Last week, Malawi’s Institute of Public Opinion Research (Ipor) released its Local Governance Performance Index (LGPI) focusing on education and healthcare service delivery. Our Reporter ALBERT SHARRA caught up with Ipor national investigator Boniface Dulani for deeper insights into the study.
How important is the new index?
The index is a project that seeks to gauge ordinary people’s evaluations of development at the local level on five dimensions: land; education & health; elections & political participation; welfare & security, and dispute resolution. These are measured and compared along gender, ethnicity, age, class, region and village as well as along family systems. This is achieved through a multi-layered sampling design to generate statistically significant results at the village, traditional authority and district level. This design allows us to make comparisons not only of performance at the regional or national level, but also to capture variation at the household and village levels.
What are the major findings?
There are a number of new and important findings. Some of the key highlights from the findings on education include the fact that the younger generation is increasingly more educated than the older folk, which is good news. However, the education system continues to face several challenges that are impacting on overall quality. Classroom sizes, especially in the first years of primary school, remain unsustainably high, with 55 percent of parents reporting that their child’s class is overcrowded. And despite the fact that primary education is supposedly free, we see that parents are still being requested to make all manner of payments that effectively amount to fees. Ability to purchase uniforms, as well as long distances to school-with 17 percent of children taking more than an hour to get to school-are important barriers to school enrolment and retention. Other key findings on education include the fact that drop outs tend to happen early and absenteeism is highest among the youngest learners, largely due to illness.
What about healthcare service?
On health, a majority of Malawians [53 percent] report as being in poor or very poor health. A higher proportion of the elderly, women and low income households report relatively higher rates of depression and feeling hopeless. A very high proportion of Malawians [80 percent] visited a health facility in the preceding three years to seek care. While a surprisingly high proportion of Malawians [81 percent] report being satisfied with the quality of care received at their last visit to a health facility, only 45% say
that a doctor was present at the time of their visit while only 20 percent found the cost of treatment to have been reasonable.
You sampled 8 000 people out of 17 million Malawians .Is this a true reflection of the national situation?
The validity of surveys depends a great deal on how the sample was drawn. I always use the example of someone who wants to check if they have applied enough sugar to their cup of tea as an illustration to explain the principle of sampling. Once you have applied the sugar, you do not need to drink the entire cup to be satisfied that the tea is sweet enough. You stir and take a random sip and based on that, you can be confident you have enough sugar or need to add more. Sampling works the same way.
The findings show that people are satisfied with education and health services. Should we believe this?
There are both positive and negative sides to the quality of education and health services in the country. This is despite the fact that, as you observe, the media and other opinion makers have used a broad brush to paint the social system as being in a total and perpetual state of decay. The survey on the other hand allow us to disaggregate the areas of the health and education systems that are doing fine from those that need addressing-including overcrowding in classrooms; long distances between schools, especially in rural areas; absence of doctors, especially in the mornings when people come for consultation; increasing cases of depression, especially among women; and high cost of treatment.
What are some of the major insights from this study?
One important lesson from this study is that the quality of education and health services varies from place to place. In terms of education quality, the top rated districts are Nkhata Bay, Rumphi and Chitipa and the worst being Blantyre, Mulanje and Dedza. For health services quality, the top performing districts are Mangochi and Kasungu while the worst-rated districts are Blantyre, Lilongwe and Nsanje. This variation calls for tailor-made projects to suit specific areas and households rather than standard wholesale approach that assumes one solution fits all.
What do you recommend as the way forward?
With today’s mantra of evidence-based policy-making, there are important lessons and recommendations from this study. It highlights areas that need intervention, including the need for adequate classroom space, especially in high population areas; constructing new schools to reduce distance that learners have to walk; the need to address bottlenecks that contribute to school absenteeism and drop outs, disaggregated by gender; revisiting the claims of free primary education when parents are still being required to pay other forms of fees and school uniforms. In health, the findings highlight several areas that require government attention, including recruitment of adequate doctors and ensuring that they are available in hospitals; making cost of treatment available as well as increasing availability of services such as antenatal and contraception services.
Who are you targeting with this research finding?
Everyone who is interested in development. This includes policy makers, political party leaders; development partners, development practitioners including civil servants and civil society organisations, academics, media and ordinary Malawians themselves.