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.

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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