Parliament’ s Committee on Health has revived a proposal to introduce user fees in public health facilities, noting that government is grappling to adequately finance the health sector.
Committee chairperson Mathews Ngwale sparked the debate on Friday in Lilongwe during a panel discussion titled Cost-benefit Analysis For Selected Interventions With Better Health Outcomes and Value for Money in Malawi organised by the National Planning Commission (NPC) in collaboration with African Institute for Development Policy (Afidep) and Copenhagen Consensus Centre under the Malawi Priorities Project.
He said it is worrisome that 56 years af ter independence, 70 percent of the country’s health budget is funded by donors.
Said Ngwale: “This issue of hospital user fees is sensitive. When we say let’s pay, many people avoid the issue. So we are simply starting the discussion as a committee, that we need to bring in health financing. We cannot depend on the national budget anymore because every year, the budget is short by far.
“You are aware that 70 percent of the health sector budget is financed by donors. As a nation, we cannot continue this way, to be proud as Malawians when our medicines are given to us by someone else.”
He said the strides registered in the fight against HIV/Aids, tuberculosis and Covid-19, among others, are all largely attributable to donor support.
The chairperson admitted that most Malawians are poor and cannot afford paying for health care, but was quick to propose that a study should be conducted to identify the ultra poor citizens who may be offered access cards to free public health services.
“This is a proposal that can succeed and we can take our pride back as a nation. For instance, if each one of us in the population contributes K1 000 annual fee towards health financing, we could raise about K17 billion and make a difference,” Ngwale argued.
Ministry of Health chief of health services Queen Dube argued that Parliament has the
mandate to discuss such matters and come up with a resolution, saying what government is looking for is universal health coverage.
She said under the policy there are pillars including quality health service delivery and equitable access to the services regardless of one’s economic status.
Dube said: “On how we exactly achieve universal coverage, do we introduce user fees, do we introduce health insurance, that’s for the lawmakers to sort out. What we are clear about is that we need resources, for us to be able to achieve what we set out to do”.
She called for collaborative efforts among stakeholders to agree the best way to achieve adequate health financing to ensure that everyone has access to quality health care without begging.
NPC director of knowledge and learning Joseph Nagoli said Malawi needs to attain sustainable health financing in line with Malawi 2063 which entails wealth creation and self sustenance.
The Malawi Growth Development Strategy III states that Malawi is the only country in the Southern Africa Development Community region that offers free public health care.
The document, among other financing mechanisms, proposes expanding user fees to ensure sustainability of health service provision.
Health activists and the Ministry of Health remain coy about the proposal, saying it contradicts the Universal Health Coverage Policy.
Earlier the Malawi Health Equity Network executive director George Jobe described the proposals to introduce user fees as an ‘elitist view’ to punish the poor.
He said government should instead work towards addressing the inefficiencies in the system, which include corruption and wastage of resources.
Public health expert Professor Adamson Muula also argued that introduction of user fees is not a panacea to challenges facing the health sector.
In 2015, the Ministry of Health announced plans to introduce user fees in central and district hospitals as part of public reforms, but the decision was reversed a year later after public criticism.
Health financing in Malawi has remained an issue as government has usually failed to meet the Abuja Declaration which demands at least 15 percent of the national budget to health. In the current budget, the health sector accounts for 11 percent.