Of hospital user fees in Malawi

Recently there has been a lot of discussion and debate on the intention of government to introduce user fees in all public hospitals in the country. Some are for it while others are against it, based on where you gather your evidence. This is not a new phenomenon. In fact, some claim that this is what led to the Cabinet crisis way back during Kamuzu Banda’s rule in the 1960s.

Chimbali:   Patients must pay

Chimbali: Patients must pay

Well, we are now in the 20th century where the delivery of health services has completely changed. Even viruses have evolved to become more virulent than before. However, the fundamental principle of asking people to pay for their health care services is still applicable in the present status.

The recent reform areas of the health sector are four. They cover the area of reviewing partnerships with Christian Health Association of Malawi (Cham) to improve equity and access to health care, establishing a health fund to expand the base for collecting and managing revenue for health services, introducing health insurance to all salaried personnel alongside expanding the scope of payment services with an aim of providing an opportunity to those who are on salary pay for their health care, and providing more powers to central and district hospitals to manage the delivery of services without much interference from Capital Hill. These are just proposals and considerations that Capital Hill is seriously considering.

However, the matter at hand is the user fees as some have observed, which is slightly linked to the health insurance and payment of health services. As a matter of fact, Capital Hill is not in any way introducing user fees in public hospitals, much as more people still favour this concept and we are happy for such feedback. The concerns of equity and its economic value are at the centre stage. It is, however, well documented that most countries within the Sadc and beyond do not offer free health care and their health care system differs from ours. More often our border districts spend more money, time and other resources to assist people from other countries because our services are free.

While the issue of user fees and payment in hospitals using health insurance maybe operationally challenged; we, however, want to confront and address the mindset first. We think it is high time that people start considering good health as a great resource for their individual and family development. I am sure that not many people would want to be sick and be bed-ridden. We all want good health. However, our mindset need to change.

We need to start thinking of investing in health as a priority at all times. If we start to consider good health with an economical view, we would see that we cannot even whine further if asked to pay. Take, for example, the provision of mosquito nets for free to prevent malaria. Yet, people end up misusing them and get malaria. Eventually, when they go to the hospital, there is no medication to treat the malaria and all the blame goes to government for failing to take care of its people. Who is to blame in the first place when government provided an option to prevention?

The list of unhealthy practices and behaviours that we willfully do and eventually become a burden to government are more. It includes drink and driving, low condom use, failure to construct a toilet instead using the bush and poor adherence to treatment. All these unhealthy behaviours end up burdening the health services.

I also share the view that government has an obligation to assist its citizens at all times because of the taxes we pay, but why not use the tax to develop our country in other areas rather than supporting situations that would otherwise be prevented? Our health care is very fragile due to over-reliance on donor support and we need to be responsible for our own health.

What is being proposed in the reforms is for a good cause, it does not aim at punishing anyone. The message for now is that these are just proposals and the debate will continue. I am sure that the health sector will also be vibrant and deliver as we expect it to be. The demand for more quality services is also expected from all health workers.

  • The author is Ministry of Health public relations officer
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38 thoughts on “Of hospital user fees in Malawi”

  1. John says:

    it means the poor will be paying while the rich president and ministers will be going abroad with the tax payers money in expensive hospitals. Is that fair? wosauka kumalipira koma wolemera ndikumapita kunja kuchipatala mwaulere. zibwana zokhazokha.

  2. Kada says:

    Actually, the villagers you are worried about are already used to paying even higher fees kwa asing’anga. So what can stop them from paying K1, 500 at a hospital?

  3. Gareth Bale's left foot says:

    Hahahaha… Malawi wa lero!

  4. memory c says:

    Good idea coming from bad people. Why good idea? This will force people to engage in disease prevention measures. Remember “prevention is better than cure.” People get free mosquito nets and they dont use them, as a result they suffer from malaria. They go to hospital and get free LA, and after taking 12 of the 24 LA tablets they get better and stop taking medication. 14 days later they are down again but this time its a serious case. They go back to hospital again to be admitted and get other expensive malaria treatment and food and so forth for free. The only problem here is that the proponents are thieves.

  5. Immigration office we pay something but yet akuti mabuku akusowa ndalam zikumagwira ntchito yanji?????, and now we need to pay something kuchipatala do you think chithandizo chipezeka apa, tingo nena mosabisa apa anthuwa tiwalemelesa ndithu coz the money will just Go in their pocket ngati awa aku immigration,

    kulembetsa = k 500
    kuonana ndi dotolo= k 500
    makhwala= k 500
    kuthandizidwa mwamsanga = k1000.
    Kodi apa amalawi pakhale chilungamo apa?????

  6. Kanyimbi says:

    If some countries are willing to pay for our healthy so what about ourselves? Zinazu a Malawi tiziganiza mozama.

  7. But 1500 is too much. At least K250 is ok

  8. Bokhobokho says:

    Ife ndiye tinatopa nako kulipira. Bola amnzathu mumangoyenda mofewa zaulele zokha zokha. Udala ndinu Asaaaaa !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

  9. Chilembwe says:

    Imagine some others salaries ranger is k300 to k350 kwacha per day,do u think they can manager to pay user fee?be allow those company who makes sachet to restart then increase tax.

  10. john says:

    They can charge

  11. am acivil servant and everymonth goverment deducts PAYE from my salary.if it introduces mandatory health scheme then it should do the calculations out of the PAYE not my NET salary,another point of strikes if the issue is not handled with caution

  12. Jokujoku says:

    Nothing can change here, you just have the innermost secret with your European funders of IMF. You just indeed want to reduce the population by killing the man on the street( poor people) sent by the aims of the billionairs club. They have indeed failed by way of contraceptives and condomizing,war, aids, ebola and other biological war fare. Check it out and mark ma word

  13. bentby smart says:

    I totally rubbish this columnist . In fact he is propagandist. We are saying malawi is the No.1 poorest country on earth where its citizen can’t afford 1 dollar a day. So u think where will those poor rural masses get treatment. Mr chimbali, please kumene mukumakumanako muzikambirana za nzeru musaone kuti poti iwe Kamanga tayi nde omse amamanga tayi, ena olo lamba wamene amausowa….

    1. koma Umbulu? says:

      So where will the govt find money to ran hospitals? This world is full of struggles only degrees differs.

  14. khisa kayoka says:

    I fully support the motion,but government should come up with fair fees,which will meet access to all poor Malawianbin rural areas

  15. Mtupatupa says:

    Much as better health service delivery is required to all, but what will our taxes be for? Any way its like free primary where the poor while others and cabinet ministers are educating their kids out side the country using the poor people taxes money.

  16. Blessings says:

    Let me differ with chimbali though i appreciate that we agree to disagree after all we are different.the fee introduction will increase inequality betwn u the rich and the poor,wen u r sick medical schemes are provded to elsewhere to get the medics money frm our taxes laving poor malawian at a disadvantage. We know chimbali u dont care with ur so called prpposed policies but propagandas for the poor malawian.wen making them consult if not resign pliz .dont draw line btwn malawi and neigbouring countries!!! We are different on GNP they were empowered !! Wen dd u empowered malawians? Mosambik tanzania zambia maiowa autukuka kwambiri pachuma!!!!!!!

  17. parasido says:

    My view is that it is corruption and mismanagement that will make any of these proposals not work. Look at how we are failing to deal with cashgate, do you think people will be afraid to steal?

  18. jovelyn kasondo says:

    iwe guantanamo pako wanva wati achite impose? iwe nsete eti! Nanuso a henry muli milomo ngati ma gizzard a nkhuku kumaikira kumbuyo zimenezi? system yanu ndiyachinyengo mukufuna ndalamaxo muxikanyengera baxi. a simple example z dat local gvnt fail to manage misonkho amatolera mmisika zonse amaika mmapanti kumapititsa kwao aaaaaa mmene azibera ndalama ximeneyomo? dikirani muone xomwe xichitike

  19. james makawa says:

    no way pple to pay chambili u r stupid in south africa public clinics and hospitals are for free dont lie to pple fuck u

  20. Wakupa says:

    It is a good idea but u MUST kuba. If all governments were serious to control kuba there could be no shortage of medicine. If u are failing to curb kuba kwa mankhwala how are u going to make sure that the money collected will be used for the intended purpose

  21. ilquest says:

    This is social construction of reality vs bereaucracy vs structural violence/social suffering. Structural adjustment policies prescribed by IMF/World Bank did not or will never work in developing world. Sit back, relax and scrutize from yonder about the an unticipated/unintended consequences of purposive social action and then you will be enlightened on commodification of health. I beg to remain yours!

  22. Native says:

    if the paying system was introduced sometime back, my parents could have died. Medical treatment is very expensive, some treatments can cost as much as MK1Million and even more. and if someone needs surgery , see how much this would cost. Most senior officials are on medical schemes and most of these the state pay there hospital bills. I am a health professional and I strongly oppose this direct paying by patients. I would suggest the government copy the health care system from either France or Singapore as these nations have the best health care system in the world. This copying should be holistic, people’s economies should be improved , most people should be economically independent. May God bless our land

  23. Likoma Economist says:

    Poor Govt policies are perpertuating depedency syndrome and exacerbating poverty. What many (rural Malawians) know is producing kids. Once the kid is born, they shun responsibility and govt takes over through: free food (input subsidy), cash transfer, free health, free education, and now free housing etc. All this just encourages laziness and over population. Seriously, is Malawi a welfare state?

  24. Yhm says:

    this long overdue. Firzt is to put systems that will support the funds patients or guardians will be paying. Secondly; to find out why paying units failed? or was discontinued? thirdly, will the payments be accross the board or will be titrated tier system? fourthly will the funds be subjected to be used at the center of collection or be deposited in account no One? All the best but policy surely should not fail this time.

  25. GUANTANAMO says:

    I repeat, if yu want to impliment hospital fees successfully, don’t say “its coz JB stole the money”. Even me will crush you. Secondly, farm input subsidy progrm must come to an abrupt end. Its not assisting in averting hunger. Rather, its an instrument of winning votes. Yu cannot assist a person for ever. Yu assist someone to stand on his own. APM wil be in good books if he impliments genuine reforms without political inclinations.

  26. Bwampini says:

    In all there meeting, these pple wth their ties on their necks and smelling perfumes n deodorant sprays, they don’t think about smbody in a village who tastes tea/coffee only on Xmas. As a matter of facts, no poor patients are immediately refered to these hospitals. Health Centres are just giving them Panado for any disease they can explain to them. If you don’t see the outcome for this, poor patients will NEVER Ever referred to. Will be dying at homes. Our health workers are very unapproachable to the poor patients. I am saying this wth xperience.

    Ngati munthu ak akulephera kugula 2nd hand pant pa msika, nde mwati akapezeke ndi ndalama yakuchipatala? Think about the poor who are the majority in our country and are the ones needs gvt hospitals help

  27. Mvumbi says:

    Ndimacheza Ndimzanga Wina Wake Now Workng At Dedza Hosp Ndiye Amandiuza Dat Panado Ndipanado Yemwe Amaxowa.Den Nafunsa Wat F Govt Introduces Fees In Public Hospz and she Happly Welcomed For Short Period It Dat T Wil Solve Problem Of Drug Shortage And Over Dependance On Capital Hil.4m Nowhere She Said No Is Bad ,4m Ha Own 2yrs Exprience Amat Many Pipo Who Visit Public Hosp Are Poorest Of Poor Then She Fees In Public Hosp To Ha T Wz Like Milkng Thin Cow.2gether We Agred Dat Govt Shud Nt Introduce Fees.Pliz Ministy Of Healthe There Stil Room To Think About Remember The Plebelians In Thalire,chilomo,makanjira And Mamvende.

  28. bwanji kodi says:

    zokomela petala ndi getu wakeyo zimenezi.

  29. GUANTANAMO says:

    Let us pay something. Era of free things is gone. Yu can start with k200. Use our traditional chiefs to make villagers understand. Remove politics out. Make people understand that govt is doing this in the interest of its people. Money collected from hospitals and health centers must be diposited into the district treasury account and could be use to buy gloves, pain killers, dustbins, novida, simple stationary. Not for car maintenance, locum, tea breaks, etc. If some will oppose it just impose

  30. Chikondi says:

    health reforms are long overdue. people should understand what is being proposed before they comment. Its a very simple thing. if you are sick you are meant to start seeking help at a health centre where you will be assisted for free. should you feel that you would rather be seen at a central hospital then you will be charged a fee for bypassing the health center and district hospital

  31. Salayekha says:

    Most of you commenting here can in actual fact afford to pay for hospitals, and that’s great. Yes, we need a better health care system, but is making the poor farmer who struggles to feed his family the appropriate way forward? People will be dettered to visit hospitals when ill because of lack of funds. Is this the kind of Malawi you want? Yes, we need a better health care system, but this is not the way forward. This will harm the poor Malawian more than it will harm you. It will harm the vulnerable, the very people the government is there to protect. Why not reallocate taxes in order to fund a better health care systems? Apply for international grants perhaps?

  32. Nansani wa chingoni says:

    People must pay. A lot of villagers have access only to Mission Hospitals that charge a fee so what’s so special with those near public hospitals?? It’s about time everyone became responsible for their health!!

  33. Comment Treatment is a right of a citizen if you pay is it still a right? if you find an ans then go ahead with your plans

  34. Eeish says:

    All I can say is “2 points”. We need more reforms in Agriculture subsidy which continues to drain resources and skew the budget, education, where university students (parents and relatives) do not want to invest in their own bright future by not pay anything, etc. Unless this mindset changes, Malawians will continue to snore as unresponsible perpetual beggars. and this country will never develop. We need to take responsibility for our own destiny NYASAs. wake up. Ndakwiyilatu.

  35. Emmatuwa says:

    Mr Ambali bwinotu musakhale m’modzi mwa anthu akuba cashgate. kodi mukufuna kutolera ndalama kuti boma libweze ku Capital Hill zimene munaba BOMA LOIPA ILI SINDINALIONETSO.

  36. koma Umbulu? says:

    Mr. Chimbali, I’m for hospitals that it should start charging reasonable fees for quality health services. These people that resist, they pay goats, chickens etc to traditional doctors to access their services. It is high time that we move out of freebies and become responsible. People resist calls to start using toilets yet when they fall sick, they rush to hospitals for free services. I believe that paying will made us to be reasonable and careful.

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