DHOs applying expenditure control measures for rural primary health service delivery

The austerity measures to cut on public spending which President Lazarus Chakwera announced in May as the country is grappling with cost of living due to the high inflation rate and devaluation of the kwacha, have filtered down to the health sector.

An internal memo for District Health Offices (DHOs) which we have seen — entitled ‘District Leadership Perspective on Health Service Delivery with Rising Cost of Essential Supplies’ — outlines cost-cutting measures targeting primary health service delivery, this comes following high inflation rate and devaluation of the kwacha, which has led to “substantive increase in cost of essential supplies”.

“These supplies form integral part of our Primary Health service delivery in country’s health centres and district hospitals,” says the memo. “The districts have not been able to cushion against the price increase.

Some ambulances must be parked

“This is because the prices increments have been effected while the financial year was already in session. For example, during the 2022/2023 budget preparations, fuel pump price was at around K900 per litre, now the price has doubled.

“While we wait for possible budget adjustment during the mid-year budget review, there is a need to urgently make some temporary changes in the district operations.

“It should also be noted that according to existing policies, there are some services that are mandatory while others are not provided for.

The services are are up for recommendations for suspension include:
* Collection and delivery of dead bodies — In adherence to infection prevention measure, ambulances are not allowed to carry dead bodies;
* Picking and dropping health workers on night duty to and from the hospital — During night duty, all health workers are required to sleep within the facility. This also has direct impact on patient outcome;
* Number of ambulances. Depending on the district volume, the district health management leadership may decide to park some of its ambulances and keep one running for the district hospital and a maximum of 3 ambulances for health centers;
* All ambulances should operate from the district health offices;
* District should only operate two utility vehicles and park the rest;
* DHO health centre clinical and outreach clinic visits should be suspended unless a motorcycle may be used for some specific visits;
District health management integrated support supervision should be reduced from quarterly to biannually;
* Patients food — Hospitals should minimize food rations to 1 meal a day for a patient and districts should suspend provision of meals to staff on duty;
* Use of standby generators bigger than 15KVA should be suspended and instead use smaller ones in specific key strategic sections of the hospitals; and
* Health centre emergency drug ordering and delivery from the district health office should be done per clusters.

While emphasizing that the adjustments “may be temporary until the situation normalizes”, the memo maintains that “these recommendations are for re-enforcement of the practices that are already stipulated in the policies”.

“In addition, the Ministry will consider adaption and adoption those recommendations that are not stipulated in the existing policies.”

Last month, in adhering to Chakwera’s directive of the austerity expenditure control measures, Secretary to the President & Cabinet, Collen Zamba directed that all Grade D directors and other senior officers should now be allocated 250 litres of fuel a month for use in government vehicles assigned to them.

Zamba notified the concerned senior government officers that this was a follow up to her circular she issued on June 3, 2022 on the expenditure control measures, saying: “Controlling officers are advised to ensure that only those officers who have received authority from my Office to self-drive are allocated this fuel and that this authority only applies for local travel.

“For long distance travel, they should be assigned drivers from the pool,” she said.

The austerity measures to cut public spending — which Chakwera announced on May 31 and were not subject to amendment by any Government Ministry, Agency, Department or Parastatal without prior authorization from the Office of the President — are:
1) Public officers, including the President, who need to travel abroad for their work out of absolute necessity will only be allowed to take no more than three trips during the remainder of the year, unless in cases of unforeseen extreme emergency;
2) The number of people in a delegation travelling abroad will be subjected to stringent restrictions;
3) No top-up allowances will be paid to public officers on fully funded trips for work, training, workshops or conferences;
4) Ministry officials traveling within the region for work must fly economy class;
5) All controlling officers will be held responsible for ensuring strict adherence to spending limits we have set for domestic travel;
6) All boards of state-owned enterprises and statutory corporations must confine themselves to quarterly meetings, plus one extraordinary meeting per quarter for emergency situations pursuant to the approval of the line Minister, unless allowed otherwise by the President’s office;
7) Allocations of fuel allowance for all Cabinet Members is to be cut by 20%;
8) The issuance of fuel to public officers who are not entitled to the same is forbidden, and my office will soon provide detailed guidelines on how this will be regulated;
9) The Minister of Transport is directed to provide guidelines to MDAs for the Government-wide adoption of distance charts to regulate fuel consumption per vehicle;
10) The movement of pool vehicles owned by the Government beyond 6pm shall be restricted, and no driver shall be permitted to take such vehicles to their homes, and controlling officers must justify to my office any emergency exceptions to be made;
11) Procurement of new vehicles by MDAs has forthwith been suspended until further notice from the President’s office, and when this restriction is lifted, his office will regulate what model of vehicles are procured for public officers of different grades to end the culture of people feeling entitled to 4x4s;
12) To end the practice of public officers driving Government vehicles they are not authorized to, all public officers authorized to self-drive will soon be issued with an authorization card to be enforced on the roads by the police;
13) The renewal or signing of new employment contracts in all state-owned enterprises is forbidden forthwith, except for special circumstances that must be approved by the President’s office, and this restriction will not be lifted until the Office of the Comptroller of Statutory Corporations is done reviewing the remuneration in this sector to ensure that it reflects the state of the economy and the performance of the institution;
14) No procuring entity in the Government shall be allowed to import goods or services into the country unless proof that the goods and services cannot be procured locally is submitted to and approved by the Minister of Finance.

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