A paper composed by early career researchers at RESEP, Martin Mwale and Dr Martina Mchenga, and their co-author Dr Gowokani Chirwa, has recently been published in a highly ranked international journal. The paper, A spatial analysis of out-of-pocket payments for healthcare in Malawi, was published in Health Policy and Planning, a journal ranked in the top 30 of all journals in its category.

Regarding the motivation for the study, Dr Mchenga said that whilst a lot of research has been done on out-of-pocket expenditures and their impact on household welfare, the field “was lacking …  identification of the regions/areas exactly where these expenditures are likely to occur, and if there are spill-overs to other neighbouring areas.”

Dr Mchenga further explained that the authors wanted to identify specific areas that had irregularly high expenditures, the purpose being “to analyse [the] unique features those areas have that make them more vulnerable to such expenses.” The authors hypothesised that contexts characterised by the lack of a well-functioning social health insurance scheme, poor performing public healthcare system, and very low levels of private health insurance, increase the likelihood that communities will be more vulnerable to catastrophic out of pocket expenditures than others.

It is Dr Mchenga’s belief that “identifying the hotspots and examining if there are spill-overs would make for targeted policy interventions”. Moreover, she believes that the study’s findings are generalisable to other countries that share similar economic demographic characteristics, as well as lack the necessary social or national health schemes. This is important, she claims, because policies, particularly those targeting areas more prone to catastrophic health expenditures, generally don’t account for spill-overs. “In most LMICs countries”, said Dr Mchenga, “specifically in Malawi, there is low usage of research to inform policy.”

Dr Mchenga recently finished her doctoral degree with RESEP where she continues to work as a researcher. Since acquiring her doctorate, she has had the opportunity to work as an Overseas Development Institute (ODI) fellow. In this role, she worked in the health financing unit of the Ministry of Health in both Malawi and Sierra Leone. Dr Mchenga’s research focusses on health financing and health systems strengthening in relation to universal health coverage. In 2017, she published a paper that looked at the impact that out-of-pocket expenditures have on household welfare in Malawi.

Martin Mwale, currently a PhD candidate with RESEP, has academic interests that lie in explaining household welfare in low-income countries. In particular, Martin’s PhD research examines how farm input subsidies affect household welfare, with a focus on the unintended consequences these programmes have on women and children.