Hospital reforms drag for 13 years

The process of turning the country’s four central hospitals into independent trusts has dragged for about 13 years since around 2000 and it is unclear when the process will be concluded because of several hiccups, including lack of political will, Weekend Nation has learnt.

The process largely aims at devolving the control of central hospitals and later district hospitals from the Ministry of Health to independent boards of directors.

Due to the delay, managements of Kamuzu, Queen Elizabeth, Mzuzu and Zomba central hospitals, cannot handle indiscipline cases ranging from drug fraud, insubordination, negligence and underperformances.

Speaking in separate interview this week, three members of the hospital reform technical working group confided in Weekend Nation that the reforms delay has worsened indiscipline in the country’s hospitals as some implicated health personnel use their connections at the Ministry of Health to avoid disciplinary actions from their hospital managements.

“We have had several cases with clear evidence such as patients dying because of negligence of some doctors and nurses, but hospital managements fail to discipline the implicated staff because they are connected to senior officials at the Ministry of Health.

“What do you expect hospital directors to do when some staff challenge them that they can’t be punished because they have connections even to State House. This is why we want hospitals to be independent of political powers so that they can save patients efficiently,” said one member of the technical working group.

In an interview on Tuesday, the group’s chairperson Dr.NoordenAlide confirmed that the reform process is, among others, aimed at giving powers to hospital managements to control their staff.

He said they are working on another draft document containing recommendations on how to successfully implement autonomy of the hospitals, saying they will present the document to the Health Minister for government consideration.

“From 2000 and there about, Ministry of Health and its partners set priorities on hospital reforms, particularly targeting central hospitals. This led to setting up of a technical working group. In responding to the problems hospitals were facing, there was a proposal for autonomy of the hospitals.

“However, the hospital autonomy was not accepted. because it was misunderstood as trying to privatise hospitals.

“Between that time and now, we have only been implementing systems strengthening reforms to improve management and performance within the breadth that we are allowed,” said Alide.

He said minor reforms central hospitals have been implementing include outsourcing of catering and cleaning services as well as exploring their own income-generation activities such as introduction of paying wards.

Alide said reforms such as those relating to control over workforce in the hospitals are beyond Ministry of Health as they need approval of the Office of the President and Cabinet (OPC).

“Ministry of Health’s role is to provide evidence to the machinery of decision-making in government that autonomy of hospitals does not infringe on the rights of Malawians, but improves the performance of hospitals,” said Alide.

According to some internal communication Weekend Nation has seen, the proposed reforms would also see some central hospitals outsourcing pharmacy services from private companies instead of having their own pharmacy departments to curb drug pilferages.

In an emailed response on Thursday, Malawi Health Equity Network (Mhen) executive director Martha Kwataine said the proposal is in line with the country’s decentralisation efforts.

“Devolvement is not just about resources, but also the power to make critical decisions as well as having the right mix of members of staff and management. Hospitals will be held accountable for their decisions rather than is currently the case where everything is centralised and the end result is mediocrity and laxity.

“Once the institutions have their own boards in place, they should be in a position to hire the right staff, discipline and even fire non-performers. Currently, non-performing staff are just transferred from one institution to another because of the centralised system that is highly bureaucratic,” said Kwataine.

She also corroborated that hospitals have had several cases of abuse of patients with clear evidence in which she said some patients have lost their lives due to health staff misconduct.

“Due to connections with officials from Ministry of Health including OPC, they [staff] get away with such cases, thereby compromising service delivery.

Ministry of Health spokesperson Henry Chimbali on Friday said there is enough political will on the process, adding the reforms have taken long because they involve many components; hence, they may not be concluded so soon.

“No one is delaying the process. It is the same ministry headquarters that started to pursue this approach some years back because we saw the benefits of adopting this arrangement and it can’t be the same institution delaying the process and completion.

“You must know that this is a process that has to stand the test of many things and consider a lot of things as well; as such, all what is concerned has to be thoroughly looked into because it has implications whether positive or negative.

“At present, we are not stuck. Very significant progress has been made and if we compare from where we were and where we are now, so much has beendone,” said Chimbali.