Malawi
A low-income country with national oral morphine production and a reputation for nurse prescribing, which tests whether task-shifted prescribing holds up in law.
9 domains reviewed · 9 high-confidence · 4 dated estimates · 9 material gaps
WHO region: Africa. World Bank income group: Income group not yet retrieved.
- Domains reviewed
- 9 of 9
- Hospice: 2 of 4
- Backed by a primary document
- 0 of 9
- Open questions
- 13
- Sources behind this dossier
- 11
- Newest source 2026
Lessons from Malawi
- Council endorsement is not legal authority. Malawi's medical and nursing councils endorsed nurse prescribing but the 1957 statute was never amended, so nurses prescribe only in emergencies. The statute should be amended with, or before, any council endorsement.103
- A short accredited course feeding a degree pathway gives a certificate-to-diploma ladder. It is the closest structural model in the register for a short certificate.103
- A funded programme with tracked hospital indicators (services established, patients on morphine, referrals) showed integration within a year. A training pilot should report the same indicators, not attendance.104
- National production and free public provision did not prevent district stockouts. Last-mile distribution needs its own plan.103
- Home-based palliative programs for poor rural families may need to include food and income support, since patients and caregivers report these needs alongside symptom care.419,417
- Central bulk procurement and a national task force monitoring morphine availability can widen access, but old narcotics laws may still block nurse prescribing unless they are amended.103
- Routine screening of family caregivers for psychological distress can be built into palliative services where many caregivers are distressed.418
Palliative care
Is morphine available in Malawi?
Opioid supply. Is a therapeutic opioid physically available in the wards that need it? Every country on this question
- 0.41 mg per personSOURCE-CHECKED
Morphine consumption, Malawi, 2009103
Last checked 2026-09-24.
Cite this figure: - 0.82 mg per personSOURCE-CHECKED · 2013 DATA
Morphine consumption, Malawi, 2013103
Last checked 2026-09-24.
The latest figure found.
Cite this figure:
Oral morphine is produced nationally and procured through the Central Medical Store, free in the public sector. Stockouts persist, especially at district hospitals outside the larger towns.103
How does Malawi regulate opioids for pain?
Narcotics regulation. What licensing regime governs stocking and dispensing, and when did it last change? Every country on this question
A standalone national palliative care policy dates from 2014. A 2013 assessment found prescription duration limits, restricted dispensing sites and negative language in law, and the Narcotics Act of 1957 is reported still unamended.103
Who can prescribe morphine in Malawi?
Prescriber authority. Who is legally allowed to prescribe, and can that group be widened? Every country on this question
Oncologists, surgeons and family physicians prescribe. The medical and nursing councils have endorsed nurse prescribing, but in practice nurses prescribe only in emergencies under an informal ministry agreement, because the statute was never changed.103
Has the nursing council formally defined nurse prescribing authority, and does the statute now support it?
Help answer it:Search PubMedHow does palliative care reach patients in Malawi?
Service delivery. Through what structure does care actually reach a patient at home? Every country on this question
- 12 facilities of 13SOURCE-CHECKED · 2012 DATA
Southern region facilities with an established palliative service after the programme, Malawi, 2012104
Last checked 2026-09-24.
Cite this figure: - 463 patientsSOURCE-CHECKED · 2012 DATA
Palliative patients receiving morphine at programme facilities, Malawi, 2012104
Last checked 2026-09-24.
From 77 patients at two hospitals at baseline.
Cite this figure:
Care runs through specialist hospital clinics, district hospitals and community care. A funded southern region programme established services in most participating facilities within about a year.104,105
How many district hospitals nationally now run a palliative service?
Help answer it:Search PubMedWho pays for palliative care in Malawi?
Financing. Who pays for the drug, the visit and the workforce? Every country on this question
Public clinics provide palliative care and essential opioids free of charge. Centres of excellence and scale-up programmes depend heavily on donors, and family costs remain catastrophic.105,103
What share of palliative spending is government rather than donor?
Help answer it:Search PubMedHow are palliative care clinicians trained in Malawi?
Training and recognition. What credential exists, who awards it, and does anyone recognize it? Every country on this question
- 253 staffSOURCE-CHECKED · 2012 DATA
Staff trained across programme facilities, Malawi, 2012104
Last checked 2026-09-24.
From 79 at baseline.
Cite this figure:
An accredited five-day introductory course run with the Ministry of Health since 2006 sits at the base, with a Bachelor of Science in Palliative Care for clinical officers and nurses from 2018.103,104
How many clinicians hold the course certificate or the degree?
Help answer it:Search PubMedHow does Malawi prevent opioid misuse without blocking pain relief?
Opioid safeguards. How are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief? Every country on this question
Malawi orders morphine in bulk through the Central Medical Store, provides essential opioids free in the public sector, and has a national task force monitoring morphine availability. Barriers identified in 2013 included two-week prescription limits, and the 1957 Narcotic Act still does not allow nurse prescribing even though professional councils have approved it. Stockouts still occur, mainly in district hospitals.103
Does Malawi have any opioid agonist treatment or naloxone program, and has the Narcotic Act been amended to allow nurse prescribing?
Help answer it:Search PubMedHow do children get palliative care in Malawi?
Children's palliative care. How do children with life-limiting conditions get palliative care and the medicines they need? Every country on this question
Malawi was the first African country with specialist palliative care services for children, and the Umodzi program is integrated into pediatric care. A Lilongwe pediatric hematology-oncology palliative program enrolled 315 patients over three years, and 53% of deaths occurred at home. Caregivers of children with cancer describe stigma and need psychosocial, spiritual and financial support.103,593,594
How many children receive palliative care in Malawi outside Blantyre and Lilongwe, and which oral morphine formulations are available for them?
Help answer it:Search PubMedHospice care in Malawi
How the hospice model works here, who can use it, who pays and who it reaches. Covered 2 of 4.
What does hospice care look like in Malawi?
Hospice model. What does hospice mean here, who runs it, and in what settings? Every country on this question
Malawi's literature mostly uses the term palliative care, delivered through hospital-based programs, home-based care and some NGO stand-alone centres. Dedicated inpatient hospice facilities are rare; St. Gabriel's Hospital has a dedicated inpatient palliative care unit with 24 hospice beds. Hospitals in a southern Malawi project increased referrals to hospice or other palliative care programs.103,104
Besides St. Gabriel's Hospital, which facilities in Malawi provide dedicated hospice beds, and who runs them?
Help answer it:Search PubMedWho can get hospice care in Malawi?
Hospice eligibility. Who can enter hospice, on what criteria, and how late do patients arrive? Every country on this question
What admission criteria do Malawi's hospice beds or stand-alone centres use, and at what stage are patients referred?
Help answer it:Search PubMedWho pays for hospice care in Malawi?
Hospice funding. Who pays for hospice care: a public benefit, insurance, charity or families? Every country on this question
How are Malawi's hospice beds and stand-alone palliative care centres funded, and what share comes from donors?
Help answer it:Search PubMedHow many people reach hospice in Malawi?
Hospice reach. How many dying people use hospice, and who is left out? Every country on this question
Most palliative care in Malawi is hospital-based, and dedicated inpatient hospice capacity appears small, with St Gabriel's Hospital in Namitete running a 24-bed hospice unit. In a 2012 program in 13 southern hospitals, 104 of 153 recorded referrals were palliative care referrals, mostly to hospital palliative care services and hospice programs. That evaluation was funded and co-authored by APCA.103,104
How many patients use hospice beds or hospice home programs in Malawi each year, and are rural patients reached?
Help answer it:Search PubMedWhat fills the gap in Malawi
How people get care outside formal services: families, faith communities, volunteers, health workers, healers, other medicines and charity. Described, not scored.
- Family caregiving
Women at the end of life in rural Malawi depended on family and community care that was both critical and precarious, and all participants in one NGO program faced food insecurity. Among 308 family caregivers at two rural hospitals, one a mission hospital, 41.9% had psychological distress and 57.1% reported social support.416,417,418
Subnational evidence- Community health workers and home-based care
In rural Neno District, a Partners In Health and government program links hospital, clinic and home care, with referrals to community health worker support and socioeconomic assistance. Many patients reported needing income or food, and 72% of enrollees lived more than five kilometres from a clinic. Evaluations were done by program partners.419,421,420
Subnational evidenceSelf-reported
Sources cited here
- 103Palumbo N, Tilly A, Namisango E, Ntizimira C, Thambo L, Chikasema M, Rodin G.
Palliative care in Malawi: a scoping review. BMC Palliative Care 2023;22(1):146. DOI 10.1186/s12904-023-01264-8. National policy of 2014; opioid barriers identified in 2013 and the Narcotics Act of 1957 reportedly unamended; nurse prescribing only in emergencies under an informal Ministry of Health agreement despite endorsement by the medical and nursing councils; morphine consumption for 2009 and 2013; central procurement and continuing stockouts; an accredited five-day introductory course from 2006 and a Bachelor of Science in Palliative Care from 2018. Full text read.
- 104Kiyange F, Atieno M, Luyirika EBK, Ali Z, Musau H, Thambo L, et al.
Measuring palliative care integration in Malawi through service provision, access, and training indicators: the Waterloo Coalition Initiative. BMC Palliative Care 2024;23(1):17. DOI 10.1186/s12904-023-01331-0. Thirteen hospitals and health centres in the southern region: staff trained, services established, patients on morphine and referrals, against baseline. Full text read.
- 105Mukhula V, Sibale D, Tarmahomed L, Dzamalala C, Msyamboza K, Chasimpha S.
Characterising cancer burden and quality of care at two palliative care clinics in Malawi. Malawi Medical Journal 2017;29(2):130-135. DOI 10.4314/mmj.v29i2.10. Clinics at Queen Elizabeth Central Hospital and Mzuzu Central Hospital provide services free of charge. Full text read.
- 418Matandika I, Mnenula M, Lutala P
Social support and psychological distress among family caregivers of palliative patients at two rural hospitals in Malawi: a cross-sectional study. BMC Palliat Care 2025;24(1):302. Cross-sectional survey of 308 family caregivers at Nkhoma Mission Hospital and Neno District Hospital in rural Malawi; 41.9% had psychological distress. Abstract read.
- 593Silverstein A, Butia M, Bank R, et al.
Palliative Care Services within a Pediatric Hematology-Oncology Program in a Low-Resource Setting. J Pain Symptom Manage 2022;63(5):e473-e480. Three-year retrospective description of a pediatric hematology-oncology palliative care program in Lilongwe serving 315 patients; program staff describing their own service (self-evaluation, single site). Abstract read.
- 594Phiri L, Li WHC, Phiri PGMC, et al.
Experiences of caregivers of children with cancer in Malawi: A qualitative study. Cancer Med 2024;13(2):e6963. Qualitative interviews with 22 caregivers of children receiving cancer treatment in Malawi on psychosocial burden and support needs. Abstract read.
- 419Herce ME, Elmore SN, Kalanga N, et al.
Assessing and responding to palliative care needs in rural sub-Saharan Africa: results from a model intervention and situation analysis in Malawi. PLoS One 2014;9(10):e110457. Rapid evaluation of the first 9 months of the Neno Palliative Care Program run by Partners In Health and the Malawi government. Evaluated by program partners. Abstract read.
- 417Dressel A, Mkandawire E, Gondwe KW, et al.
The intersection of food insecurity and health for rural Malawian women at the end of life. Int J Palliat Nurs 2020;26(7):372-382. Interviews with 26 women at the end of life and 14 caregivers in a community palliative care program run by an AIDS support organisation in Kasungu, Malawi. Abstract read.
- 416Hawkins MM, Dressel A, Kendall N, et al.
The changing dynamics of community care and support in rural Malawi: The impact on Women's health and wellbeing at end of life. Soc Sci Med 2022;301:114934. Critical ethnography with women receiving end-of-life care from an NGO in rural Central Malawi and their caregivers. Abstract read.
- 421S Phiri A, Mulwafu M, Robbins Zaniku H, et al.
Toward enhanced decentralized palliative care services in Neno District, Malawi: a qualitative study. BMC Palliat Care 2024;23(1):132. Focus groups with 14 health workers and 15 patients at two health centers in Neno District, Malawi, on decentralized palliative care. Authors linked to Partners In Health. Abstract read.
- 420Phiri AS, Gilbert H, Herce ME, et al.
Improving palliative care access in rural Malawi: insights from a mixed-methods exploration of structural and social determinants. BMC Palliat Care 2026;25(1). Mixed-methods study of nine palliative care facilities and 44 key informants in rural Neno District, Malawi. Single district; authors linked to Partners In Health. Abstract read.