Decentralisation and the provision of health care facilities and services: The role of social awareness and mobilisation in promoting the right to health for rural Malawian women

This study analyses the potential for health sector decentralisation reforms in Malawi to spur delivery of basic social services and consequent promotion of local human development, leading to the realisation of women’s right to healthcare facilities, goods and services. The paper is developed on a case study that is supported and augmented by focus group discussions; key informant interviews and desk research in order to assess the validity of perceived benefits of the reforms. The study has revealed that there is generally increased knowledge among the populace on human rights in general. However, knowledge gaps are evident on economic, social and cultural rights, including the subject under study. Another positive outcome of the reforms relate to the creation of spaces (village development committees and area development committees) that allow for inclusive citizen participation in matters that affect them. Civil society organisations, particularly the Malawi Economic Justice Network (MHEN), have exploited these spaces to put women’s right to healthcare facilities, goods and services on the national and international agenda. Such advocacy initiatives have pressured the Malawi government to work toward meeting its obligation to fulfil women’s right to healthcare facilities, goods and services. The study concludes that decentralisation reforms in Malawi have not yielded perceived benefits, at least in the health-sector. Accordingly, the paper suggests some recommendations to the Malawi government, donors, CSOs and local structures on how decentralisation reforms in the health sector could yield meaningful results.