Health funding under scrutiny

The Health Donors Group has asked Malawi Government to comply with the 15 percent allocation stipulated in the Abuja Declaration and pool local resources to address challenges in the health sector.

Speaking in an interview in Lilongwe on Wednesday after the group met the Parliamentary Committee on Health and discussed how best donor funds can be managed, Health Donors Group chairperson Tedla Damte said besides increasing allocation to the health sector, government should explore alternatives.

He said: “The first thing is that it is very much important that government contribution meets the Abuja Declaration.

“It is also important that government engages the private sector to come more and more to strengthen the health sector and value their contribution in the health sector and also support them to have more private sector players in the health sector.”

In 2001, Malawi alongside other African Union member States signed the Abuja Declaration, committing to allocate 15 percent of resources in their national budgets to the health sector to improve service delivery.

Damte, who is Unicef Malawi chief of health, said Malawi should also start planning to exit external financing for the health sector.

He advised the country to look at how it can sustain the gains made through donor support to the health sector.

Damte also commended Malawi for achieving various international health goals.

On his part, Parliamentary Committee on Health chairperson Matthews Ngwale said it is difficult at the moment for the Malawi Government to implement the 15 percent due to financial challenges.

He said realistically the country can only allocate what it can manage to source.

Ngwale said: “If they [government] do not have resources, what can they do? They will just listen and go. That is our problem at the moment.

“We have been pushing the government to increase funding, but it hasn’t increased much. This year we are at nine percent.

The Sadc Declaration says 11 percent; the Abuja declaration says 15 percent. Other countries fund more than those percentages. Ourselves, we don’t because we have limited resources.”

He said Malawi needs to work on diversifying exports to raise more revenue and increase financing to the health sector. Ngwale further said mines, industrial hemp and other commodities can be utilised to fund the health sector.

According to data from Ministry of Finance, health sector allocations expressed as a share of the total budget and gross domestic product have stagnated over the past three years and have been consistently lower than the 2016/17 levels.

In 2020/21, government allocated a total of K204.7 billion compared to K163 billion in 2019/20 while in 2018/19 the sector got K134 billion from K124 billion in 2017/18.

In his reaction, Ministry of Finance spokesperson Williams Banda said the government’s resource envelope is narrow; hence, hard to meet the 15 percent requirement.

However, he said government is committed to ensuring that more resources are allocated to the health sector. He also said that already the health and education sectors get a lion’s share in the national budget.

Banda said: “It is not like government does not want to allocate more resources. So, government tries to meet the commitments but it’s the resources that are not enough.

“But also if you look at other activities for the health sector, you will find that the budget is more than 15 percent. There are medical supplies, including drugs that come duty-free. If you can do tax analysis, you will find that it [the contribution] is more than 15 percent.”

But Health Rights Education Programme executive director Maziko Matemba agreed with donors that government needs to increase the health budget allocation.

He said Malawi cannot continue relying on donors for funding the Covid-19 pandemic has also heavily affected them.

Matemba said: “We should learn a lesson from the Covid-19 pandemic that the health sector needs more investment.

According to the country’s Health Sector Strategic Plan II (2012-2022), health care financing in Malawi is still unsustainable and unpredictable.

From 2012/13 to 2014/15, development partners’ contributions accounted for an average 61.6 percent of total health expenditure.

Government, according to the strategic plan, accounted for an average of 25.5 percent and households 12.9 percent of the health expenditure.

Since signing the Abuja Declaration to allocate 15 percent of the National Budget, the highest allocation ever made was about 11 percent.