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)