An Overview of the Available Health System for Monitoring Non-Communicable Diseases in Malawi

Research Article

J Cardiovasc Disord. 2021; 7(2): 1047.

An Overview of the Available Health System for Monitoring Non-Communicable Diseases in Malawi

Safary E1,2* and Mtaita C1,3

1Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany

2Foundation for Innovative New Diagnostics, Geneva, Switzerland

3Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Bonn, Germany

*Corresponding author: Elvis Safary, Heidelberg Institute of Global Health, Heidelberg, 69115, Germany

Received: September 01, 2021; Accepted:October 01, 2021; Published: October 08, 2021


Background: Non-Communicable Diseases (NCDs) are a major cause of morbidity and mortality in Malawi and they come second as the leading cause of death in adults after HIV and AIDS. The World Health Organization (WHO) highlighted the importance of NCD monitoring as a key action which were adopted by the Member States in addressing NCDs. The framework is composed of nine global targets and 25 indicators aimed at combating global mortality for the four main NCDs. This study aimed to examine the existing national NCD monitoring tools, activities and gaps in Malawi based on WHO Global Monitoring Framework for NCDs.

Methods: A desk review was conducted from June to August 2021, to examine the existing national NCD monitoring tool in Malawi from multiple sources. Policy and program documents relating to NCD monitoring in Malawi from 2011 to 2021 were identified and analyzed.

Results: The findings of this review are presented according to the three major themes of the Global Monitoring Framework: Health systems capacity, monitoring of risk factors, and monitoring of mortality and morbidity outcomes. Malawi has an NCD monitoring tool in place that is adequate for the WHO NCD Global Monitoring Framework. However, there are still gaps with data from monitoring health systems indicators of the framework and hence requires strengthening.

Conclusion: The country must also look beyond these set of indicators and target increasing burden and impact of COVID-19 pandemic.

Keywords: Non-communicable diseases; Malawi; COVID-19; Surveillance


Non-Communicable Diseases (NCDs) are the leading cause of death globally [1] and are strongly influenced by four main behavioral risk factors: tobacco use, insufficient physical activity, harmful use of alcohol and unhealthy diet, which leads to elevated blood pressure, raised blood glucose and cholesterol levels and excess body weight [1]. Non-communicable diseases (NCDs) are significant causes of morbidity and mortality in Malawi and the second leading cause of deaths in adults after HIV and AIDS [2]. NCD incidence are rapidly high, according to the Malawian Ministry of Health (MOH) in 2017, NCDs in the country accounted for at least 12% of total disability adjusted life years (DALYS) and at 16%, are the second leading cause of death after HIV/AIDS [3]. NCD disproportionally affect young people, with up to 60.5% of NCD DALYs constituting people under the age of 40, as compared to 18.5% in high-income countries [4]. The World Health Organization (WHO) has elaborated strengthening surveillance at national level as a priority for tackling Non-Communicable Diseases (NCD) [5-7]. This is an ongoing systematic collection and analysis of data to provide appropriate information regarding a country’s NCD burden, the population groups at risk, estimates the NCD mortality and morbidity, risk factors and determinants of disease over time. In 2000, the global strategy for the prevention and control of NCDs sanctioned by the World Health Assembly highlighted the surveillance to track and monitoring the major risk factors as a central priority [5]. The WHO however has also recognized that several key steps must be taken to strengthen surveillance for NCD [7]. These include prioritizing monitoring and surveillance of behavioral and metabolic risk factors in low-resource settings, components of the NCD surveillance framework, and strengthening and integrating the NCD surveillance system into existing national health information system such as the District Health Information System (DHIS). In 2012, the WHO set a comprehensive set of nine global targets and 25 indicators, [5] with the aim to ensure prevention, treatment and accountability for NCDs in WHO supported countries. Malawi is a landlocked country in Southeast Africa with an area around 120,000 square kilometers, but it is also one of the most densely populated countries in Africa with 21.2 million people [2]. Urbanization and environmental factors, low health literacy and rapid aging have contributed to steady increase in the prevalence of NCDs in Malawi [8]. Following the 2011 United nations declaration on NCDs, Malawi developed and launched the 2011-2016 Health Sector Strategic Plan including NCDs and the National Action Framework for NCDs in 2013 [9] which focused primarily on a narrower set of conditions comprised of cardiovascular disease, diabetes, chronic respiratory diseases and cancer. This was then followed by the National Action Plan for the Prevention and Management of Non-Communicable Diseases (NAP-NCD) 2017-2022 [10]. The framework expands its emphasis beyond the traditionally recognized NCDs and emphases an integrated approach, noting that addressing the more broad burden of NCD will be a critical step towards Universal Health Coverage (UHC) for Malawi [10]. The NAP-NCD 2017-2022 had incorporated the WHO-NCD global monitoring targets and emphasizes the precarious importance of an effective surveillance system to track, trace and construe tends in risk factor (behavioral risk factors, physiological and metabolic risk factors and social determinants), morbidity (cancer incidence and type) and mortality (NCD- specific mortality), and health systems capacity and responses (interventions and health system capacity such as infrastructure, policies and plans, access to key health-care interventions and treatment). The main objective of this study is to examine the current national NCD monitoring tools, activities and gaps in Malawi based on the Global Monitoring Framework for NCDs.


A desk review was conducted from June to August 2021, to examine the existing national NCD monitoring tool in Malawi from multiple sources. The search strategies included literature databases, search engines, and google websites. The search strategy included the following terms: Malawi, non-communicable diseases, monitoring, surveillance, guidelines, framework and standards. A search was conducted in June and July 2021 using Google scholar and PubMed. Additionally, relevant documents in the internet were also searched including a search of relevant organizations and institutions for gray literatures. Authors targeted only documents that were relevant to the research objective. Relevant policy documents, guidelines, program documents and reports were collected from suitable organizations and institutions based on the research topic. Finally, routine data including monitoring and evaluation of NCD were collected for inclusion in the review.