4 August 2015

Malawi: Tackling Malawi's Health Systems Challenges

It is important to acknowledge that in order to understand and improve an organization there is need to understand the people who work for it and how they interact with the organization.

Similarly, need arises to understand the people who benefit from the goods/services of the organization and how they interact with it.

In perspective, not all changes lead to improvements but all improvements lead to changes.

The incumbent administration promised a reformed public sector in their tenure of office if elected.

In essence let us focus on what the common Malawian in the remotest village is facing in relation to what the incumbent administration is implementing today as compared to what people expect of it.

Fast forward to our health sector and precisely health centres ,which are absolute providers of the Essential Health Package(EHP) which is a combination of diseases/conditions affecting the underprivileged as well as their drugs/treatments encompassed in the term Primary Health Care(PHC) implying the first line of entry into the healthcare services.

Sadly we are experiencing persistent drug and equipment shortages-same old song, staff shortages-same old chant, poor infrastructure-same old story, poor information management-same old mantra, lack of fuel and broken down vehicles-same old narrative and then among others shortage of funds-same old farce.

It should be articulated that the health system is made up of six key building blocks namely: health services delivery; health workforce; health information management systems; drugs, vaccines and medical technologies; health financing; and stewardship and governance.

This paper digs deep into the health financing component which is often blamed for causing most of the problems mentioned above and below affecting the other building blocks.

Without adequate money: health workers cannot be paid sufficiently and on time which is currently the scenario from month-to-month, for instance last month health workers were paid on the 42nd day of the month; drugs, vaccines, instruments and medical technologies cannot be acquired and sustained which is also the situation on the ground with most facilities relying on donations; assets e.g. vehicles and buildings cannot be acquired and managed effectively hence most facilities surviving on handouts and hand-to-mouth arrangements; without money health data cannot be managed efficiently to support the evidence base for decision makers which results in poor health stewardship and governance and so on and so forth.

Simply put money is key to the functionality of any health system be it in a rich or impoverished country.

In 2006, Malawi became a signatory to the Abuja declaration on improving access to health for all by 2010 on among others HIV/AIDS, Tuberculosis and Malaria. The pact requires participant nations to ensure that 15% of their national budget is allocated to the health sector.

Being a signatory, Malawi government was bound to ensure that year-in year-out 15% of its national budget is for the health sector in order to ensure that the health of every deserving citizen is covered.

However, years down the line the country has always fallen short of providing adequate funds to the health sector for 'deserving' citizens to benefit.

Mostly doesn't exceed 10% of the national budget as evidenced in the 2015/2016 low health budgetary allocation causing pandemonium amongst health/social activists and the general public in particular.

The health system is a social service. A point of contact between a government and its people, it therefore calls for equity and equality of access to healthcare for every citizen.

President Peter Mutharika and his health minister Jean Kalirani must be reminded that (Health) resources are finite. A choice must be made about which resources to use for which activities. By choosing to use resources for one activity, the opportunity of using those resources for alternative activities is given up and the benefits associated with the best alternative use of resources is lost.

The questions are: has the DPP administration provided enough resources to cater for the health system public sector reforms entrusted in the hands of VP Chilima? Has service delivery been improved in terms of quality, safety, coverage and access? Have human resources for health been managed effectively and efficiently?

Are health workers performance appraised, incentivized and motivated? Are health personnel and patients aware of these much touted reforms? Have we shielded the poor from further impoverishment due to ill-health under EHP services? Do we have state-of-the-art medical technologies in our health facilities at primary level (health centers), secondary level (district and mission hospitals) and tertiary level (central hospitals)?

Is it prudent, as a nation, to go to expensive South African clinics where unfortunately we are attended to by Malawian professionals who succumbed to brain-drain and migrated southwards in search for greener pastures?

Do we prioritize million-dollar banquets and parties at the expense of improving our health systems? What did the death of our beloved Head of state the late Bingu WA Mutharika teach us as a nation? The last question goes to those at the top of the power ladder.


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