There is this question that has daunted us for generations. Should Malawians pay for healthcare? Depending on what are your assumptions and understanding of the questions, several alternatives may emerge. So, we have one group that says that Malawians must pay for their healthcare. The other group would question what the responsibility of the central government is if citizens start paying for healthcare. The third group, I suppose, can say that it does not know what is best and what was bad.
Maybe I can start by asking the question: what is healthcare? To many of us, healthcare is about health clinics, hospitals and pharmacies. This is one but incomplete view of what healthcare is all about. Healthcare is delivered by not just the formal Western-orientated health system. Let us also recognise that much of healthcare is delivered at home. The other part of healthcare is delivered by the traditional healing system and other players. So, the question as to whether we should pay for healthcare is rather limited.
Now, maybe a more precise question is: Should Malawians pay for healthcare delivered from the public health system? This answer cannot be answered directly without understanding what we are talking about. The public health system delivers curative health care, e.g. treatment of sexually transmitted infections, malaria and tuberculosis, as well as preventative care, e.g. vaccinations.
So if we just lump the public health care system, the question I would ask is: do we want that parents or guardians who take young children for vaccination get charged for the service? The answer, I think, would be a no. If we charged people for vaccinations, what if they decide then not to take the children for vaccinations and other services that are provided at the under-five clinic? So we may have to decide which services we can charge and which ones we will let people get for free? So there has to be criteria.
Then we move to the next question: Is it all people we are talking about who must pay for the selected services or there are some people who may have to be exempted? Are we going to charge prisoners for accessing care at a prison hospital or we are going to exempt them, or we are going to let them die? If we let the prisoners get free service while in the free society people are paying what questions will come our way? Further, if we ask people to pay something for the care they received, how much are we going to charge for which services? Let me hasten to say that the Christian Health Association (Cham) facilities have this worked out already and so I am not raising new questions
We then may have also to attend to the question: why is it that we want to charge what are called user fees? Is it because we don’t have the money to pay for the services? Is it just because nothing comes for free? Is it because we need to raise extra money to improve the services? Are we charging because people are already paying for services elsewhere?