Health advocates, who include the powerful Actionaid, Oxfam and Save the Children, are up in arms, asking the government to halt its decision to introduce paying wards in public district hospitals.
In a joint statement, the 10 health advocates are expressing strong reservations about this latest attempt by the ministry of Health to generate more money for the health sector, arguing it will only further escalate health inequalities in Malawi.
Country director for Oxfam Malawi, John Makina says: “Any system where paying fees gives access to higher quality services, leaving lower quality for those who cannot afford to pay, is fundamentally inequitable.
“Oxfarm and other members of Malawi’s Universal Health Coverage (UHC) coalition argue there is a strong risk that patients who pay, will get prioritised over those who cannot afford to pay.
“In short-staffed hospitals, doctors and nurses may end up spending more time in paying wards and when there are shortages of drugs, the available drugs may be given to those patients who can pay.”
The statement says the government of Malawi has been conducting a dangerous experiment with out of pocket payments in recent years introducing bypass fees charged when accessing central hospitals without a referral and expanding fee paying wards in the same facilities.
The statement says despite government claims that fees will remain optional; situations where they are in effect compulsory are widespread.
“For example in Lilongwe city, which only has a few primary healthcare centres, people are often forced to seek health services directly at the central hospitals and then they have to pay the bypass fee,” says the health advocates.
The health advocates are therefore asking the government and development partners that introducing regressive health financing mechanisms and especially out of pocket payments is not an equitable way for the country to mobilise domestic resources.