‘Health system has failed us’
Government plans to introduce sweeping reforms to the health sector. PAIDA KADZAKUMANJA engages Minister of Health JEAN KALILANI to expound on the radical reforms.
Q: People feel the health reforms are overly ambitious and might take time before they are fully implemented, what is your comment?
A: As far as I know, we have set timelines for every reform area. We have set up task forces for each of the reform areas comprising various expertise from across the knowledge spectrum of the country to ensure that we get the evidence and advice right in order to make correct decisions as we lay a solid foundation for the most efficient, equitable and highly sustainable health delivery system we aspire to have in this country in the long term. I am also pleased to see that some of the initial assignments that are a foundation to the completion and achievement of the reforms are progressing well. I am aware of the challenges that we may meet in the course of this process but the environment looks very promising and we hope we will achieve our goal for the betterment of our country. I know that we are walking on a path that is new and presents a unique challenge, but government is committed to the reform process. The reforms we have embarked on, therefore, are ambitious indeed, but realistic and achievable at the same time.
Q
Malawi has some of the poorest people, most of whom are living below a dollar a day, is government convinced that such people will be able to pay hospital fees?
A
This is an area that has caused a lot of confusion. You are aware that currently we have paying sections in public some hospitals. The proposal is to expand the current scope of paying services across many public health facilities. This is independent of the other proposals which aim to ensure that the proportion of Malawians making out-of-pocket health care expenditures for health remains low. For this, we are concurrently proposing to establish a health insurance scheme, starting with those in wage employment and expanding that to cover the informal sector and the rest of unemployed overtime. The paying sections will give options to Malawians who have ability to pay and wish to access paying services in public facilities. With stronger paying sections in public facilities, and a mechanism of retaining the revenue in the facilities, the revenue generated will improve and sustain quality services both in the paying and non-paying sections.
Q
How will government make sure that the health fund is not abused? Isn’t this another way of milking into the taxpayers money?
A
Not at all. The proposal to establish a health fund is to increase the revenue base for the health sector, and this is consistent with what other countries with critical health financing gaps are doing in the region. We are proposing this and indeed all the health financing reforms taking into account the other bold reforms on public financial management that President Peter Mutharika launched. In this country, we have the Road Fund Administration which is working so well. The health fund will work based on the same principle and foundations and assist government to generate the much needed revenue for improving the health care delivery system.
Q
Why has government decided on coming up with these reforms? How long will they take before they are in place?
A
We are aware of the many areas that urgently require bold decisions by government in the direction of these reforms, but we have decided to focus on the four reform areas to give a better platform for further improvements in the sector. We are continuously looking at areas that are generating a lot of inefficiencies and inequalities, and once we have outlined the basic frameworks and have finalised consultations, in the next rounds of the performance contract agreements, we will be proposing additional areas of reform. We have to see this as a process and it will take time to fix many of the key challenges we have in the health sector. We have set different targets and timelines for each reform area. In summary, we are focussing on reviewing our partnership agreement with Christian Health Association of Malawi; health insurance; establishment of the health fund; hospital operations reforms in areas such as laundry, pharmacies, food and rations cleaning and perhaps transport.
Q
What is the ministry’s immediate challenge on this?
A
The first priority is for the general public to understand why we are doing all these reforms. Our overall goal is to see that we have an efficient and effective health care service in Malawi. Over a long time, Malawians have been complaining that our system is not delivering as they expect it to be. We believe this is an opportunity for us to show to the people of Malawi that we can do certain things differently and achieve better outcomes with the level of resources available in the country. We want people to debate on these issues and provide us with some suggestions and feedback in areas they feel we need to change. This is not an overnight transition; we will consult people, different sections of the society so that we generate appropriate support.
Q
Does government have the capacity to fully make the health reforms a reality?
A
Yes, the capacity is there and we know what it will take. I am very optimistic that we will complete this task. This change is not only for the health sector but the general population, we need their support to see that we establish a good health care system that responds to needs of the people of this country. I am pledging my support and I will see to it that we complete these reforms.
Q
Any last comment?
A
We cannot be relying on a system that has been failing us for the past 50 years. A system that was built for less than 4 million people; a system that had less disease burden than now. The present health care system needs a major re-think and shakeup and this is what we are exactly doing. I therefore believe it is time to change and most likely, we will get different results. The Ministry of Health is welcoming all the suggestions and they can send them through email to healthreforms@gmail.com or visit and provide feedback on our Facebook page www.facebook.com/malawimoh
