The potential impact of declining development assistance for healthcare on population health: projections for Malawi

Development assistance for health (DAH) to Malawi will likely decrease as a fraction of GDP in the next few decades. Given the country’s significant reliance on DAH for the delivery of its healthcare services, estimating the impact that this could have on health projections for the country is particularly urgent. We use the Malawi-specific, individual-based “all diseases – whole health-system” Thanzi La Onse model to estimate the impact this could have on health system capacities, proxied by the availability of human resources for health, and consequently on population health outcomes. We estimate that the projected changes in DAH could result in a 7-15.8% increase in disability-adjusted life years compared to a scenario where health spending as a percentage of GDP remains unchanged. This could cause a reversal of gains achieved to date in many areas of health, although progress against HIV/AIDS appears to be less vulnerable. The burden due to non-communicable diseases, on the other hand, is found to increase irrespective of yearly growth in health expenditure, if assuming current reach and scope of interventions. Finally, we find that greater health expenditure will improve population health outcomes, but at a diminishing rate.