In response to ongoing reductions in external funding for HIV programming and in anticipation of the USG funding pause, Malawi emerged as a frontrunner in contingency planning to protect its HIV response. ASLM spoke with Chifundo Hiwa Kamuloni, Assistant Deputy Director, HTSS – Diagnostics, Ministry of Health, Malawi, who shared how the country developed and implemented a proactive strategy that prioritized essential services, preserved laboratory capacity, and maintained public trust during a time of uncertainty. The lessons from Malawi offer a compelling model for other countries seeking to build resilient, adaptable health systems.
ASLM: Malawi was one of the first countries to develop a contingency plan in light of the USG funding pause. What informed its development, and what were the key considerations?
Chifundo Hiwa: We developed our contingency plan in response to declining external support for HIV programs. Even before the USG funding pause, we saw the need to prepare for possible disruptions to ensure critical services continued.
The plan focused on maintaining antiretroviral therapy, HIV testing, and treatment monitoring—key pillars of HIV care. We prioritized uninterrupted ART for over one million Malawians, preserving HIV testing for case identification and linkage, and ensuring consistent monitoring to prevent treatment failure or resistance. Furthermore, we worked with partners to align resources and manage funding shortfalls.
ASLM: In the event of reduced funding, which services are continued and which are scaled down, and why?
Chifundo Hiwa: In such situations, our priority is to maintain core HIV/AIDS services like antiretroviral therapy (ART), prevention of mother to child transmission (PMTCT), HIV testing, and viral load monitoring. These are essential for preventing new infections and keeping those living with HIV healthy.
Non-essential services, such as outreach programs and research, are temporarily scaled down to preserve resources and workforce capacity for critical care and prevention.
ASLM: How effective was the contingency plan after the USG stop work order?
Chifundo Hiwa: The contingency plan was highly effective, allowing us to act quickly and avoid disorganization. With priorities and strategies already outlined, we reallocated resources and explored alternative funding without delay.
The plan identified services like post-exposure prophlaxis (PEP) and Pre-exposure prophylaxis (PrEP) as non-essential in a constrained funding environment. By deprioritizing these, we focused resources on sustaining core services like ART, HIV testing, and treatment monitoring.
Strong stakeholder coordination, built into the plan, allowed for effective support. Weekly check-ins, aligned priorities, and transparent communication ensured service continuity and maintained public trust.
ASLM: What laboratory services were prioritized, and how is implementation progressing?
Chifundo Hiwa: We focused our laboratory efforts on the most critical testing services—targeted viral load testing, early infant diagnosis (EID), and HIV diagnostics. To support this, we strategically reallocated resources to keep key testing hubs operational, maintain sample transportation systems, and prevent commodity stockouts.
Weekly coordination meetings at various levels of the MOH ensured that support was channeled to the areas with the highest need. This targeted approach has helped us sustain essential lab services even with constrained resources.
ASLM: What advice would you give to other countries that have not yet developed a contingency plan?
Chifundo Hiwa: Start now. A contingency plan is a vital component of health system preparedness. Identify and protect your core services – ART, PMTCT, HIV testing, and lab diagnostics. Assess your available resources and plan how they can be reallocated if needed.
It’s also important to establish coordination frameworks with stakeholders early on and define clear roles for communication, decision-making, and monitoring during crises. Learn from countries like Malawi, we were able to maintain stability and protect lives because we planned ahead. Strengthening system resilience now will help prevent setbacks in future emergencies.