Every Malawian knows this story. A mother sits on a hospital bench with a feverish child on her lap. The clinician writes a prescription, but medicine is finished. The poor woman is told to buy it at a private pharmacy. She has to borrow money. Long after her child is well, the debt is still with her.
Government hospitals are free only on paper. When there is no medicine, test kits and money for transport, care is not free.
The cost has only moved from the hospital counter to the family’s pocket.
This is why we need a national health insurance scheme. We already pay for health care, but unfairly.
In 2001, African leaders met in Abuja and promised to spend at least 15 percent of national budgets on health.
Malawi’s K768 billion healthcare budget falls below 10 percent, far below what we promised.
Donors carry much of the load to save Malawians’ lives. However, a donor-funded health system is not safe for anyone. When aid goes down, the sick person in Dedza or Karonga feels it first.
Health-for-all experts speak of ‘catastrophic health spending’ when medical bills are so heavy that a family falls into poverty or sinks deeper into it.
One study in Malawi found that health spending took more than 40 percent of the money about 1.3 percent of households remain with after buying food.
This may look small, but they are not. The same findings show that families above the 40 percent line spent, on average, over half of their non-food money on health.
For a family that farms to eat and trades to survive, one illness can swallow school fees, seed money and even housing.
Behind each number is a child who leaves school, a field or goat that is sold, a small business that closes.
Health insurance is not only for the rich. It works like the village burial society. Many people put in a small amount, so that whoever meets trouble does not suffer alone.
A good scheme would give hospitals steady income for buying medicine and fixing equipment.
It would make us less donor-dependent and protect people we often forget: farmers, market vendors, minibus drivers and house workers. None of them has an employer paying for medical cover.
Other countries show us the way—and the danger.
In Rwanda, community health insurance helped cover about 85 percent of people, according to its 2023/24 household survey.
Ghana is a warning. Its scheme has struggled with money, late payments and unpaid hospital claims. Insurance that does not pay hospitals is just a receipt for a broken promise.
If we are serious, we must plan carefully. Government must help pay for the poorest families. Payments must fit farming life, with payment times after harvest, not in the hungry season.
Mobile money, which millions of us already use, can make joining, paying and claiming easy.
But the scheme must be open and honest. The money must reach patients, not private pockets.
However, we must improve quality. Insurance must come with medicine, tests, referral services and motivated healthcare workers. Nobody will keep paying for a clinic with empty shelves.
Parliament and the Ministry of Health have talked about health financing reform for years. The talking cannot go on forever. Every year of delay means more mothers on more hospital benches, forced to choose between treatment today and poverty tomorrow.
Health insurance will not fix every problem in our hospitals, but it can make sure no family sells its future to pay for a feverish child’s treatment.
It is time our leaders gave us a better plan.
