Malawi has prioritized health system reforms as part of its efforts to advance towards Universal Health Coverage. A key health systems
reform is the shift from passive to strategic health purchasing, aimed at ensuring that purchasing arrangements—financed through multiple sources—are more efficient and deliver better value for money. Our findings reveal that the country has policy frameworks that guide the application of strategic health purchasing reforms. Despite this, passive purchasing remains dominant, and primary health facilities continue to operate in limited facility autonomy. This policy brief summarizes key features of Malawi’s SHP reforms, highlights progress and emerging challenges, and outlines opportunities to optimize purchasing functions and health system performance, particularly through realistic budgeting, improved donor alignment, and enhanced performance monitoring.