Accountability of public officials

Score: 25

6.1.1g Human rights risk

Score: 50

6.1.2a Orderly transfers of power

Score: 50

6.1.3a Risk of social unrest

Score: 0

6.1.4a Risk of terrorism

Score: 100

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 75

6.1.5a Presence or risk of armed conflict

Score: 100

6.1.6a Government territorial control

Score: 100

6.1.7a International tensions

Score: 75

6.2.1a Adult literacy rate (15+ years old, both sexes)

Score: 74.27

6.2.2a UNDP Gender Inequality Index score

Score: 21.87

6.2.3a Poverty gap at $1.90 a day (2011 PPP) (%)

Score: 8

6.2.3b Share of employment in the informal sector

Score: 0

6.2.3c Coverage of social insurance programs (% of population)

Score: 0

6.2.4a Public confidence in government

Score: 100

6.2.5a Robust, open, diverse local media and reporting

Score: 0

6.2.6a Gini coefficient

Score: 61.5

6.3.1a Adequacy of road network

Score: 25

6.3.2a Adequacy of airports

Score: 25

6.3.3a Adequacy of power network

Score: 0

6.4.1a Urban population (% of total population)

Score: 95.49

6.4.2a Change in forest area (percentage points)

Score: 23.68

6.4.3a Natural disaster risk

Score: 0

6.5.1a Total life expectancy (years)

Score: 58.47

6.5.1b NCD mortality rate

Score: 53.26

6.5.1c Population aged 65+

Score: 94.48

6.5.1d Tobacco use (% of adults)

Score: 64

6.5.1e Level of adult obesity (%)

Score: 90.94

6.5.1f Age-standardised prevalence of mental health disorders (per 100 000 people)

Score: 69.83

6.5.2a Access to potable water

Score: 72.96

6.5.2b Access to at least basic sanitation facilities

Score: 48.93

6.5.2c Percentage of health-care facilities with no access to any electricity supply

Score: 72.92

6.5.3a Domestic general government health expenditure per capita (PPP)

Score: 0.98

6.5.4a Trust medical and health advice from the government

Score: 100

6.5.4b Trust medical and health advice from medical workers

Score: 100