Malawi Health Sector Reforms: Task force, delegates debate user fees introduction

Debate continues on the proposed extension of paying services in public hospitals nationwide with members of a task force on the issue saying the reform will not result in increased funding to hospitals as Malawians will likely shun medical care.

A report on the preliminary findings of the task force was presented at the Mid-Year Review of the Health Sector Wide Approach meeting in Lilongwe on Monday.

Government has proposed four health reforms for feasibility review by task forces, among them establishment of a health fund, introduction of user fees and establishment of a national health insurance scheme to ease the burden on government funding to the health sector.

However, in his presentation of the task force findings, Gowokani Chirwa,  said literature review from least developed countries and sub-Saharan Africa indicated that user fees were an inappropriate financing mechanism for the government to consider.

“User fees are ineffective as they do not raise much revenue. They are inefficient due to large administrative costs and they are inequitable because they exclude the poor,” he said.

Chirwa said a study of the region had found that many countries were reversing the policy on user fees, among them Zambia, Burundi, Niger, Liberia and Kenya.

In their literature review, the task force found that in Kenya and Mali, increase in fees on curative care services resulted in reduced uptake and lower demand for curative and preventive health care.

The task force also found that when user fees were introduced in Malawi in 1964, they died a natural death due to political influences and there had been no initiative to address design and implementation that would have deemed it necessary.

Said Chirwa: “No study has looked at the equity impacts of user fees in public hospitals at the time they were being implemented. We recommend that the government maintains the by-pass fee for non-referred and non-emergency cases and well-detailed study must be done to assess the ability or willingness to pay for private wings in public facilities.”

Reacting to the report and Chirwa’s remarks that government was not proposing that people start paying, chairperson of the Health Committee of Parliament Juliana Lunguzi bemoaned the contradictory information coming out on the proposed reforms.

Dr George Mtafu, technical adviser in the Ministry of Health, said introduction of paying services would be competing against excellent facilities in private hospitals where people are willing to pay for quality services.

“Government infrastructure is not updated to be competitive; it has remained so since 1964. How can we make money from such unproductive services and infrastructure?” he asked.

Chairperson of the task force Dr Noel Kayange said within the research studies reviewed, improved quality of services could lead to increased access even among the poorest populations.

He said a calculation done on the K1 500 bypass fees introduced at Kamuzu Central Hospital (KCH) shows that it could result in K30 million revenue per month which could contribute effectively to the required monthly funding of K55 million.

Meanwhile, the task forces are expected to carry out further research, including field visits to beef up their reports before submission to the Ministry of Health.

Minister of Health Jean Kalirani said on Monday that the reports from the taskforces would be submitted to Cabinet for approval or Parliament if they required changes in the law.