Soft targets in the health sector

There were protests by health personnel at Mwanza District Hospital where medical employees were accusing some of their senior managers of deliberately failing to pay them their locum allowances.

On Monday this week, medical workers at Chikwawa District Hospital laid down their tools, demanding the transfer of the hospital accountant over allegations of mismanagement of funds and failure to pay them their locum allowances.

The workers returned to work after the hospital management sent the harassed officer on an emergency leave. Similar issues have cropped up in Mchinji and other district health offices (DHOs) nationwide.

It is a trend that is frightening because it threatens the very lives of patients that locum is supposed to help save. You see, locum medical services are supposed to provide temporary cover for workers on annual leave, sick leave or any other short-term absences such as going for workshops, training, conferences or even funerals that are a necessary part of someone’s social life and career development and/or enhancement.

Thus, the remaining medical workers are asked to offer “out of hours” services for which they are paid extra.

It is that extra that is not being paid in places such as Chikwawa, Mwanza and others; hence, the instabilities in these DHOs. The problem of none payment of locum has little or nothing to do with any accountant at any DHO or senior management there.

It has mostly to do with Capital Hill: high vacancy rates and insufficient funding to DHOs.

Let me start with vacancy rates.

Last week, The Nation reported that there is a vacancy rate of 52 percent in the public health sector. In other words, of all the established health posts, only 48 percent have been filled.

Government is not just recruiting enough medical personnel—there are too many long-term vacancies incurred through retirements, resignations and outright failure to recruit on the part of the Ministry of Health (MoH).

Faced with such a huge gap in service provision, someone at Capital Hill decided that instead of using locum for its intended purpose of filling for short-term absences, they have turned it into a permanent solution for the staff shortages in the public health sector.

As a result, locum expenses have reached unsustainable escalations. Even MoH Principal Secretary McPhail Magwira, noting that locum allowances were introduced in the country’s health facilities as compensation due to shortage of staff, agrees that the costs are now astronomical.

“Locum allowances are paid at district level through other recurrent transactions [ORT] fund, but the problem is that the demands [for the allowances] are high to the extent that they are affecting their [DHOs’] budgets,” said Magwira, urging hospital authorities to come up with proper rosters for staff to minimise locum expenditures. Magwira may be right in saying operational inefficiencies could be worsening the locum costs, but the solution he is providing is a typical short-term solution to a long-term and complicated problem.

The fact is that recruiting full time people in our hospitals gives us better value for money than the locum system not only because it will cut the spiralling locum services engagement costs, but also because services to patients will be much better as less tired people will be attending to them.

Indeed, the National Organisation of Nurses and Midwives of Malawi, has in the past preached against locum, arguing it leaves health workers too exhausted to effectively and efficiently care for patients.

I now turn to the funding issue.

Look, locum is paid under DHOs’ ORT budget, which is an operational one that also caters for drug purchases, buying of food staffs for patients, fuel for ambulances and their maintenance, among other things.

The problem is that people, including the irate health personnel up in arms against their accountants and senior management, do not realise that being allocated money and actually getting it from Treasury are two different things.

Over the past years, DHOs have only been getting just a fraction of their monthly allocations that cannot cover even half of their expenditure items.

DHOs have had to make difficult choices: with the little on the table, should they pay locum or buy drugs and save immediate lives? Should they pay locum or buy fuel to ferry a seriously ill patient to a referral hospital such as Queen Elizabeth Central Hospital?

Should they pay locum or pay electricity bills so that surgeries can proceed? In the end, they postpone locum, hoping that the next ORT funding will be better than the last—only to go through the same vicious cycle.

So, DHOs and their accountants maybe soft targets for bitter health personnel. They may even be transferred or sent on forced leave. But that will not bring an increase in ORT to cater for locums. The next accountant or DHO will also have to go through the same tough balancing act of prioritisation and locum may not make the list.

If you have to go after anyone, go after Capital Hill. But as usual, we Malawians have a tendency of respecting government too much while victimising our fellow weaklings who are victims of the very government we allow to get away with murder.

It is a shame really.