One for the Health System

Friday again.

I must say that I have developed this fear that I might run out of things to write. You people who studied English at a deeper level. What do you call this feeling? Agraphnophobia or something? No sure. I am not a linguist, anyway. Why should I care?

Having said that, I must say I have not run out if things to rant about. Still got some, but I will sort of skip the Neno killings and the President's fall. People have already talked about that and criticized who was supposed to be criticized, which means I can take things a bit personally and talk about my love for listening to wise words.

I love talking to smart people and it is one of my hobbies. I also believe that being smart is contagious. I have over time come to realize that I might not be friends with all the smart people I desire to befriend but the least I can do is to settle for a unidirectional conversation by listening to tapes and watching clips. I would recommend that you do the same based on what your interests are.

I happen to like a certain type of talks called TED talks. They sort of happen annually and the smartest people around give talks, each around a quarter an hour or so, talking about stuff they think they know best. This is an international thing and limited in publicity as it may be, it also happens in Malawi. Actually one of my friends presented on a topic I am not sure of, but that is not the point. The point I have is based from a talk by one of the doctors in the country; one Dr Perry Jansen.

The good doctor heads a foundation called Partners in Hope. Yes, those people who have a hospital in Area 36, Lilongwe. He happened to give a thought provoking titled "A Recipe for Strengthening Health Systems in Africa".

I could transcribe the whole talk if I tried to give you the whole thing, but that would make my post longer. When it comes to reading and writing we don’t like long. In a nutshell, he began by exposing the gaps that are in our health system. He talked of how health systems are ranking and how ours was ranked 185 out of 192, only a position ahead of Liberia, a country that was one of the most hit by the outbreak. He was right to do that when he questioned our readiness should such an outbreak hit Malawi. He also pointed out that some medical emergencies that are synonymous with death in Malawi are treatable elsewhere and it is because stakeholders have not invested enough in the health system to make it the fully functional heath system it has to be.

Having talked of the problem, he went on to talk about the recipe for strengthening the health system starting with the ingredients. The first to be mentioned was economic growth. Sort of makes sense and doesn’t need much explanation. In the WHO framework of a health system it is clear that financial resources are one of the building blocks for a health system. Ideally, the more you have, the better health service provision will be.

The other ingredient that is crucial is that of human resources. He expressed hope in the fact that the College of Medicine is training young doctors who will in the years to come man our health system and turn out to be the much needed specialists in our public hospitals.

Then there was a crucial element he mentioned on the merging of the two ingredients. He talked of how the health system in low and middle income countries are dependent on aid. He talked of how aid cripples of health systems into dependence and proposed strengthening of health systems as opposed to providing health needs of the day, which nosedives health systems into the bottomless pit of more dependence.

To conclude, he said that we have all the ingredients we need to have the better health system we deserve and that all we needed was just to put them all together and get cooking. Fancy, right? I would say the good doctor had a point but at the rate at which we are doing things, we might continue to starve even with the whole set of ingredients in the kitchen.

To begin with, our economy is hardly growing. We are still relying on tobacco as our main source of income in the midst of bans against smoking and tobacco trade and all the other reasons that you may attribute our economic stagnation to. In my view, Perry provides us with a wake-up call. If we need to see a healthier nation, we should up our game economically.

Then comes the issue of staffing. The College of Medicine (I prefer school; medicine is learnt in schools and not colleges) is still training doctors and other health professionals. CHAM colleges, Kamuzu College of Nursing, St John of God and all the other institutions you can think of are producing health workers but the retention rate is a bit worrying. Poor conditions in our health system have forced health workers to look for greener pastures everywhere else and losing grip over doctors (some of whom are specialist) and other health workers has left a lot of unnecessary gaps. Unfortunately we don’t seem to be on the way to positive change on this one.

On the issue of donors who are funding a big chunk of our health budget, their loss of trust in our donors has bred a resolution of direct funding into whatever they want to fund, whether it is a priority or not. If they think circumcision is the way to help Malawi’s health system that will be the way they will go despite the government prioritizing malaria control over circumcision (just an example, eti?) In as much as we might have the desire to strengthen the system, so long as the people who do not have the resources will need more than just words to be convinced to pump in funds to strengthen the system. Or the other option could be doing it on our own; funding our own bid to strengthen our health system. How feasible that is remains a question you and I have to answer; but not out loud.

Conclusion? Dr Perry Jansen in his smartness told us the things we might need to have a healthier nation but it will take all of us and our government to sort this out for a better and healthier Malawi. We need to realize that aid is unsustainable and that what we need are not just the needs for today but those for generations to come.

Some of you know a couple of smart people who “own” the health system. May you kindly share this article to them, but better still, share the link below to them.

https://www.youtube.com/watch?v=2ghdE4WWI4M

Yours seriously,

Richie (Doctor to be)

Envisioning a Poverty-free Malawi

P

overty reduction has been a song that we have been singing for as long time in Malawi and the fact that little, if any, leaves some people wondering if we could really end poverty in the next 20 years or so. Many young people have lost the hope of a new and poverty free Malawi, but I believe that with some few practical strategies, extreme poverty can be a story of the past.

In my view, the main key to reducing and eradicating extreme poverty is the use of a multisectoral and multidisciplinary approach in poverty reduction. In simple terms, I believe that everyone in the country has a role to play in reducing poverty contrary to popular belief that it is the job of the government to take us out of this extreme poverty. Much as the government has a role to play, the private sector, the academia, media and the general public all have roles to play in poverty reduction and I will try to explain on how this could be done.

We cannot ignore the fact that the government is a key player in the reduction of poverty in the country. This role does not just come with the drafting of economic policies in some office as we have been made to believe over years. It comes with the development of well laid and long term development plans that are carefully made and implemented. Talking of development plans, Malawi does not have a well laid development agenda and as such the government runs development projects mostly for political credit. This is why some projects are abandoned immediately after the transition from one ruling political party to another costing the tax-payer, local or foreign (as some of these are donor funded) a fortune. This is one of the things that have stagnated development in the country for some time and it is one of the reasons we are still where we are, in the top ten of the poorest countries in the world.

Another thing that has contributed to the stagnation of development in the country is the fact that government runs more liabilities than assets and that has been emulated by many organizations and political parties. With the privatization of government owned companies the only revenue the government gets is from the taxes that are incurred. The government, however runs a civil service that is draining a lot in salaries and allowances with little productivity. If we are to move on and to reduce poverty, the government needs to consider ownership of assets in terms of services that can generate revenue for the government directly.

The things I highlighted are mostly to do with the government machinery and the policies therein but the other factor we do not have to overlook is the fact that the people who are running the government also have a role to play. The gap that we have as a nation is that we have a lot of people in high positions who abuse the public purse and that is costing the ordinary Malawian. Malawi needs leaders and technical people who have risen above self-enrichment and look for the common good. Unfortunately there is no screening tool that determines how honest an office bearer can be and thus we need a stronger justice system that can bring those caught to book for them to serve as a lesson to others.

The last thing on the part of the government is that our governments need to seriously consider what it can provide for free within its own means. Currently the government is providing free healthcare, free primary school education and subsidized farm inputs. In tertiary education the government is also providing free training for primary school teachers and sponsoring students in the public universities. This has affected the quality of the service delivered and maintaining the subsidized and free services has proven unsustainable over the years.

There is a need for the review of some of these things that are being provided for free or almost free and they are draining the government of monetary resources while on the other hand creating spirit of dependence and entitlement to the general public. Fees, for example, can be introduced in the teachers’ colleges and health facilities. In public universities, the government should also consider revising the fees upwards while making sure that the private sector and other stakeholders are partnered with to make sure that the adjustments do not affect access to tertiary education. We as Malawians need also need to embrace these changes as they come and we have to realize that the things we call free are not actually free as someone else somewhere pays for them.

A lot of things have been highlighted on the government side but we also need to realize that it is not the job of the government alone to alleviate the country of poverty. This means that everyone also has to play a role in alleviating poverty in their families and societies if the country is to take a step in eradicating poverty, other than pointing to the government. The fact that there is a reciprocated relationship between the economic growth of a country and the people therein and that if we are to individually develop economically, the country would also advance in poverty eradication.

This realization bring us to the fact that most of us Malawians are not financially independent and are contributing little to our development. Most of us think of life in terms of survival in terms of employment and that has limited us to survival and not development. This might be due to the school system which does not include much on financial literacy and entrepreneurship. Our school books have been filled with classical professions but make no mention of business entrepreneurship. As something people can venture into which diverts people’s attention from ways of generating resources that can impact the country on a larger scale through

I feel like there is a need for everyone to take this into account if we are to develop. On the other hand, there is hope in the country as there are some people that have taken up the task of making us all realize that there is more we can do for the country through entrepreneurship and job creation.

The government should consider supporting these initiatives as they can lead to the development of small and medium scale businesses; widening the tax base and creating some job opportunities that can in turn improve the living conditions of the people. Courses on entrepreneurship and financial literacy should also be integrated in the school curriculums to encourage the art of saving and investing in young people. To be realistic, this might take time to be implemented and this where the importance of the media comes in.

The media has a role to play in making sure that opportunities are given to those who would like to share knowledge on financial literacy and entrepreneurship in the country. This can be in terms of offering free slots and coverage of events that are aimed at imparting skills in business and financial management and it can be a more development oriented form of social responsibility to any form of media house.

The academia also has a very crucial role to play if the country is to move from the extreme poverty it is in. this role comes in the form of generation of more development oriented evidence in crucial fields like health, agriculture, engineering and natural resource management among others. Malawi has been blessed with a lot of resources, natural and otherwise and we have a lot of untapped potential for development. With just the right amount of evidence and application thereof we could see the country transforming beyond recognition.

In the same line, there is a need for the bridging of the gap between those who generate evidence i.e. researchers and those who need it i.e. the lawmakers to improve the quality of argument when debating on matters of national importance in parliament.

The role of the youth in poverty eradication cannot be overlooked in Malawi. As future leaders, we have a role to play now and it is encouraging to note that with time many of the young people in the country are coming to realize the importance of thinking beyond oneself when it comes to development and are doing something about it. This, however, is not the way everyone thinks and there is a need for snowballing of these ideas among the youth to ensure sustained development in the future. Young people also need to voice out views on issues that matter in the country other than just staying silent on issues that affect them.

On the government side, the youth need empowerment and their initiatives need to be supported if the country is to develop. There are so many young people who have brilliant ideas that have the potential of transforming the country. Many of these ideas and dreams die before actualization because of lack of support from the government and other stakeholders. For the country to develop, however, the youth need to be empowered financially and intellectually for continual development.

The youth themselves also need to come to the realization that they need to work their way out and rise if they are to make things work for the betterment of the country. The reality on the ground in the country is that there is need for hard work and persistence is someone is to get support, financial and otherwise for a new idea. This is what lacks in many young people and others have resigned to fate pointing it at the big people and accusing them of not giving young people opportunities. The counter argument to that could be that young people do not need to sit down and wait for the support of whoever can provide it but have to constantly keep knocking on their doors while giving them enough reasons to support their initiatives.

The main emphasis of my argument is on the importance of a multidisciplinary and multisectoral approach. Everyone has a role to play in the reduction of poverty in the country and if we are to do that in unison as a nation we might just see the country transform beyond recognition within the next 20 years or less. This however depends on a strong political will from the government and the support of everyone from the non-governmental organizations, private sector and the general public.

The first way to go if we are to develop and to eradicate poverty is mindset change. Both the government and the general public need to think in terms of asset accumulation and revenue generation for the development of our country. The government needs to be run like a business and it should be running some assets that can generate some reasonable revenue at the end of the day. We also need to change our mindset and switch to focusing on wealth building other than poverty reduction which is limited to solving the problems of the day.

We also need to get into the habit of thinking beyond ourselves in order to develop and to rise above extreme poverty. People need to move from self-enrichment to thinking of the greater good and about the next generation when planning developmental projects.

This reflection might not be as technical as it can be, but it is a big part of what Malawi needs if it is to move from extreme poverty. It might have not contained economic terms and figures, but if applied on the ground the fruits thereof might be reflected in both our development indices and above that the living conditions of the people.

One for the Chilembwe Day

Chilembwe Day. I am not sure whether to wish you a Happy Chilembwe Day because I am not sure if it is supposed to be a happy day. All I know is that it is day that has to be commemorated and I am surely having fears that over time this day will lose its relevance and we might as well end up scrapping it off our calendar. That I wouldn’t like.

Taking this holiday into consideration, this day has just been an added Saturday to the week; as in, I am having an otherwise normal week with two Saturdays. This is because I have not seen anything that sounds like some national commemoration of a national hero of some sort. I know this might be due to my absence from the front of a TV screen or lack of interest in listening to the radio. Perhaps it is the place I am based at which sometimes locks me into a world of my own; in a place where I do not have a connection to the outside world.

While I just knew that today was a public holiday, I got the reminder of the real thing from a Whatsapp group. One good member posted an audio clip of one man who narrated that he remembers Chilembwe as someone who started a premature struggle against white people who would have developed the country if they were not chased in 1915. He went on to say we should compare ourselves with those countries that gained independence in the 90’s and see the development gap between the us and our counterparts. Pretty much that.

The audio clip generated some debate on the forum. Most of the people who commented on the issue were in agreement with what Frank (I think that is what he claimed his first name was; I don’t like using surnames) said and a good number were silent. If my memory serves me well, I was the only person who opposed that for what I think was a good reason.

In the first place, I personally do not think that the Chilembwe uprising (that’s what we learnt in Social Studies, Standard 6) did much in ousting white settlers in the country. They remained here till the 60’s. Make no mistake, I am not saying that it did not have any effect on our independence. Chilembwe’s stuggle, in a way empowered the people; helping them realize that they could fight for their own rights and independence, which manifested a couple of decades later by the beginning of the fight for independence from the colonial rule by some locals.
In short, white settlers stayed even after the uprising, so saying that the Chilembwe uprising pushed out people who would have developed this nation sort of sounds baseless to me.

I could talk more on this point, but it is not that important. On the other hand, the other fault I had with this gentleman’s reasoning was the “tikudikira mzungu” ideology of thinking about retrospective “ifs” of development. Yes. Some countries might have been developed by their colonial masters but that ignores the fact that development has continued in those countries even under native rule. Here at home we have the Malawi Congress Party which likes to boast (note; it’s not boost) about what they did in their 31 years in power, and I must say there are a couple of developments and innovations. Not sure whether they are right to add that to their political CV but the main point is that there have been some innovative projects that were done post-colonial period and what we have failed is keeping on keeping on in the path of development.

That was one big digression. I was talking about how over time we are having a disregard of this Chilembwe so called day commemoration and I think I might have the reason for that. Actually I think that that is the reason someone might wake up and decide to take off the reverend’s face from the 500 bucks note (we call it galu or mjavi, do we not?) The reason is simple and it is that we do not have good documentation of Chilembwe’s history. I recently read an account of the death of the reverend online. The author of the article claimed that he got them from some court records in which some officers were testifying in a bid to collect the bounty that was put on Chilembwe. This was a white fella, by the way. Not, in any way, a Malawian. Tinadikira mzungu, and we don’t have much of our own records or a 1500 paged book about a person we consider a national hero. If that Chilembwe play is still aired on the local radio, MBC 1, it will soon no longer be aired and when the holiday goes that far, we might as well decide to take it off the calendar because at the end of the day it will just be setting us one day behind when it comes to productivity. For no reason.

On the other hand, I think we all have something to learn from the good reverend and that is patriotism and putting the lives of people before personal interests. I choose to ignore the statements going around that the Chilembwe struggle was more personal than it was for the people’s good. I think that this is one major element that is lacking among the modern day Malawian. Then there is the courage. I don’t have to explain that.

If you, like me, did not do anything at all to commemorate this day, then at least look at the positive side of Chilembwe and look think of what you can give to those who are underprivileged or oppressed within your vicinity; think of how you can positively impact their lives. Probably the most important point in the whole article. Another man of God, the Major 1, has already started doing it. Why not you?

Yet Another Random Thought

Malawi, 2016.

Sometimes it is good to talk about the country. I am told there have been a couple of prophecies from prophets I never knew before about a southern African nation that will face a lot of troubles in this year and that 10 out of the 60 or so prophesies are linked to Malawi. Well, I guess we need to brace ourselves for hard times and to pray while working with our hands and brains for better lives and a better Malawi.

Of course when we talk of hard times we talk of financial troubles. That one is a big one and for those who think that economic hardships are not an issue, you should think again with the entanglement of donor aid and homosexuality issues in mind.

Having scooped a gold medal of poverty in 2015 (I am told we might not be the poorest but we are somewhere in the top 10; leaves me not sure if that should be an adequate consolation) people have been saying a lot on the causes of our economic woes while contributing little when it comes to solutions.

Relevant authorities have of course been blaming a lot of things; the floods, the chashgate scandal (funny how presidents claim having inherited empty coffers in Malawi), poor tobacco prices and all the other complicated stuff beyond the comprehension of my medical mind.
If I am to join the sort of blame game we all get into in trying to find what is causing our economic problems as a country, I would say that all of our issues fall into failing to put the resources we have to proper use. This could be the natural resources but above that we have failed to use the available financial resources big time. Unfortunately this happens at all levels; national, district, family and individual level.

At national level, different people will give you different figures as to how the money in the budget is swindled. The highest figure I have heard is 70%; someone claiming that as much as 70% of our budget ends up in people’s pockets, cashed out straight from account number one. How true that is remains an issue of debate, but the obvious thing is that this is happening in our midst. Somehow, some in authority end up blaming lack of donor support when asked as to why we are not developing. No comment (my comments do not come out good on these issues).
I once talked to an MRA worker, who in passing asked me how much I thought MRA collected in a single day. In my naivety I mentioned a modest rand of K100 million to K250 million only to be told that they collect a whooping K1 billion in a single day. Billion, esteemed readers. In a year, the idea is that the money collected, if kept well would accumulate to around K300 billion. Interestingly, we haven’t managed to work with the potential of our tax collector and the proceeds thereof to do anything to show off. This gentleman complained, and I quote, “MRA keeps 1% of the money and the rest is banked with account number 1 which is at the mercy of politicians”. Tikukuonani.

Then comes the funding from international organizations. Some of these have lost trust with the government and its account number 1 madness and have resorted to funding grassroot projects directly. Many of them are working in our villages but we don’t see much of sustained results. Reason? When the money comes it is only 40% or less used for the project while the rest goes into the coordinator or manager’s pocket. That is the sort of Malawi we have.

We have a country in which people look at public and project funds as something they can embezzle without remorse. People in the public service can decide to have a workshop at the lake when they can do it in Chiradzulu, just to have accommodation and meal allowances. People sit in three seminars a day, just to sign for allowances without making any meaningful contribution. Self-enrichment has become the order of the day and it is so rooted that people no longer regard it as an offence.

As young people, we might think that this is none of our business, but it has everything to do with the Malawi all of us are calling for a fix for. I would like to put it to you that this country is not poor because of lack of resources but because of the failure to use the resources that we have

While I have talked of the issue at a national level, I have observed that most problems at national level also manifest at personal level. Everyone wants to develop oneself and there are resources at our disposal for the job. These resources can be human, financial and otherwise. While sometimes we might have issues identifying what we have (this country has that issue), we are being presented with a call to put the resources at our disposal to the best of their use. The time we have, the friends we have, the money, school, knowledge and all. It is only when we do that in our personal lives that we, who will be in authority in the near future will begin to see the need for replicating that at community then national level.

This country can still be saved and this way of thinking is one of the many ways. National problem, from which you can derive a personal lesson when you see it.

Call for Change

We are finally in 2016. This year is attracting a lot of positive expectations from different groups of people. The first one is that of the people who had it all rosy in 2015, and are looking forward to the continuation of all the good things in their lives. The other group is that of those who had it tough and are looking forward to a positive change.

The New Year, then, comes with a lot of expectations, realistic and unrealistic alike. While it is important to recognize the significance of a calendar year, it is also important to look at the opposite extreme end where there is a philosophy that any new year is just another batch of 365 days. Conditions are very unlikely to change; we will have the same people around us, same resources to work with, and same opportunities. There will be pretty much the same everything.

For things (outcomes) to change, however, there must be some change in the inputs and the materials you work with. If you think of it, the conditions around us would not change a lot in the year based on what I have already highlighted. Things will not just get better because some 5 on the number of the year after Jesus Christ has changed to 6. Considering the outcome of everything as a product of our reaction to surrounding and the way in which we respond to the surrounding, we are left with the option of changing the way we respond to things or deal with stuff in order to make things change for the better.

There has been a lot of talk about how the government is not handling issues well. I have participated in the rant through some posts on this very blog out of frustration, but from the look of things, how it works is like the more people talk, the worse things get. That gives me the boldness to be the bearer of bad news; the one who tells you that this gafment (in Bakili Muluzi tone) is not changing anytime soon, however loudly the reforms by the veep will be preached.

If you are in college, the National Council of Higher Education will not handle the fees issue in any better way and we will continue to struggle if we give this issue the same response. Those lecturers who have been labelled as tough will continue to be, and they might as well get worse as they get older.

Those who have been complaining about high rates of unemployment and increasing cost of living, brace yourselves. Things are about to get tougher.

I spoiled the celebration, but trust me, it is not just for the fun of it. These are the realities that are within our country and since the only change that can take place with man things is for the worse, we need to change the way we work and respond to our surrounding if we are to make it and enjoy in this year.

If it is an improvement in the grades that you need, there should be a positive change in the way you work academically. If it is finances you want to improve, then maybe it is high time you made or refined a saving or investing strategy. If it is social life you want to improve, you might want to lose or add some friends and build a productive network. The main point is just that the same input cannot produce different results because it is a new year.
We have been presented with a new year and it is an opportunity for us to make things better, but things will not get better on their own. They require an effort applied in the right way, and better outcomes require that we refocus our energies on the right things and in the right proportions.

While things might get tough on the way, it will be important for us to focus on making ways other than making excuses. We should remember that in the midst of the same troubles we are meeting, others are making it and progressing. What we should do is to learn them and to forge ahead in our drive towards success.

Jack Sparrow, one of my favorite movie characters once said that the problem is not the problem but your attitude towards the problem. He couldn’t have said it better. Probably something you and I could learn from.

Too general, but that is it.

Oh! Happy New Year from Richie. This is post 1 of the more than 52 that are coming. Assuming that you will buy me birthday gifts, because if you don’t I will stop.