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Malawi’s interest in social health insurance dates back to 2011 as a means to reduce donor dependency and increase domestic resource mobilization for health. In May 2015 the Malawian Ministry of Health (MOH) contacted one of its external partners to conduct an assessment of the appropriateness and feasibility of National Health Insurance (NHI) against two alternative options: continuing with a tax (and donor)-funded NHI, and introducing a purchaser-provider split without a revenue collection function. The results of the study reported  herewith in this paper indicate that introducing a NHI in Malawi would increase revenues for health, but these would come predominantly from the formal sector and would be unlikely to cover the health sector funding gap. Furthermore, the performance of existing poverty identification and targeting mechanisms did not commensurate with the requirements of a NHI. Incentives to enrol in NHI were found to be insufficient to reach scale unless service fees are introduced, which would negatively affect equity and financial risk protection.
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