Malawi health care system under threat


Lilongwe – Deaths from preventable diseases are spiralling in a Malawi hospital due to drug shortages and lack of essential medical supplies such as equipment.

This recently forced health workers at Kamuzu Central Hospital in Malawi’s capital city, Lilongwe, to march to parliament where they presented a petition asking government to urgently address the challenges.

A representative of the hospital staff, Steven Mjuweni, said the hospital witnesses about 40 deaths in a day from diseases that could easily be treated if the hospital had basic supplies or drugs and equipment.

The situation comes on the heels of revelations that some of the country’s civil service workers, politicians and private businesses have since 2009 fraudulently siphoned over US$4 million in both taxpayers’ and donor aid money meant for development work as well as to help lift up the healthcare system.

According to media reports, the plundered financial resources are enough to build 12 district hospitals, 314 health centres with five staff houses, train 200 000 nurse-midwife technicians and 40 000 doctors for a period of over five years.

Experts estimate that the amount is enough to procure HIV and AIDS life prolonging treatment for 50 000 people of the 500 000 people in need of antiretroviral treatment for 25 years.

Mjuweni said that currently patients at Kamuzu Central Hospital, the central regions’ major referral hospital, “are unnecessarily suffering from preventable illnesses and death.”

The petition indicated that the hospital does not have theatre supplies, such as sutures, bandages, and faces masks, a situation which forces the hospital to cancel surgeries and consequently lead to the swelling of in-patients in the hospital wards who are kept on a surgical waiting list.

Mjuweni said the situation threatens both patients and workers with the risk of contracting diseases because of the unavailability of sterilisation supplies. Health and development economist for the Centre for Global Development in USA, Dr Maureen Lewis, believes that an effective and efficient health care system requires a viable combination of financial resources, human resources, and supplies, as well as timely mobilisation and distribution of service delivery.

She notes that good governance is a critical factor in making a functional health system. In her paper titled “Corruption in public health”, Lewis observes that government effectiveness, corruption and accountability offer a thin and intertwined line for policy targets.

“Staffing is the single most important element of health care delivery but absenteeism, low productivity of medical staff and outright corruption that underlies drug management and leakages in developing countries undermines service delivery,” she says pointing out that availability of drugs and supplies complement health professionals “their absence reflect poor management and corruption”.

Lewis says that the greatest weakness in most health care systems were in drug and equipment procurement, performance and quality monitoring, audits, distribution and deficient inventory management, security and information systems.

In order to achieve quality procurement, storage and distribution of drugs and medical supplies in Malawi’s public health facilities, the government turned the Central Medical Stores into a trust. However, it has lately been learnt that the trust does not have the capacity to fulfil its core mandate.

Inexperienced personnel, storage limitations and a fleet of old vehicles are some of the challenges that dog the entity.

Lewis notes; “Drugs tend to be a commonly ‘leaked’ product given that it can fetch a higher price in the private market.”

She observes that lack of drugs in the public sector has channelled the essential commodities to private pharmacies and clinics attributing the situation to low pay of public servants. 

“Low wages also lead workers to seek additional employment outside government.”

“The constant need for supplies to complement the skills and infrastructure investment of government offer an opportunity for petty theft,” says Lewis pointing out that misuse of funds often occurs in the process of tendering and payment, “something countries ought to guard against through proper procedures and regular audits”.

Whether public resources for staff and other inputs reach the front line such as clinics and hospitals that deliver health services to the population, public expenditure tracking’s need to follow the flow of funds through the labyrinth of government bureaucracy to determine if the funds reach each of the designated levels, suggests Lewis.

The former World Bank Human Development Network chief economist also observes that a few physicians have the training or experience necessary to effectively manage health systems, hospitals and clinics.

Lewis notes that since corruption in the health sector is not an isolated public service failure, addressing the irregularities, procurement and distribution of drugs, deployment of staff requires an integrated, mutually reinforcing anti-corruption strategy with strong political backing.

“Making clean government a priority allows irregularities to be identified and address which bolsters efforts in the sector to put in place effective oversight and detection, and endorses disciplining corrupt practices once detected,” she says warning that the returns of health investments are low where governance is not addressed and that the health system must be engaged to improve government effectiveness and control corruption.

“Where public services are free or subsidised, with intention to promote access and utilisation of vital health services, the abuses related to drugs, staff absences and informal payments undermine these objectives as well as the credibility and effectiveness of public services.

“Without attention to these non-medical issues, clinical care quality and equity in access will be lost, leading to both lower health status and poorly spent public revenues. 

Good governance promotes economic growth and effective public services and the health sector cannot afford to be side-lined,” Lewis add.

November 2013
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