hospitals cut services amid funding drought

Despite assurances from Minister of Health Jean Kalilani to Parliament that government had released emergency funds to district hospitals, a Weekend Nation investigation shows that most of them got nothing from Treasury in May and June.

According to a report on the status of funding in hospitals for the months of May, June and July 2015 that Weekend Nation has seen, district health offices (DHO) such as Balaka, Chitipa, Chiradzulu, Karonga, Machinga, Mzimba and Phalombe received little to no funding for June to the extent that essential services were halted.

According to the document, due to the inadequate funding, the hospitals stopped serving hot meals for night duty staff or paying them for working locum shifts Further, the hospitals procedures and only conducted emergency cases because there were no theatre supplies.

Surgeries at Chitipa District Hospital were only “being undertaken because Services for Support Delivery Integration supported them with Surf powder for their laundry” but would experience problems once the supplies run out.

Further, due to shortage of fuel, some hospitals grounded their ambulances and generators were not working.

At Mzimba South DHO, due to fuel shortages, there was no transport for collecting blood from Mzuzu, putting the lives of patients requiring blood transfusion at risk.

In addition, Weekend Nation has established that health centres in these districts had no transport for referrals to the district hospitals, such that patients were being asked to find their own means.

In a letter dated June 24 2015 to the Secretary of Health, district health officer for Chiradzulu, Dr Chinomba Gama, lamented that the situation for the district was so dire that it could demotivate health workers and lead to an ineffective or non-functional referral system due to lack of fuel.

“The district benefits from Norad funds that we last received in April 2015. The funds are meant for very critical areas for the hospitals. The district, just like all others, has not up to date received funding for the months of May and June 2015 and the ministry is well aware about the issue,” writes Gama.

Chairperson of Parliamentary Committee on Health, Juliana Lunguzi, has described the situation as unfortunate and she calls into question government’s priorities.

She challenged government to explain what criteria it had used for some hospitals to receive resources when others did not following her discovery that Thyolo, among few other districts, were funded as normally.

“We are in a crisis in as far as the health situation is concerned” said Lunguzi.

In a separate interview, Malawi Health Equity Network executive director Martha Kwataine said her organisation was saddened by the development.

“The referral system is in shambles. Pregnant women with complications are dying while waiting for an ambulance when the DHOs have no fuel for the vehicles. The nation is in a crisis. Government must ensure that the lives of  its citizens are a priority. Imagine, we spend K300 million for independence celebrations when hospitals have no fuel for ambulances, does that make sense?” wondered Kwataine.

Meanwhile, government is currently in talks with bilateral partners over the resumption of the discrete health funding for all hospitals whose funding has not been forthcoming since May.

The development has led to the hospitals to resort to begging from well-wishers and borrowing to feed patients.
Director of planning in the Ministry of Health, Dr Dalitso Kabambe, confirmed both the suspension and the talks, but was quick to say the suspension is not definite and will resume once they agree on the new modalities of dispensing funding.
“Since Cashgate surfaced in 2013, donors suspended both the sector and general budget support, and in this case the health sector suffered greatly. Through talks, the Norwegian government and the Flanders International Cooperation Agency [Fica] have been forthcoming in helping the health sector through the discrete funding. Recently, the funding stopped, but we are in talks with our partners and we are hopeful of the outcome,” he said.

According to Kabambe, the German government will be another player in the discrete funding.

First Secretary at the Norwegian Embassy Hildegunn Tobiassen, however, denied suspending the discrete funding, but he confirmed the talks.

“Norway has been supporting the health sector with a three-year agreement that we entered into in 2012. In 2013, after Cashgate, the funds were earmarked to districts and central hospitals through a commercial account. In accordance with the agreement from 2012, the last payment was made end 2014. There has thus not been a suspension of funds.

“Norway, together with other bilateral partners, is currently in discussions with the Government of Malawi about coordinated channelling of support to the sector. We hope to be ready to enter into agreement in September–October this year,” he said.

The Norwegian government, through the Norwegian Agency for Development Cooperation (Norad), took over disbursement of locum to hospital staff working overtime, water and electricity bills, fuel for ambulances, maintenance and patients’ food.

The National Organisation of Nurses and Midwives of Malawi (Nonm) executive director Harriet Kapyepye was shocked that government decided not to fund some of its hospitals at a time it should be upholding people’s basic rights.

“The affected hospitals and their health centres and health posts, including many other health care programmes, have been grounded because resources and supplies are not available or are in short supply. In this situation, therefore, patients, [the majority of whom] are very poor and dependent on public health care suffer a lot as they are denied the opportunity for timely treatment, care and management.

“Their suffering is not relieved, their illnesses are not treated and many succumb to unnecessary deaths which could have been avoided. Lives of patients are at great risk by these needless funding cuts by government,” said Kapyepye.
She further expressed worry over the impact funding cuts would have on achieving Millennium Development Goals (MDGs) on child and maternal health.

“The situation is worse for maternity cases that need specialised care and management at the mother institutions. Studies have shown that delays to reach for specialised care and management for maternity cases which cannot be handled at primary level is one of the causes of maternal deaths and worse still if the woman will not be efficiently attended to because supplies are not available or are in short supply,” said Kapyepye.

Treasury spokesperson Nations Msowoya acknowledged the funding challenges the hospitals are facing, but assured government is working to ease them.

“It is common knowledge that funding has been difficult for government departments and ministries. The Treasury is doing everything possible to provide emergency funding to DHOs that exhausted their funding.

“However, the zero funding to some district hospitals was because the DHOs had exhausted all their funding and it was difficult for Treasury to fund them as the 2015/16 budget had not yet been passed,” said Msowoya. n