A tale of Malawi’s reeling health sector

In the running to Malawi’s 20th May 2014 tripartite elections, two separate studies by Afrobarometer and Catholic Commission for Justice and Peace (CCJP) established that among key issues that would determine outcome of elections were food security, national security, economic stabilisation, farming subsidies and, to a lesser extent looting of state resources by civil servants and politicians, commonly known as Cashgate.

These are indeed some of the Malawi’s perennial problems. Those who are up-to-date with Malawi’s socio-political and economic issues would not be surprised. Conspicuously missing however are education and health sectors. How could Malawians not see these sectors as a priority? These two sectors are in serious need of a revamp, in terms of human resources, infrastructure and provision of basic materials and services.  http://www.theguardian.com/global-development/poverty-matters/2014/jul/06/malawi-50-years-independence-education-challenge

As I argued here, education is a key to development of a nation and education remains a big challenge to Malawi, 50 years after its independence from Britain, which colonised this country for 71 years. Just as with education no country can develop without efficient health care system, it takes healthy population to build a nation. Goals of sustainable development cannot be achieved when there is a high prevalence of debilitating illnesses.

Hospital ward at KCH

Hospital ward at KCH

United Nations Development Programme figures show that Malawi is likely to meet MDGs on reduced child mortality and combating HIV and AIDS, malaria and other diseases. At the same time the country is unlikely to meet MGD on improved maternal health. This is the case irrespective of notable efforts by Malawi government to achieve this goal.

However, government efforts do not go far enough, and this has been a general feeling for those working in health sector and those advocating for improved sector in the country. In June 2013, influential local civil society organisations (CSOs) joined forces to petition Malawi parliament to increase health budget allocation from 12% to 15% in 2013/ 2014 budget.

The CSOs noted some of the funding could come from farm input subsidies programme (fisp), which they observed has become inefficient and only exist because it is politically correct and serves political purposes instead of national interest. Fisp received 18% of the budget allocation in 2013/ 2014.

The last 20 years of democracy in Malawi have shown that leaders in the country prioritise programmes that are likely to win them the elections, which come every five years. This is why it is enticing for leaders to prioritise areas that are seen as politically correct, even if ineffective, and areas that do not need long-term planning, beyond the five years voting interval – fisp perfectly fits this criteria.

Increased budget allocation would not solve all the problems but would certainly go a long way in sorting some of the basic problems within the health sector; closure of a mortuary in Salima, for months, for lack of US$126 to fix “door handles”. Increased budget allocation would also show some political will and commitment by the government.

Perhaps we all need a constant reminder of these unflattering stats to full realise the extent of the problem at hand: with a GDP of US$4,265 billion per capita and estimated 15 million people, Malawi is listed among low-income countries in the world.

According Unicef 61 per cent of Malawians live below the poverty line of less than US$1.25 a day and majority of this population rely on government for provision of health services. Malawi government and Christian Hospital Association of Malawi (CHAM) are the main health service providers in the country. Malawi government provides 60%, CHAM 35% and the 5% is provided by the private sector.

According to Ministry of Health, 75% of Malawians have access to health services, and it is important to stress that these figures do not include the quality of the service, which is unknown. However, this must also be understood in the context of a huge shortage of health workers in the country. Doctor-to-patient ration is at 88,321 to 1.

Various reports indicate that Malawi is among developing countries suffering from “brain drain” of medical workers to developing countries. It is easy to get hang up on this, yet, we must realise that this, again, highlight the lack of funding in the sector, which contributes to poor and unsatisfactory conditions of service for health workers who are in huge demand in developed countries.

It is a double loss when a country, let alone a poor country, use its resources to train medical workers and fail to retain them once graduated. It is equally shambolic when you train them and fail to deploy for lack of funding, which is what is currently happing in Malawi.

The Nation newspaper of 10th July 2014 reported that ministry of health was failing to deploy about 100 nursing graduates national wide because there was a suspension on recruitment and promotion of nurses. It has been six months since these nurses graduated.

Henry Chimbali, the ministry’s spokesperson told the newspaper: “we are waiting for communication from the department to lift the suspension. We got a circular in April 2014 to be applicable until the end of the financial year.” According to Nation on Sunday, these graduate have since written the Minister of Health, Jean Kalilani seeking her intervention on the issue. Now it is taking the health workers to push bureaucracies for action. Should we shout “brain drain!” when these health workers take up employment elsewhere?

In his independence day speech on 6th July, President Peter Mutharika noticed that among other problems that have undermined development efforts in Malawi’s 50 years of independence was a mismatch between policy and service delivery. It is good that President Mutharika is aware of some of these policy flaws. Now he needs to act. The good thing is that Malawi government is still working on the national budget. These issues must be prioritised, whether donors release budget support or not.

MPs deny giving themselves a pay rise? There’s no smoke without fire

Meanwhile, MPs have denied reports that they have given themselves a 100% pay rise, days after the issue was reported. You wonder if the MPs retreated. Perhaps they testing waters? Any of this would suggest people power, which is good. Anything is possible but I do not believe the story was an outright fabrication. There is no smoke without fire, as they say.

Is it not sad that in the midst of the current financial crisis, MPs should be in the media denying alleged pay increase instead of discussing issues affecting welfare of their people? Malawi does not even have a 2014/15 national budget yet. What signal are stories of pay increase sending to the donors that are currently holding up 40% of annual budget contribution?

The problem, as I argued here last week, is the sickening national culture that we have developed over the years. It has become “normal” for Malawians to see those in position of power to abuse resources. Those that stand up against it are seen as “controversial” and “jealous”. Even the local media are happy to use the “controversial” tag for outspoken folks. MPs are aware of this culture, and they have always given themselves the pay rise with a full knowledge that they will get away with it. This is why I say it is good if MPs have retreated after sensing public outrage.

“We are a joke of a nation, led by jokers,” as Boniface Dulani rightly pointed out on my twitter timeline before MPs refusal. Whatever the truth is, the whole issue points to a reckless if not careless bunch of greedy folks masquerading as representatives of people. Our MPs can do better, much better.

 

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