My Turn

National Health Bill

Two years ago, the government of Malawi took a big step towards drafting a completely new Health Bill. Although the Bill is yet to be completed, its importance cannot be emphasised enough; it is long overdue. The draftsmen of the Health Bill have demonstrated a level of hard work, willingness and intrinsic commitment to reviewing and amending what will become the new Health Act if Parliament sanctions it. We sincerely give credit to this initiative. However, it is necessary to mention that many important steps have been skipped. The drafting process of the Bill has been flouted with impunity and not informed by evidence.

Malawi currently operates under a Public Health Act that was drafted and passed in 1948. It has undergone two revisions, one in 1968 and another in 1976. The urgency for a new Health Bill stems from the fact that the current Public Health Act is too old and fragmented. Most importantly, the 1948 Public Health Act is inadequate to deal with complex public health issues.

The emergence of global diseases such as HIV and Aids as well as the advances in global connectivity and technology, including advances in medicine and public health practice, means we need new methods that promote and protect public health.

Legitimate national laws and regulations will play a big role in domestic and local strategies to prevent and manage emerging and re-emerging diseases.

Recognising this fact, the formation of the health law requires consideration of legal consistency between domestic laws, national laws and international treaties. Administrative structures to regulate the miscellaneous provisions of the Bill are important. Regrettably, the Bill does not provide such a framework. It is also unclear whether it is flexible and able to adapt to new approaches and threats to public health.

The big problem with the Bill is that it has not been subject to debate and peer review discussions with public health experts. We believe it takes more than principles to draft any well rounded legislative proposal.

The current Bill is yet to be issued for consultation and it is unlikely that it will be introduced for consultation discussion any time soon. The new Mental Health Bill, for example, was passed without extensive consultation with people who have mental illnesses, their families, clinicians and advocates.

The HIV Bill is being suffocated in a similar way. This kind of drafting process contradicts the tenets of the freedom of information enshrined in the Laws of Malawi and basically undermines the legitimacy of government policy.

We have identified a number of concerns and discrepancies within the current Health Bill. Our preliminary review suggests the Bill does not reflect the need for strong and relevant public health legislation that can improve, for example, water quality and housing, discourage deforestation, and protect individuals from the emerging threats of the diseases.

The Bill does not recognise the role for homeopaths and practitioners of Indian Systems of medicine. Traditional medicine policy remains to be addressed despite the fact that the vast majority of Malawians (80 percent) receive their primary health care from traditional healers.

Cultural practices such as “kulowakufa and female genital mutilation (FGM)” are widely practised in the country and have direct consequences on public health but these salient issues are yet to be tackled exclusively in the Bill.

The issue of religious beliefs affecting vaccine uptake or medicines cannot be ignored or dealt with by simply imposing measures that limits the freedom of individuals. Restriction must be in accordance with the law, based on a legitimate objective, the least restrictive and intrusive means available. We are against a bill based on arbitrary unreasonable or discriminatory laws.

There is a need to balance between civil liberties and the need to protect public health to enable authorities act expeditiously. Unfortunately, there are no such safeguards in the current Bill.

Most of the issues raised so far can be addressed through consultation or peer review with the various experts and members of the general public raising concerns. This would save our poor government money.-The author belongs to a health advocacy group, the Malawi Public Health Forum

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