Hospitals ration food

The recent decision by government to cut funding for public hospitals by four percent has started biting as some health facilities are ratioining food and only giving patients porridge and one proper meal per day.

But the Ministry of Health said it is not its policy to give patients one meal a day after breakfast, saying the issue of budgeting and food for patients is now under district councils and director of health and social services.

“What we know is that they prioritise based on availability of funds,” said the ministry’s spokesperson Joshua Malango in an interview recently.

Seven district councils also confirmed that the problem has come about because they prioritise paying off debts the hospitals have with suppliers of foodstuffs.

They said the 2017/18 revised funding by four percent for the hospitals has exacerbated the problem further.

The food shortage established over a month, in eight public hospitals across the country, has left both patients and guardians with an enormous task to find supplementary food to enhance the healing process.

Chiradzulu, Mulanje, Zomba, Dedza, Dowa, Ntchisi, Rumphi and Nkhata Bay are some of the hospitals where officials have confirmed the problem.

At around noon, Maureen Julio, a guardian from Nkula Village, T/A Ntchema in Chiradzulu gathers sticks from a nearby bush at Chiradzulu District Hospital to make fire she would use to prepare food for her sick relative.

“Since we arrived two weeks ago, the hospital has been serving porridge at 6am and nsima at 4pm. The nsima at 4pm is supposed to be lunch and supper, which is not enough food for my patient. She is taking drugs which require that she eats enough food,” she explains.

“I asked relatives in the village to bring flour to be supplementing her diet,” said Julio.

As Julio was talking to this reporter, Catherine Salijeni, a post-natal patient from Namacho Village in T/A Kadewere, was panting with hunger.

Her only guardian, an old woman, was babysitting Salijeni’s new-born baby.

“As you can see me, I have just delivered and I am weak. I need to eat regularly as a nursing woman,” she says. I want to prepare nsima.

“This is a big problem, but I am lucky because some patients admitted to this hospital come from Mulanje and Phalombe districts and the only food they have is from the hospital,” she explains.

At Zomba Central Hospital, which we visited the same day, scores of female guardians, with cooking utensils, lined up the brick fence outside, waiting for time to access wards.

Weary Agnes Nikisi from Liti Village Sub T/A Nkagula in Zomba district claimed the problem has been compounded by the fact that guardians are not allowed to give food to patients despite that the hospital does not provide regular meals.

“We are not allowed to get food to the wards for patients. Yet the hospital only offers one meal per day, after giving patients porridge in the morning. Why are they treating patients like this?” she queried.

A patient we found in the corridors of Mulanje District Hospital said he had spent a month in the facility where he had been forced to beg for money.

“I will be here longer because I am on tuberculosis treatment. But without enough food, I cannot survive. That is why I am begging for money,” he said.

Society for Medical Doctors (SMD) president Amos Nyaka in a telephone interview said lack of food to patients affects the healing process.

“Food is important as it is the first medicine. As such, patients must have a good diet in order to heal. It is essential that patients must have good nutrition at regular intervals to expedite recovery. It is imperative that this problem is solved quickly to avoid worse scenarios,” he said.

Budget constraints

Mulanje district hospital spokesperson Innocent Chavinda and Dowa district commissioner Alex Mdooko attributed reduced food in their district hospitals to debts the hospitals have with suppliers of foodstuffs.

They said the hospitals were struggling to offset old debts for fear of lawsuits by suppliers.

Said Chavinda: “Reducing meals to patients is a decision that was made to ensure patients have something to eat for the whole month. Otherwise, if we give them three meals a day the food would be depleted before the end of the month.

On the other hand, Mdooko, who as DC has oversight for all financial activities at the district, said the hospital has to balance between what it gets for food purchases versus debts that it accumulated overtime with food suppliers.

“There is no vote for debt servicing so hospitals resort to using the same funding they get for food per month to pay off the debts, hence the problem,” he said.

Spokesperson for Nkhata Bay District Hospital Christopher Singini while not divulging the reasons for the reduced meals confirmed, in an interview, that  the hospital was serving one main meal a day—either lunch or supper —after porridge in the morning.

“It is true that at the moment we are serving patients one meal per day. I cannot say exactly what has caused this but our cashflow is not allowing us at the moment to serve more than two meals per day,” he said.

However, DC for Rumphi Lusizi Nhlane while admitting that for a few days the hospital in the district reduced the number of meals to patients attributed the problem to a technical problem.

“I know this happened only for two days because of a technical problem. For two days, the hospital did not use their electric cooking pots because there was no cooking oil, which is used to control heat and that made it difficult for patients to be supplied adequate food,” said Nhlane.

Health officials at Ntchisi District Hospital refused to speak, referring us to the Ministry of Health.

But Malango in a WhatsApp response said the issue of budgeting and food for patients is now under district councils and director of health and social services.

“What we know is that they prioritise based on the availability of funds,” he said.

Malawi Health Equity Network (Mhen)—a grouping of NGOs working in the health sector—last month blamed government for putting public hospitals in what it described as a “man-made crisis”.

In a press statement, Mhen specifically faulted Dedza District Council for not adequately funding the district hospital for two months.

“Health services in all the districts are generally suffering. Disbursement of funds to districts is not happening timely and without following cashflows. These inconsistencies lead to district health offices [DHOs] to accumulate debts to service providers to keep the health facilities running,” said the statement.

Impact of power outages

It said the problem is compounded by power outages which have led to increase in fuel budget as fuel consumption by generators has almost tripled.

The statement cited one notable case at Dedza District Hospital where hospital staff on April 9 2018 marched from the hospital to the district commissioner’s office to present their grievances.

Stanley Tchuti, a financial analyst at the National Local Government Finance Committee (NLGFC)—which handles budgets for district hospitals—admitted, in a telephone interview, that there is no end in sight for the problem due to funding constraints.

He said: “It is common knowledge that the funding that we get for health is not adequate and that is not peculiar to the hospitals. Although we lobby for increased funding, it has been a challenge because each ministry has ceilings. As such, we are funded based on those ceilings.

“The situation in the hospitals arises from the fact that controlling officers are not allowed to overspend. So hospitals may decide to reduce the number of meals as a measure to control expenditure.”

Treasury spokesperson Davis Sado, in an e-mailed response, also said government’s decision to cut funding for ministries, departments and agencies (MDAs) was based on performance of the MDAs.

Said Sado: “The 2017/18 financial year’s approved budget was revised based on the performance during the first half of the financial year and projected performance of the budget in the second half of the year. As such, the expenditure budget was revised down wards by K9.3 billion.

“To cover for the revised expenditures, the Treasury had to reduce almost all budget lines. Treasury revises the budget at vote level but actual lines of expenditure are done by respective MDAs.”