Economics of health care in Malawi
Thanks to the Ministry of Health (MoH) and the United Nations Population Fund (UNFPA), I was one of the participants at the editors meeting the two institutions jointly organised last weekend to share with us developments in the sector and discuss how to improve coverage of health issues in the media.
The meeting also helped to create goodwill and mutual understanding between the media and health authorities, having appreciated each other’s capabilities and limitations.
Overall, it was a great learning experience for participants from both sides, if it can be sustained.
During the meeting, I was particularly drawn to a presentation on the Malawi Health Sector Strategic Plan (HSSP) covering the period 2011 and 2016.
The HSSP succeeded the Programme of Work (PoW) executed between 2004 and 2010. PoW was instrumental in guiding implementation of interventions aimed at improving Malawians’ health status.
Obviously, it had mixed outcomes, with hits and misses in terms of achievement of goals and objectives.
Naturally, I was drawn to the financials. I was interested in the ideal cost of implementing the HSSP; how much the Malawi Government can manage to raise, what the gaps are and if there is any hope of filling them.
The figures make interesting reading. Ideally, this strategy should cost $3.2 billion over the five-year period or $640 million per year. This translates into $41.3 per person.
The projected available resources—which government believes it can mobilise over the years— amount to $2.48 billion or $520 million per year or $34 per capita, which is well below the $55 that the World Health Organisation (WHO) recommends for a country to maintain minimum health standards. It must be noted that the projected resource envelop that government says it can put together includes commitments that may come from our external development partners and services that the Christian Health Association of Malawi (Cham) offers. It, however, excludes private sector health service providers.
The gap between the ideal cost of the strategy and what government thinks it can manage over the implementation period is $600 million. Spread over the five-year period, this leaves a yawning hole of $120 million per annum.
There is, therefore, no doubt that we as a country need to find alternative mechanisms of financing health service delivery given the large shortfall and the seemingly lack of other means of finding this money.
But that is what economics is all about—there are a lot of competing wants, but by the end of the day, we have to look at what is needed, prioritise those needs and allocate resources accordingly.
Most importantly, there has to be an efficient application of these resources to get the best return. That means we must cut out waste.
Stories of drugs expiring and being destroyed at Central Medical Stores cannot help us much. If anything, these stories shoo away any well-wisher locally and internationally who may have wanted to help us with funds and close the budget gap in this critical sector.
Government must work to close all the loopholes that are being used to steal drugs from the poor and sell them to private hospitals to be accessed by the rich who have comprehensive medical insurance to take care of the exorbitant bills.
It means that we must tighten our procurement processes, systems and procedures so that goods and services are procured in the most cost-effective manner possible through competitive, transparent and accountable bidding processes.
Awarding contracts to firms that have no technical and financial capacity to deliver quality should be a thing of the past, so too should the tendency of awarding business to those who are politically connected to the ruling party.
We must strengthen our laws and allow justice to prevail at all times. There are stories abound of pharmacists caught red-handed stealing drugs, but are set free by courts either because the laws are too archaic or some silly technicalities have stood in the way of justice.
To survive on this shoe-string budget and implement the HSSP, there is need to change the way civil servants do things at Capital Hill and in districts nationwide.
The culture of kusolola, which drains 30 percent of the national budget, is the monster that gnaws at the heart of our souls and prospers when the majority submerges into the dirty waters of extreme poverty where death is needlessly inevitable.
Government workers must locate their moral compass wherever they dumped it and allow it to guide their decision-making at all times. If they cannot find it, then the civil service is not their place—we can do without their tainted service.
