PRESS STATEMENT
Health advocates express their concern: as
the Malawi Government considers introducing
paying wards into district hospitals
Lilongwe: 19th April 2017: Paying wards may soon be established in district hospitals across the
country — if a feasibility assessment that has been undertaken in the last month gets the go ahead.
Health advocates are expressing their strong reservations about this latest attempt by the Ministry
of Health to generate more money for the health sector ~ arguing it will only further escalate health
inequities in Malawi.
Country Director for Oxfam Malawi, John Makina says, "Any system where paying fees gives access
to higher-quality services, leaving lower quality for those who cannot afford to pay, is fundamentally
inequitable, Oxfam and other members of Malawi's Universal Health Coverage (UHC) Coalition argue
there is a strong risk that patients who pay, will get prioritised over those who cannot afford to pay.
In short-staffed hospitals, doctors and nurses may end up spending more time in paying wards, and
when there are shortages of drugs, the available drugs may be given to those patients who can pay,”
explains Makina.
The Government of Malawi has been conducting a dangerous experiment with out of pocket
payments in recent years, introducing bypass fees charged when accessing central hospitals without
a referral, and expanding fee-paying wards in the same facilities. Despite government claims that
fees will remain optional, situations where they are in effect compulsory are widespread. For example
in Lilongwe City, which only has a few primary healthcare centres, people are often forced to seek
health services directly at the central hospitals and then have to pay the bypass fee.
We understand that three weeks ago Directors of Central Hospitals and District Health Officers met
to discuss the feasibility of expanding optional paying wings to the districts and a team from the
Ministry of Health has been travelling around the country visiting various facilities to assess the
logistics of setting up paying wings. ‘The UHC Coalition was alarmed to see that the idea has also
been mentioned in the government's recent funding request to the Global Fund - in response to a
question regarding Malawi's plans for increasing domestic resources for health.
The members of the UHC coalition are sending an urgent message to government and
development partners that introducing regressive health financing mechanisms, and
especially out of pocket payments is not an equitable way for the country to mol
domestic resources.
The health sector has been suffering from a severe lack of financing in recent years, accelerated
by corruption scandals within the sector and a subsequent withdrawal of donor budget support.
While the Coalition supports the need for the Government to mobilise additional revenue for health
to fill this financing gap, it is deeply worried by any proposals to introduce or expand out of pocket
payments, which will only punish the poorest people. If some of the few bed spaces in district
hospitals are subjected to paying, there will definitely be increased congestion in the non-paying
wards. In addition, revenues raised from such payments are often minimal, rarely contributing more
than 5 per cent of running costs for health systems.
The UHC coalition calls upon the Government to:
1. Desist from expanding or introducing out-of-pocket payments, through paying wings in the
district hospitals, because such plans are not a progressive way for the country to meet
donor expectations around scaling up domestic resources for health.
Ensure that the country is currently getting value for money from limited health funds, by
reducing inefficiencies and ensuring cost-effectiveness.
The UHC calls upon development partners to:
1. Support the Government of Malawi to remove existing out of pocket payments in the public
health care system and expand public financing for the health sector.
2. Support mechanisms for transitional funding for the health sector (rather than adopting
piecemeal project based activities) with a view to restoring direct budget support to the
health sector in the medium term.
Finally, the UHC coalition would like to remind the Malawi Government that it has the responsibility
to ensure that all policies that are developed and implemented are pro-poor and protect the poor
from further impoverishment. The government should also ensure that current and new policies
in the health sector aim at attaining universal health coverage for Malawians.
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Seroraee commen HT ‘Save the Children
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STATE OF THE NATION ADDRESS BY PETER MUTHARIKA, PRESIDENT OF THE REPUBLIC OF MALAWI ON THE OCCASION OF THE STATE OPENING OF THE 3RD MEETING IN THE 47TH SESSION OF PARLIAMENT AND 2018/2019 BUDGET MEETING LILONGWE