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The Ministry of Health move will push a lot of Malawians into poverty as studies elsewhere
have shown - thereby widening the inequality gap and frustrating government efforts
aimed at alleviating poverty and attaining UHC as stipulated in the SDGs.
Universal Health Coverage means all people must be able to access the healthcare they
need, without facing financial hardship. Introducing user fees for health in Malawi will
be tantamount to the violation of the right to health of the citizens, who are currently
struggling to even put food on their tables, says Martha Khonje, ActionAid Country
Director.
Studies have shown that direct payments by patients for health services pushes 100
million people worldwide every year into poverty, and countless more go without the
healthcare they desperately need.
While the Government argues that user fees will be introduced on an opt-in basis, the
coalition says this will still have a catastrophic impact on Malawians living in poverty.
Any introduction of user fees will be disastrous for poor Malawians. Richer people who
can afford to pay for healthcare will automatically be prioritised and will receive better
services at the expense of the poor, says Master Mphande, Napham Executive Director.
Evidence on user fees from other countries overwhelmingly points to their failure as a
health financing mechanism says Safari Mbewe, MANET+ Executive Director.
User fees are known to raise negligible amounts of money for the health sector, at an
enormous cost to peoples lives, especially the poorest and most vulnerable, says Mbewe.
Zambia found the expense of administering user fees almost equal to the revenue raised
- forcing the countrys leadership to abolish user fees in primary and secondary health
care.
Oxfam in Malawi Country Director John Makina concurs with Mbewe: Malawi has
historically been a leader in maintaining free, public healthcare. The Government must
abolish all user fees in public health facilities, and instead focus its energies on mobilising
additional public funds for health. It must honour and spend 15% of its annual budgets
to the health sector for a start as committed in the Abuja Declaration.
Nicolette Jackson, Mdecins sans Frontires Deputy Head of Mission in Malawi adds: the
government and civil society organisations must continue to lobby donors to provide
direct funding to the health sector as a way of supplementing government efforts to
deliver quality health care. The international community must do more to address
Malawis health financing gap for the country to achieve UHC.
The international consensus on health financing for UHC is that it is vital to replace private
voluntary financing (user fees and private insurance) with public financing mechanisms
(tax and aid). This is what Malawi did in the 1960s and what the rest of the continent
is now following. It would be a terrible tragedy for Malawi to move in the opposite
direction away from UHC. Recently there has been wide spread calls against User fees
with the World Bank president, Jim Yong Kim describing user fees as both unjust and
unnecessary.