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| Opinion |
| Budget falls short |
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by
Tom Likambale, 29 September 2004
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20:01:55
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A Patient’s Bill of Rights and Responsibilities is reported in the final drafting stages for presentation to Parliament.
I do not know what will be in that bill. However, perhaps the first “right” of a patient is to receive reasonable treatment — be it palliative or curative. The courtesies required of medical personnel, while important, are secondary to this one.
To the extent that medicines, health facilities and personnel are woefully inadequate in our country, especially while HIV-Aids continues its grim progress, we already violate this primary right.
But there is good news which we must emphasise first. Finance Minister Goodall Gondwe’s maiden budget represents a welcome departure from previous budgets. It allocates Health the second largest vote of K9.1 billion, an improvement from K5.6 billion last year. A significant increase this is, to be sure, but we must hasten to add, in the same breath, that this represents only 11 percent of the total budgetary allocations for 2004/2005.
Things ought to be different. The average in Canadian provinces and territories — they have socialised health care there — is 40 percent of annual budgetary allocation to health. Our specific problems require that we match, if not exceed, the 40 percent benchmark if we are to respond effectively to our emergencies.
Some will find the Canadian comparison unseemly. Nevertheless, it is germane as Canadian jurisdictions have nothing approaching our HIV-Aids pandemic and therefore, if anything, we should outspend them as a percentage of our budgetary allocation to health.
HIV-Aids keeps piling heavy strain on our health network. Fully 60 percent of hospital beds in the public system are believed occupied by HIV-infected patients — this being a conservative estimate. Roughly 800,000 Malawians are believed infected with HIV but only about 25,000 receive Anti-Retro Viral (ARV) treatments.
HIV-Aids is not only butchering Malawians, it is also creating orphans at an accelerated rate, creating problems in other social areas. We now have at least a million orphans, for example — many being raised by grandparents in the twilight of their lives; others in orphanages.
As if these realities weren’t grotesque enough, our healthcare system also has to deal with other pressing issues, including TB and malaria, both reported to be on the rise, perhaps due to weakened immune systems resulting from HIV infection.
Our healthcare system is clearly under comprehensive attack and 11 percent of our money is a pittance in confronting these threats.
The Gondwe budget increases allocations to the Ministry of Information and Tourism in the amount of K225 million. The minister allows that this is eight times the amount allocated last year to this sector. There are also increases in development expenditures in the Ministry of Trade and Private Sector to K155 million from K4.3 million last year, and in the Ministry of Mines and Environmental Affairs by K852 million, among others.
If we are talking about increasing Malawi’s tourism potential, for example, perhaps improving our health facilities will do a lot more to attract tourists. They are humans too and like to know that while they are busy taking pictures of lizards, if they should fall and break a limb, they will be treated adequately in a reasonably staffed and equipped facility.
There is a growing tendency now, for example, for travel agents in North America to offer information on HIV statistics and medical facilities of destinations. Surely, our grim health statistics must be costing us. In this respect, a kwacha spent on improving our public health facilities and the overall health of Malawians is a surefire way of increasing Malawi’s tourism potential.
We have a serious emergency on our hands in the health system, ladies and gentlemen. Until this sector sees noticeable improvements very soon, that is to say, until we are willing to spend much more on the public health system immediately to cause rapid improvements, it is hard to imagine the sustainability of improvements in the tourism sector or to attract foreign investment partners in other economic sectors.
A cursory glance at Aids-fighting efforts in Malawi gives the impression that we are mainly, and rightly, concerned with prevention. However, there is an immediate need to rapidly increase the number of HIV-infected who are on ARVs.
This requires finding ways to widen testing. Our health personnel know how to achieve this end and should be allowed to put their expertise into operation for that purpose. Clearly, if 800,000 are infected, it is a joke that only 25,000 are on these life-prolonging drugs.
Our hospitals are themselves in critical condition — overcrowded, understaffed, under equipped and infected. Admission in a public hospital, in some places, is itself a health hazard. It is important to rapidly expand the home care programme. Where it doesn’t exist we need to create one to ease the burden on hospitals and give them a chance to refurbish and replenish themselves.
In rural areas in particular, where distances to hospitals can be daunting, especially for the sick, it behooves our government to allocate resources for mobile clinics that are efficient and sustainable. But in cities too, such a programme would help ease the overcrowding in city hospitals.
At the end of 1999, the doctor-patient ratio was reported to be around 1:80,000. We need to improve the ratio of health practitioner (not necessarily doctor) to patient. By the same token we need to pay them a living wage to discourage them from flying off to the United Kingdom to become caregivers to Her Majesty’s loyal elderly patients.
More than this, government should empower hospitals to raise funds independently to augment their government subventions. Government has done this with universities, to modest reviews. Why not do the same with hospitals?
As dire as our national health system is, the proposed Patient’s Bill of Rights and Responsibilities should include clauses that compel public hospitals to make reasonable efforts to offer reasonable treatments. |
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