If you religiously follow the blog you might have noted that I have always kept "Richie Online" and "Dr Kamwezi" from meeting except for one time that I wrote about our ailing health system. That, I have always done out of my professionalism. I have known myself to be verbose and I avoid mixing my health profession and my semiprofessional writing for the fear of spitting too much. On the other hand, I think my dear young and innovative readers need to understand some of the bright and dark sides of our systems as they are scaling up their efforts to make a better Malawi.
A few days ago, my friend Max (Dr Maxwell Abraham Ayaya Yohane) tagged me in a post on Facebook. This post was something he had shared from a very grateful person who was suggesting that we all need to stop whining about the shortfalls of the public health service as it provides every basic need to every patient in this nation. The whole post got me tempted to respond with paragraphs of explanations but having seen the comments, I decided to hold my peace for the reason that there was a steep gradient of knowledge between the satisfied guy and me, a front-liner in the health system.
The issue of lack of resources is not much of a surprise in our health service. We hear about stockouts of essential drugs and important diagnostic equipment day in day out and that is the norm of the day. We have lost lives to curable diseases because of lack of basic things in the public health service and we haven't seen much change despite the numerous cries from the concerned. The problem is that the problems occur both centrally and peripherally. Meaning? While we have problem with lack of resources at government level, the same resources, little as they may be, tend to be abused at every level. One Peter Kumpalume once wondered as to whether he needed to be going to every district or health facilities. Having all this in mind, we can comfortably conclude that a majority of the problems in our health services are man made and easily preventable.
Away from the financial resources, the issue of shortage human resources is another major issue that needs sorting. Malawi has one of the worst doctor to patient ratios on the planet and the statistics are not better when we look at the nursing side. Result? Overworked and underpaid health workers. This problem of an understaffed system comes from the fact that we have only one medical school and a handful other health worker training institutions which can't keep up with the ever increasing demand for health workers in our hospitals. The solution is as good as you can guess and the only question we are left with is that of whether we will have more medical schools be it public or private to sort out the issue. One would also wonder whether the locally trained medical personnel will opt to stay amidst the seduction of the better working conditions elsewhere.
Leadership in the health service is another issue that needs to be put under the microscope. To avoid saying much about this topic, I will divert your attention to the things the WHO calls the building blocks of a health system. The World Health Organization (whoever that is) states that for any health system to function there is need for infrastructure, personnel, resources and along with that leadership and policy to govern the running of the system. There is so much that needs to be done on the policy and leadership part of the system in Malawi. I shouldn't say much on this because I might be too idealistic as I am a fresh graduate who hasn't been there yet. In my thoughts, however, we could use better policies.
The other big issue on the system is that of financing. This is the elephant in the room as it raises hot debates that seem to have no conclusion. Our public health system is completely free of charge for all patients and that includes the costs of all the expensive things like laboratory studies, imaging, surgery, intensive care admissions and outside referrals for the lucky few. Some might question this statement as a few of the services I mentioned might be offered at a small fee (especially some lab tests). That makes me wonder as to whether we need to introduce user fees in the hospitals to make some services just a bit more sustainable than they currently are. Those who are pro-user fees play the sustainability card while those who are against the fees go by the availability and accessibility argument. All those are valid but in view of the cost of services, we might consider bringing in something of the fee sort for some if not all services. My only worry is about how centralized these fees could be and how we could make sure that they work for the intended purpose.
Resources aside, I think one other bad think that we have as Malawians is that we are more passive and reactive as opposed to the ideals of being proactive with issues to do with our health system. There are very few of us who care about what goes on in the hospitals and how best things can be improved. We all worry about waiting time but we hardly do anything about it (send your child to medical school, maybe). We all look at the condittions of our infrastructure going down but we hardly do anything. Then there is this issue of theft of public resources which hasn't spared health facilities. Apart from all these, there is another issue which has had me thinking about how passive we have been in making our health system a better one.
I am pretty sure that most of us have heard about the gospel of blood donation on the radio or elsewhere. I for one haven't gone that side to be bled to save some 4 year old with malaria, some pregnant woman or some poor guy who was involved in an accident. This week at work has just shown me how irresponsible this whole "not donating blood" is as we had a total number of 17 patients requiring blood transfusions in a ward with a capacity of 60 or so. We are not talking of people with malaria or pregnant women or people who had accidents here. Interestingly enough, there were a couple of relatives who came over offering to donate blood and out of the many, very few admitted to having donated blood previously. These might be hard facts to get for some, but for me this is being reactive and it doesn't help anyone. Perhaps things would be better if a more of us could go and share that extra pint of blood with some sick soul on ward 3B at Queens. You never know who could benefit.
Having said all that, I should say our health system leaves a lot to be desired. Some have said that our problems are the price we will keep paying for having free for all health care and while they may have a point, I think the other building blocks of the health system are not to be looked at with a blind eye. We need sound policy to guide a motivated health workforce which will work in proper infrastructure with adequate resources, treating a nation of Malawians who care about and actively participate in the management of their system.
I still dream of the day when this will be a reality and I hope one day we will have a healthier nation.
A very sensitive topic indeed. Health services are expensive and if one needs ultimate health care then free services are never ideal. I am told Kamuzu wanted a paying system especially secondary and tertiary health care.
ReplyDeleteAnyway, I think one more problem to our health care is that 30% of the services are accessed by Mozambicans......it's not a classified information. I know why you winked at it. Lol