Patients forced To skip meals

Inadequate funding has forced some district hospitals to ration food for patients by scaling down from three meals to two per day.

In random checks at Karonga, Rumphi, Mangochi and Salima district hospitals, authorities confirmed that they were feeding patients either a combination of breakfast and lunch or just breakfast and dinner.

The country’s four central hospitals, on the other hand, said they are able to provide three meals, but decry delayed funding from government due to challenges attributed to the roll- out of the new software for the Integrated Financial Management and Information System (Ifmis), the Malawi Government’s electronic payment platform.

In an interview last week, Karonga District director of health and social services David Sibale said the 235-bed capacity hospital can only manage two meals which cost them about K1.5 million per month. He said three meals cost at least K3 million which is not sustainable.

He said: “We are able to provide two meals per day, which is breakfast and dinner. We also provide hot meals to members of staff so that they come to work in time and don’t delay because of taking dinners first at their homes.”

Sibale said the monthly other recurrent transactions (ORT) allocation for the hospital is about K18 million. The funding also caters for electricity and water bills, fuel for vehicles, including ambulances and staff allowances.

Rumphi District Hospital spokesperson Bwanalori Mwamlima said the 250-bed facility is only providing breakfast and lunch due to limited finances.

He said: “Normally, we have suppliers who bring us food commodities and the hospital prepares, so it is a bit difficult for now to quantify everything.

“Like our colleagues, we are providing breakfast and lunch, but should funds be available as required, we will be able to provide three meals to patients.”

In Salima, district hospital spokesperson Angela Nyongani-Sakwata

said they are only able to provide breakfast and a meal served around 3pm due to resource constraints.

She said: “We provide two meals, breakfast and I don’t know whether to call it lunch or dinner because it is offered around 3pm. We are not able to provide three meals because of resource constraints.

“We stopped a long time ago providing three meals, so I may not provide the exact cost, especially with the rising costs. But for the two meals, we allocate almost K3.5 million per month.”

In a separate interview, Mangochi District Hospital spokesperson Harold Kabuluzi also said they are only able to provide two meals he classified as breakfast and lunch.

But he could not be drawn to comment on why they are not able to provide dinner.

On a positive note, however, Nitchisi District director of health and social services Lumbani Munthali said the district hospital is able to provide all the three meals, including hot meals for all the staff working at night.

He said: “Ntchisi is so far doing well. Our patients are able to get all the three meals per day. This year in the budget we also include hot meals for all members on night shift, and these are clinicians, nurses, hospital attendants, drivers, guards and all other staff members.”

Mzuzu Central Hospital director Dr. Frank Sinyiza said they are able to provide all meals, including special meals for some patients.

However, he said the challenge lies with delayed payments from government, which leaves suppliers complaining.

Said Sinyiza: “We don’t have problems as we are able to provide all the meals, including for our staff working night shifts and those in the theatre.

“Nutrition plays a role in recovery of patients. Some of the patients come from far from their homes.”

He attributed delayed funding to Ifmis.

The hospital’s spokesperson Arnold Kayira added that the facility feeds 400 patients a day in terms of normal diet and another 20 who are on special diet.

Zomba Central Hospital acting director Dr. Saulos Nyirenda said delayed disbursement of funding from government was a major concern.

However, he said that despite the challenges, the hospital is providing all the meals, including special meals to some patients based on recommendations from dieticians.

Nyirenda said the delays have made the hospital fail to pay the supplier, but said the supplier has continued to deliver on his contract.

He said: “ It’s been very tough to maintain supply of food to our patients. Luckily, we haven’t had an interruption, but it’s not been easy at all.”

In Blantyre, Queen Elizabeth Central Hospital Dr. Samson Mndolo said they are able to provide all meals, including special diets prescribed by the facility’s nutritionist.

He said based on previous prices of goods, the facility spends between K8 milion and K10 million per month, but he could not be drawn to comment on delays in receiving funding.

In a separate interview, Ministry of Health spokesperson Adrian Chikumbe confirmed that central hospitals are also accumulating arrears in the procurement of food rations for patients.

Parliamentary Committee on Health chairperson Mathews Ngwale said he was learning about the situation for the first time, but said it is an issue worth checking.

He said: “Issues of provision of food stuff are budgeted at council level, that’s why you find that some districts are doing well while others are not. We [the committee] also do hospital visits and nobody has raised that issue of meals as a big issue.”

In his reaction, Malawi Health Equity Network executive director George Jobe described the situation as sad, saying with food being part of the healing process, it was not right to ration it.

He said patients go to hospitals with different conditions, including some without guardians such that it is not fair to deny them food.

Jobe said: “Policy has been that at the hospitals, people will be fed. So, if they don’t get the full meals, it has an effect on the healing process.”

In a written response to a questionnaire, Ministry of Local Government spokesperson Anjoya Mwanza said councils are independent and better-placed to explain why some of them are struggling to provide three meals.

“The ministry will find out from the councils why they are downscaling the meals in order to strike a balance because taking meals is part of the medical,” she said.

Besides Ifmis, the Malawi Government is also facing financial

challenges worsened by low revenue collections to finance the national budget. In August, Treasury reported a deficit of K9.6 billion.

Last week, Anaesthetics Association of Malawi raised an alarm on the shortage of anaesthetic drugs, especially in district hospitals, a situation that has in some cases led to deaths of patients in operating theatres.