An evaluation of how investments in health system strengthening and disease-specific programmes affect health outcomes in Malawi
This policy brief assesses how investments in both health system strengthening and disease-specific programmes influence health outcomes in Malawi, showing that integrated approaches achieve the highest impact and return on investment.
| Authors | Dr Tara Mangal, Sakshi Mohan and Prof Timothy Hallett, on behalf of the Thanzi la Onse Epidemiological Modelling Team |
| Publication date | August 2025 |
| Publication type | Policy brief |
| Programme / grant | Thanzi la Onse modelling programme; GRTD Research Commissioning Centre (RCC), co-led by 3ie and University of Birmingham |
| Funding | Foreign, Commonwealth & Development Office (FCDO) (UK Government) |
| Licence | Unless otherwise stated, content on this page is licensed under a Creative Commons Attribution 4.0 International Licence (CC BY 4.0). |
This policy brief examines the health and economic impacts of investing in broader health system strengthening (HSS) and disease-specific vertical programmes targeting HIV, tuberculosis (TB), and malaria (HTM) in Malawi. Using the Thanzi la Onse (TLO) epidemiological model, the study evaluates three investment scenarios over 2025–2035: standalone HSS investments, standalone HTM programme scale-up, and a combined approach integrating both.
The modelling incorporates detailed projections of health outcomes, including disability-adjusted life years (DALYs) averted, deaths prevented, and life expectancy gains, as well as estimates of return on investment (ROI) using a value of statistical life year framework. Scenarios include expansions in human resources for health, supply chain improvements, and enhanced programme coverage.
The findings demonstrate that investments in broader health systems generate substantial health benefits, particularly for non-HTM conditions, and deliver strong economic returns. While vertical programmes provide additional gains, their effectiveness is constrained without system-wide strengthening. A combined strategy yields the greatest health impact and ROI, highlighting the importance of integrated investment approaches for achieving sustainable health improvements in low-resource settings.
Mangal, T., Mohan, S. and Hallett, T. (2025) The health impact of investments in vertical programs and broader health system development: Findings from Malawi. London: GRTD Research Commissioning Centre.
References are provided extensively within the full report.
Supporting sources include peer-reviewed academic publications, technical reports on the Thanzi la Onse (TLO) model, and policy and economic analyses relevant to Malawi’s health system and investment frameworks.
This research output is made available in accordance with the FCDO Open Access Policy (December 2025). As part of a programme within the scope of this policy, this publication is freely accessible to all users without financial, legal, or technical barriers.
The full text is provided under a Creative Commons Attribution 4.0 International Licence (CC BY 4.0), which permits use, distribution, and adaptation of the material in any medium, provided appropriate credit is given to the original authors and source.
This output has been made available through an approved open access route and deposited in a recognised repository in line with FCDO requirements, including compliance with any required timelines for open access publication.
Where third-party material is included, users should check the relevant rights statements before reuse.
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For questions about this publication, email rcc@3ieimpact.org with ‘Findings from Malawi’ in the subject line.
