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In addition to addressing gaps in the provision of health care insurance, strategies should focus on ensuring financial risk protection of citizens and community residents during a medical emergency. The significance of access to this danger pool is finding expression during household financial shocks, as a result of health expenditure. In this regard, the fundamental function of social protection programs needs to be emphasized in the design and implementation of universal health care policies. Health insurance schemes can play a role in addressing people-centered cost and quality issues. Yet barriers in the insurance schemes, such as inability to pay, may exist. Alternative financing mechanisms, such as insurable risk pooling and insurable savings accounts, should also be considered in order to fill gaps in universal health coverage [18].

The underlying assumption that underlies the call to universal health coverage is that all need to have access to health services. This philosophy is realized in the policies that seek to achieve universal health coverage, as it implies that no one remains left behind in the health system. Since Malawi adopted the SSA agenda in 2003, there has been an overall improvement in the availability of health services, although basic services are still lacking throughout the country. Improving the quality of care is crucial in the quest for high levels of service satisfaction [36]. If one of the fundamental conditions for service satisfaction is to receive quality care, effective public sector regulation of the private and private/CHAM sectors is important [2]. Under the SSA, especially the EHP, the state should take over the responsibility for adequate regulation of its health workforce, through the setting of necessary standards and licensing requirements. This is fairly impractical, however, in countries like Malawi, with a fragmented and inadequate health workforce. Policy makers should make sure that health workers are adequately paid, and that they are protected from being overworked [33]. Indeed, as previously noted, the plight of health workers in Malawi continues to move painfully forward [36]. One of the critical aspects of this distress is the requirement for health workers to work in both the public and private/CHAM sectors. If they do not work in the public sector, they are paid less than in the private sector, and their workloads are often greater than in the private sector.


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