Malawians will be forced to dip into their pockets to bankroll community funds so as to increase domestic revenue and offset the health sector’s donor dependency, it has emerged.
The government plan, contained in the draft Health Sector Strategic Plan (HSSP) III, seeks to increase domestic mobilisation of resources to ensure sustainability of programmes in case donors slow down.
This has, however, generated doubts among community leaders who argue that experience has shown that Malawians are not responsive enough when it comes to contributing to community developments.
Reads part of the plan: “This HSSP III aims to devolve some of the revenue mobilisation responsibilities to the clients of the health system.
“There will be establishment of community health funds based on individual contributions and corporate contributions to a community managed account.
“The specific form of these community funds will differentiate based on community specific socioeconomic profiling with complete community ownership of their local health systems.”
In a written response, Ministry of Health spokesperson Adrian Chikumbe explained that the contributions will be on a voluntary basis.
He said: “The catchment populations of a health facility will be encouraged to contribute to a fund established at their local health facility.
“The aim will be to contribute to the operations of the facility, for example, buying drugs, medical supplies, small equipment and maintaining the environment of the health facility.
“The account and local health fund will be under the oversight of community accountability structures. This will complement direct facility financing government and its partners are starting to implement.”
As the government, through the HSSP III, also seeks to introduce fees in public health facilities, Chikumbe said those contributing to the community funds will not be exempted from paying the fees like everyone else.
“This will be a solidarity local fund whose aim is not to guarantee the contributor’s access to care but to improve the local health facility to better serve everyone so the issue of exemption does not arise,” the publicist said.
He further indicated that they have not estimated how much they seek to generate from the funds.
However, Senior Chief Mabilabo of Mzimba cast doubt on the project’s success, noting that community members rarely contribute to local projects.
He said: “In some projects, we had in my area, communities were asked to contribute 25 percent. We struggled to the point that the projects stagnated and it took the donors to provide more money.
“Unless there are strict measures to enforce the contributions, it will not be easy to persuade communities to dip in their pockets.”
On his part, Zomba Ntonya legislator Ned Poya also echoed Mabilabo’s concerns.
He said: “Much as the plans are good, Malawians are not good at community participation, especially financial contributions.
“We have had a lot of cases in my constituency where you introduce a project and ask communities to contribute a certain percentage. Very few people do that. The rest argue that the government has already allocated enough resources for the project.
“I doubt government would successfully implement this project regardless of the good intentions that are there.”
Poya pointed that the best way to generate revenue for the health sector is to semi-privatise the hospitals.
He added: “The best approach to increase domestic revenue for the health sector is demarcating the hospitals into paying and free wing.
“Those that are in a hurry would be able to access pay services. And I believe there will be a lot opting to access the pay service as it will be faster than the free one.”
On his part, Ministry of Health deputy director of planning Gerald Manthalu was upbeat about communities contributing even if there will be no incentives like exempting contributors from paying for treatment.
He said: “There would not be in that sense [personal incentive]. On the other hand, there would [be an incentive] if community members saw that their funds were making a difference at the health facility. So, community ownership will be paramount.”
In an earlier interview with our sister paper The Nation, health economist Gowokani Chijere Chirwa said the message from donors is clear that Malawi should begin to focus on domestic resources.
He said it is not true that Malawians cannot afford healthcare services.
Said Chirwa: “We just need to have a proper way of targeting different groups of people so that the deserving poor are not burdened.
“If you go to some rural areas where there are mission hospitals, people pay and life is normal. If people can afford to pay a prophet for healing, why not a public hospital?”
The plans to scale up domestic revenue generation come on top of the latest policy brief from the World Health Organisation (WHO) focusing on implementation of national action plan on antimicrobial resistance, which has urged Malawi to reduce donor dependency.
While the draft plan still considers donor funding as an option, it seeks to create a system which is more reliant on domestic financing.
As part of the financing model, the government intends to sustain and increase tax financing as the main source of health financing.