Life expectancy in Malawi, one of the poorest countries in the world, increased by 19 years (from 46 to 65) from 2000 to 2019 - mostly due to reductions in mortality from HIV, TB and malaria, and declines in childhood diseases. What does this very rapid demographic change mean for governments, policy planners and ordinary people now living so much longer? Will overstretched health and social protection services be able to cope with the demands that come with longer lives - rapidly increasing non-communicable diseases and dementia, and caring for a growing elderly population? Leah Malekano and Ruth Evans ask how we can ensure there is 'life' in those additional years in one of the most aid-dependent countries in the world.