A National Model for Community-Led Health Accountability
Summary
In 2025, International Treatment Preparedness Coalition (ITPC) committed to institutionalizing Community-Led Monitoring (CLM) within Malawi’s national health system to improve accountability, service quality, and health outcomes for more than 356,000 individuals by 2028. As donor funding declines and public health systems face mounting strain, this three-year initiative will embed community-generated data into national platforms, ensuring timely, people-centered decision-making. Phase one will pilot CLM integration in three districts—Zomba, Phalombe, and Mulanje—focusing on HIV services. In year two, the project will expand to six districts and include monitoring tuberculosis, mental health, and stigma. By year three, CLM indicators will inform national dashboards, budgets, and planning processes, positioning Malawi as a regional leader in inclusive health governance. The program will train community monitors, empower local health managers, and foster partnerships with government, academia, and civil society to build a sustainable, scalable model that strengthens trust, equity, and the quality of care across Malawi’s health system.
Approach
The International Treatment Preparedness Coalition (ITPC) commits to institutionalizing Community-Led Monitoring (CLM) within Malawi’s national health system, beginning with HIV services and progressively expanding to primary healthcare. Over three years, the initiative will strengthen community-led accountability mechanisms by training local monitors in selected districts on quality-assured data collection using digital tools, analysis, interpretation, and the use of data for advocacy. The project will monitor a mix of qualitative and quantitative indicators, including a limited set of clinical indicators that will serve as an ‘early warning’ for weakening health responses: HIV tests, new ART initiations, TB infections, viral load tests, and viral suppression. Supported by a National Coordinator, these monitors will lead data collection at both community and facility levels to generate evidence for stakeholder engagement at sub-national and national levels. The initiative will also pilot integration of CLM indicators into national health information systems such as DHIS2 and MAHIS. ITPC will collaborate with the Digital Health Division to initiate the development of a CLM module within DHIS2, and eventually MAHIS, using a select set of CLM indicators. The initiative will be implemented in a phased approach starting with three districts with strong infrastructure and government engagement, expanding to six districts in year two, and embedding CLM into national governance, budgeting, and planning processes in year three.
Capacity building will ensure that both community and government actors understand each system’s data collection process, and are able to analyze and interpret the data. Regular joint data reviews and feedback loops will be built into the system to support collaborative decision-making. Political will and trust will be cultivated through inclusive planning processes and policy endorsement, positioning CLM data as a complementary, actionable resource that strengthens public health responses and accountability at all levels.
This model draws on ITPC’s established CLM methodologies tested across West and Southern Africa.
Action Plan
Over three years, this commitment will follow a phased implementation plan aligned with Malawi’s national HIV strategy and broader health sector reforms. By embedding Community-Led Monitoring (CLM) into the national health information ecosystem, the project aims to strengthen service quality, increase accountability, and improve health outcomes.
Phase 1: Pilot Integration (Year 1) The initiative will launch in three districts (Zomba, Phalombe, and Mulanje) where strong government partnerships and infrastructure already exist. Community monitors will be trained in CLM methods and digital tools to collect, analyze, and act on service delivery data. These findings will be shared with district health teams to co-develop solutions. Pilots will test integration of HIV-related indicators into DHIS2 and MAHIS, Malawi’s national health data platforms.
Phase 2: District Expansion and Service Deepening (Year 2) The project will expand to six districts and extend monitoring beyond HIV to include TB, mental health, and stigma-related concerns. Data feedback loops will be institutionalized through quarterly district scorecards and planning dialogues. Community-generated data will inform district health team decisions and resource allocation. New partnerships with academic institutions and data scientists will support analysis and validation of CLM findings.
Phase 3: National Integration and Sustainability (Year 3) By year three, CLM indicators will be embedded into national dashboards, enabling real-time, community-informed decision-making. National-level planning processes—including those of the Ministry of Health and National AIDS Commission—will use CLM data to inform strategies and budgets. The program will train facility and district managers to interpret and act on CLM insights, laying the groundwork for national scale-up and adaptation to broader primary health care.
Background
Public health systems are under mounting pressure as global financing declines, donor priorities shift, and traditional data tools struggle to provide timely insights. In Malawi, where 991,000 people live with HIV and 11,800 new infections occur annually, over 90% of HIV funding is donor-dependent, with The Global Fund procuring 99% of HIV-related commodities (UNAIDS Malawi Fact Sheet, 2023; State Department, 2021) . Abrupt aid cuts in 2025 triggered severe disruptions to HIV, TB, and broader health services, resulting in stockouts of antiretrovirals and prevention supplies, treatment interruptions, and stalled prevention efforts (The Guardian, 2025) .
Malawi’s 2025–2030 National Strategic Plan for HIV recognizes Community-Led Monitoring (CLM) as a critical accountability mechanism. Community monitors in Malawi have already identified and helped resolve issues such as supply shortages, long wait times, and patient rights violations (ITPC report, 2025) . Other CLM efforts increased human resources for health, expanded access to cervical cancer screening services, reduced turnaround times for lab results, enhanced patient privacy during service delivery, and led to the refurbishment of health facility infrastructure (Liu Lathu, 2025) . In Côte d’Ivoire, community monitoring revealed that 10% of people cited cost as a barrier to HIV services, prompting the government to eliminate HIV-related user fees in 2019—resulting in a 5% increase in ART uptake at monitored sites.
Despite this evidence, CLM implementation remains nascent, fragmented, and heavily donor driven, and CLM findings remain disconnected from national health information systems like District Health Information Software (DHIS) 2 and Malawi Health Information System (MAHIS) , limiting impact and sustainability.
Effective integration of community-generated data into national platforms can close data gaps in real time thereby improving service delivery, equity, and strengthening trust in the health system. With political will, civil society momentum, and an enabling policy environment, Malawi is well-positioned to lead regional progress on CLM integration.
Progress Update
Partnership Opportunities
ITPC is seeking partnerships to scale the integration of community-led monitoring (CLM) into national health systems and beyond. ITPC welcomes collaboration with governments, civil society organizations, and implementing partners interested in adapting its CLM model, which includes tools for data collection, training, and community engagement. The organization also seeks academic partners to document, evaluate, and publish findings, as well as media collaborators to amplify public awareness of CLM’s impact on accountability and service quality. ITPC invites actors from other sectors—including climate, education, and gender equity—to explore how CLM can be adapted to support people-centered systems across issue areas. Financing collaborations across philanthropy, multilateral, and private sector partnerships are welcome. These partnerships are critical to expanding the impact, reach, effectiveness, and sustainability of CLM as a transformative approach to strengthening equity and responsiveness in service delivery., As part of this commitment, ITPC offers technical assistance, implementation tools, and shared learning resources to organizations seeking to integrate community-led monitoring (CLM) into national health systems. Drawing on experience from regional observatories and country-level CLM initiatives in Malawi, South Africa, and West Africa, ITPC provides access to tested training curricula, data collection templates, and policy advocacy strategies tailored to low-resource settings. Through collaboration with civil society networks and government partners, ITPC invites organizations to participate in peer exchanges, joint learning sessions, and cross-country technical dialogues aimed at advancing accountability and equity in HIV service delivery. This partnership opportunity is designed to accelerate CLM adoption globally by connecting stakeholders to field-tested methods and fostering a community of practice committed to people-centered health systems.