Gender-Equitable Access to Tuberculosis Care and Prevention in Malawi: A Political Economy Analysis: A Political Economy Analysis

Men constitute about 57% of all tuberculosis (TB) cases in Malawi. With Malawi remaining a highly burdened TB country, having registered 181 cases per 100,000 population in 2018, addressing the gender disparities in TB becomes a critical imperative in the nation's ongoing efforts to achieve the END TB global goals. To understand political and economic factors that affect gender-equitable TB programming in Malawi, we conducted a qualitative political economy analysis (PEA) that involved policy and stakeholder analysis guided by a modified Rapid Outcome Mapping Approach. Data for the PEA were analyzed using an inductive thematic analysis approach, and a force field analysis was further conducted to understand the driving and restraining forces that influence stakeholder involvement in gender-responsive TB control. Findings for the PEA showed that despite the established role of gender in the development and control of TB in most of the documents, the prevailing policies fail to address the gender-TB dynamics explicitly. Furthermore, policy planning and execution are fragmented, leading to poor policy cohesion and a lack of adequate consideration for gender-specific health issues. We further found that Malawi has various stakeholders with varying levels of interest and influence, capable of advancing gender-responsive TB programming. The current level of stakeholder engagement, though, faces significant challenges such as poor engagement with grassroots structures, despite such engagement having already proven effective in the control of HIV in the country. There is, therefore, a need to integrate gender-sensitive approaches into existing policy frameworks in Malawi and to strengthen collaboration among stakeholders in advancing gender-equitable TB services.