Table 1 Malawi: relevant background and data

Malawi is a landlocked country located in southeastern Africa that is bordered by Mozambique, Zambia and Tanzania. Malawi has a population 19,889,742 people, has a life expectancy of 62 years and has poverty count ratio of USD 2.15 a day of a population, and is ranked as the sixth poorest country in the world [23]. There is a high burden of disease, for example of the prevalence of HIV is 7.7 among adults, and over 990 000 people were living with HIV 2021 an incidence of 1.13 per 1000 population [24]. Malawi also faces a high burden of non-communicable diseases and an increase in their risk factors. For example, the estimated rates for heart disease, diabetes and hypertension are 9%, 6% and 16.7%, respectively [25]. The prevalence of obesity and smoking are also estimated to be 18.5% and 21.7% [26]. The health care services in Malawi are provided by three major players, the public, the private not for profit and the private for profit [27]. The prices for health services are subsidized in the private not for profit sector, and free in the public sector. In the private sector there are three major layers of service delivery, primary, secondary, and tertiary levels [28]. To achieve universal health coverage, the Ministry of Health Malawi supports palliative care service integration into existing services at all the three levels. That said, catastrophic out of pocket expenditures remain a problem for palliative care patients in Malawi. For example, research conducted in patients with advanced cancer demonstrates a high prevalence of catastrophic and out of pocket expenditure [29].