Govt reverses introduction of user fees in public hospitals

Government has reversed its decision to start charging fees for health services in public health facilities in the country as a way of making the health care financing sustainable.

As part of the ongoing reforms in the Ministry of Health (MoH), government last year announced proposals to introduce user fees in district hospitals starting July this year for those who want to receive special treatment and pay for it.

Government said the user fees would be would be introduced on an option basis for those who can afford to pay.

But Minister of Health Peter Kumpalume told Weekend Nation on Thursday there was no such policy that his ministry was supposed to implement on behalf of government.

Said Kumpalume: “This is issue has been blown out of proportion by the media and the civil society. As far as I am concerned my ministry has no such a policy”.

As part of reforms in provision of health services, aimed at making health care financing sustainable, the Ministry of Health last year scaled up parallel paying wings and introduced bypass fees in all central hospitals.

Currently, there are great disparities in the provision of health services in Malawi which are badly affecting the poor and most vulnerable in the society.

But civil society organisations (SCOs), led by Oxfam, Centre for Human Rights and Rehabilitation (CHRR), Save the Children, National Aids Support Organisation (Naso), Actionaid, Manet + and Development

Communication Trust have strongly opposed the decision to introduce user fees in public hospitals arguing that many poor people and vulnerable Malawians risk dying of curable diseases.

They have been calling on government to reverse the decision questioning the ethics behind charging patients in public hospitals describing it as preferential treatment and asking government to abolish all the existing fees in central hospitals.

The SCOs have further been arguing that the paying system creates a two-tier system, where the poorest people will be accorded the lowest health care and the longest waiting time to access health service.

They have further been arguing that the system means that money would start to speak louder than real health needs in country, a situation that they contended would breed corruption within the health delivery system.

They argued any introduction of user fees will be disastrous for poor Malawians as richer people who can afford to pay for health services will be prioritised and receive better services at the expense of the poor.

But Weekend Nation understands that government has backtracked on the proposal to start charging fees for health services in district hospitals.

The decision to reverse the introduction of charging fees means government has to put more resources into the health care budget to enable government to provide quality health services.

For example various health medicines are expected go up because all drugs are procured outside the country.

And without Identity cards hospitals especially along the borders will continue being flooded with foreigners who always take advantage of lack of Identities by Malawians.

The total budget for the 2016/27 is at K95.8 billion which experts have said could only be used for the purchase of drugs and perhaps Other Recurrent Transaction (ORT).

Cham contributes 40 percent of the health services and care in Malawi. Over 90 percent of the Cham are in rural areas and very hard to reach and very hard to work areas and serve very poor communities.

Supporters of the introduction of health fees argue that these facilities were established in early 1900 before the government was in place.

On top of heavily subsidising the cost of the services, these facilities are still surviving and moving forward in the healing ministry despite the tough economic conditions because they charge user fees.

Although it is not easy, they argue that the system has been sustainable and communities served by Cham facilities are now used and appreciate quality services.

They further argue that most patients are opting to get services at Cham facilities and private clinics and pay user fees bypassing nearby public health facilities which are dogged with procurement and management of drugs.

They also argue that most people who are accessing free services in public health facilities in urban areas pay for transport to facilities, pay accommodation where they live, pay utility bills, eat three meals a day, pay fees for their children in private schools and as such they are capable of paying for health facilities.

Ministry of Health in February this year said the introduction of bypass fees in some of the referral hospitals has promoted efficiency and helped the facilities to take care of minor financial issues when conventional funding delays or is inadequate.

CHRR executive director Timothy Mtambo whose  organisation CHRR was among CSOs against the introduction of the medical user fees has commended government for abandoning  the idea.

Said Mtambo: “This is commendable because by the end of the day it should have been the poor Malawians who are struggling even to put a meal on the table who could have suffered most.”