By Nyasa Times

Published: July 1, 2009

Folks, I have no doubt that between now and the next election in 2014 we will see more progressive changes in the country. Like any other citizen, I fully become convinced reasonably that Malawi, just as the west, can put a stop to hunger and preventable diseases that has impoverished the country for decades.  

We have the strength and humour to advance but for some reasons we are technically restrained. Hunger and ill health seem to have over powered us. How much dedication can we engage to completely transform ill health to better quality life? I guess we need to do more our selves and for once stop singing the political praises or perhaps stop altogether the angry political altercation. We need to join hands while avoiding this tradition of leaving everything to one man. 

It is possible to make changes. However, fundamental changes require great dedication and overwhelmingly positive attitudes. While I realize that many of us would love to effect change, often many times we become constrained in our actions and resources to facilitate this change.  

This does not mean we can’t do anything else. You and I can change perhaps within our lifestyles or least give out desired impressions to all those who overlook upon us. There are lots of other things we can do to help president Bingu take us out of poverty. 

If we are not political advocates, why not involve ourselves with simple things like deliberating or reflecting on emerging challenges that the government can be advised on and perhaps urged to take more serious or raise some debate on issues that are currently not debated enough. I have to serve the latter since politics is not my taste. 

First and foremost, let me acknowledge that Malawi has done very well in its policy developments. Although, it is every difficult or too early to relate what impacts of economic growth has had on individuals or the public- they seem to be physically something that has been done. Bingu through his administration have proven to us that progressive change in Malawi is a virtual reality. While Bingu’s business is incomplete, his basic objectives in health, housing and access to food are likely to maximize better quality life. Normally, the strenuous efforts to achieve as could be reckoned in Bingu’s administration are what describe doing something.

While it is difficult to stay away from politics, let me try to be neural as much possible in discussing an issue that I think is relevant to the development of our country. The idea of contributing to this forum came as result of reading a report by the World Bank and IMF which published an astonishing 8.7% economic growth for Malawi. As if that was not enough, I went on to reflect what sort progress the country has had in the past years. However, the economic index makes sense when retrospectively compared in years of annual publication. The 2003 index and years before, Malawi economic growth remained erratic and well below 2%.  

While high economic growth for Malawi is good news, what does it really mean for personal or public benefits? Given the best evidence of economic activity, what are the implications for the health delivery system? 

The case I have just provoked require great attention and consideration, including how best we can ensure that everyone potentially benefit from the economic growth. While the measure of economic growth means more jobs, production and consumptions of goods, most important indicator which most people are likely to benefit from is generally health.  

In simple terms, we can not claim to be doing well when the health service is in shambles.   

It is quite absurd to raise debate about desirable benefits the economic growth indexes has bestowed upon health. However, there is an inevitable debate about the best ways that should be considered for equitable rationing of the economic benefits. What are the considerations of rationing if all desirable benefits of the economy growth are to be realized in the health care system? In other words, the issue of economic distribution is substantial, especially in scarce resource countries were economic benefits are too minimal to reach everyone.  

Even in economies were resources are adequate, concerns over ways of sharing economic achievements emerge. While this is still an issue in the west, it doesn’t mean we put a blind eye about the similar issue in Malawi. I strongly feel distribution of resources is important issue for developing countries whose inadequate resources will never reach everyone.  

Like developing countries, Malawi need to be more concerned with equitable distribution of economic benefits. The 2008 economic growth rate, which reaches into billions of kwacha, will pay for various services for many millions of people in the country. However, there is almost no chance that the human, infrastructure, or financial resources will have to reach everyone who is in need. Even in the best circumstances when these resources reach some people, it is completed through rationing, which is one method of resource distribution. If this method is not coherently adhered to need, it may raise different problems. 

Typically, this is also another concern that prompted me to invoke this debate, which I think is controversial in policy making. However, before I highlight the controversy, let me clarify the meaning of rationing. For the purpose of this debate, I refer to rationing to describe process of choosing between beneficial services.

The rationing system, in economic terms, can be described as a process that restricts demand for a scarce resource so that it matches with supply. The notion of rationing understood on this economic basis do not imply to deprive some people of certain goods, but rather describes the genuine allocation of a scarce resources  of which there is not enough to go round.  

Often the process of rationing is thus interchangeably used with resource allocation and priority setting. Rare do politicians and policy maker use the word rationing. I might be wrong but I have never heard Bingu mention the term (Kaya kapena mu chichewe). However, recently, he has talked about allocation of ARVs while Joyce Banda has talked about allocating fixed price for agriculture produce, cotton.  

For me, I find it strange in their use of words ‘allocation of resource’ or ‘priority setting’ as these two synonyms words do not makeup in their meaning. The use of the word ‘rationing’ for some politicians sounds like the f-word.  

Think for a moment why politicians are so naïve to speak about rationing when the spectre of rationing is inescapable especially in limited resource countries. 

The actual meaning of rationing is often used to restrict consumption of good and services. For politicians, it is like digging own pit. In this case, politician and policy managers would rather describe their morally neutral concept to replace the true meaning of rationing. Often, they find priority setting’ or ‘resource allocation more comfortable words opposed to rationing. So what is the point? 

Is this allegedly fundamental problem really fundamental at all? If more resources for example were provided, could this choice of word ‘rationing’ be avoided completely?  

On one hand this explains why politicians hate and find this word exceptionally unpopular. Why policy makers often avoid the terminology in their vocabulary in their resource plans or perhaps why health managers shun the issue in as much as possible in their undertakings. The obvious reasons are embedded in the fact that politicians do not want to misinterpret meaning of rationing since the term differ from priority setting and resource allocation in a number of interpretations.  

First, rationing can imply denial or exclusion of the service. Second, it can refer to withholding consent to any allocation of resources. Third, rationing can refer to individual cases while priority setting refers to services. Fourth, rationing decisions tends to be more technical or based on effectiveness opposed to priority/ resource allocation which is purely on value judgments.   

In short, the ways our politicians or managers use these words influence how these resources are offered to a few while neglecting others. Although, I didn’t make an attempt to restrict the meaning of rationing to health care spending in the ministry of health, it is clear that there is quite a lot of politics going on in the health sector akin the sector of economic planning.  

Often many times, the criteria used to ration resources in the health sector are abused especially when deploying non price rationing. For many of our politicians and policy managers, the true meaning of rationing is not just there yet as indicated earlier. The process in which it is undertaken has never conveyed a true story of finite resources. In other words, our politicians have cleverly adopted buzzwords as is the case to influence albeit hiding public choices or decisions made within interests of citizens. As for me, this position statements is correct as I often think it is deliberately avoided because it not an end to the means.  

While this begins to explain why politicians and all those concerned overlook reality, it doesn’t mean the true meaning of rationing is not satisfied. However, they could be doing it the wrong way since it could not be portraying its basic concept of honest, openness and equitable allocation of resources based on need and consensus of people’s decisions. However, this does not mean that everyone will have a fair share of the scarce resources nevertheless; the procedure should strongly position itself to satisfy everyone if not enough of everyone. It is acceptable and we know people will never agree on criteria of how resources should be rationed. But attempts should be made completely on how best resources can be rationed.  

This can be done if our politicians and managers made efforts on speeding up the level of efficiency and stopped choosing or offering services that were ineffective or was subjective to their own need and will. Most important, politicians and managers should make attempts to providing additional resources by either deploying resources from non demanding public services such as the defence force or simply by raising taxes on non beneficial goods and services.

The idea of rationing applied to health care resource should not primarily focus on political agendas that only satisfy a few people but noble causes. As often inherently political manoeuvre, health sector is deliberately told what to do. The political choice of rationing often contrasts socially desirable returns of the health sector.  

The rational way of distributing resources should at least engage citizens by prioritizing their needs regardless of geographical or financial positions. It is important that policy managers refocus their strategies by going out in the rural areas and find out what the people want. This system approach involves recognizing values that underpin people’s priorities, and unless these are articulated and agreed upon, we risk allocating resources unfairly or to those that have great influence than the others.

In absence of a more cohesive rationing process, often result in inequities and inefficiency. If Malawi was to promote an open policy process, it should have an opportunity to ration effectively and in a manner that sustains both economic development and social cohesion. Otherwise, our politicians and resource managers would take advantage and channel our resources towards or away from particular groups on reasons unrelated to relative need of resource.  

With an open process or debate, bad political rationing will be distracted and perhaps politicians or policy managers could begin to orient their actions on health while re-planning how prevention could be encouraged to avoid diseases that keep taking away large part of resources in the form of treatment costs.  

The agenda of rationing is an important issue to our economic progress. We need a debate on how we could ensure distributive benefits and how best these resources reach the health delivery system- a system that at least everyone can seek health care.