By Imam Wali:
Phew! That sigh of relief from Nancy, who is from Kaboola Village, Traditional Authority (TA) Kamenyagwaza in Dedza District, attracts my attention in the corridors of Dedza District Hospital.
Then, before I say a word, she flashes a smile at me.
“I am happy that, after spending six-and-a-half hours on the queue, I have been helped,” she says, before adopting a pensive look.
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She then opens up about what she feels is a problem that has to be addressed.
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“One of the problems poor people like me face when we come to the hospital is that of ‘yammanja’; this is money that some healthcare workers demand so that they can assist patients. This disadvantages resource-poor patients, as they are made to watch helplessly as haves enjoy top class services. This is despite that this is a public institution and we all pay taxes,” mother of four Nancy, 42, let out what has been bothering her for some time.
She said when citizens are made to pay for what is supposed to be free-of-charge services, their right to quality healthcare is put under threat.
“If you have no money with which to bribe some medical personnel who demand money, you spend the whole day without being assisted,” she explained.
However, Dedza District Hospital spokesperson Mwayi Liabunya dismissed such claims.
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Liabunya said these are mere accusations aimed at denting the image of the facility.
“I, therefore, advise those with evidence to alert the authorities so that action can be taken. Otherwise, these are mere allegations,” Liabunya pointed out.
Meanwhile, Dedza Civil Society Organisations Chairperson Heston Nalikole has faulted the office of the ombudsman at the healthcare service facility for “sleeping on the job”.
“Complaints have been lodged before but nothing has materialised. We had a meeting with the authorities in November last year and, still, nothing has changed,” Nalikole claimed.
According to an inside source, the practice of demanding money from patients started when some healthcare workers started demanding money from patients from Mozambique.
Now even local patients are made to pay something for services that are oiled by taxpayers’ money.
Between the months of November last year and February this year, this reporter was digging into the issue, with members of the group of medical practitioners that demand money confiding in us that Mozambican patients pay more than their Malawian counterparts.
“This happens every day. The Mozambicans pay better than Malawians such that, sometimes, they pay up to K100,000 for services,” our source said.
One of the people that talked to us on condition of anonymity said, in 2023, he lost a relative to a preventable disease because of the ‘pay-money-or-rot’ system.
Some of the patients that are conversant with the system told us that they deliberately leave money in their health passports to satisfy the demand of those that are part of the ‘pay-money-or-rot’ system.
“Often, the money that is put in health passports ranges from K5,000 to K10,000 since there is no fixed amount,” the source indicated.
The reporter witnessed some patients from Mozambique being assisted in a vehicle they had come in. They got the services at the hospital’s carpark.
Our inside source told us that this starts with one phone call.
“One phone call of a Mozambican patient or some well-to-do individual is enough to prompt even those who are off-duty to rush to work and assist the patients,” the source, who indicated that some support staff are also part of the clique, claimed.
One Mozambican who often uses the ‘pay-money-or-rot’ system said he has a Malawian health passport which is well known to some healthcare service workers.
“Here [at Dedza Hospital], we are treated better than in our country. Our friendship with health personnel has blossomed. We have special people we meet here.” he said.
Although poor Malawians are looked down upon and denied access to quality health services, they are likely going to contribute to the national budget through taxes they pay when they buy a packet of salt or sugar.
This year’s proposed health sector allocation is K727.47 billion.
Previously, they also contributedK283.57 billion in the 2022-23 national budget and K101 billion in both the 2021-22 and 2020-21 fiscal years.
Nalikole says their investigations, which were conducted in 2023, revealed that patients face a plethora of challenges there.
The report was presented to Dedza District Hospital officials in November 2023 and exposed issues such as patient neglect and bribery.
“This means the public health facility is now being turned into a private health facility. This is not good,” he said.
In more ways than one, the development poses as a challenge to the attainment of Sustainable Development Goal (SDG) 4, which focuses on the need to push for Universal Health Coverage and provision of safe and effective medicines and vaccines for all.
Meanwhile, Malawi Health Equity Network Executive Director George Jobe has condemned those that are cashing in on poor patients.
“This practice of informal payments in our public healthcare service facilities is very bad. It is injuring, and sometimes leading to the death of, poor patients. Whoever demands informal payments is killing our people,” he pointed out.
Chairperson for the Parliamentary Committee on Health, Mathews Ngwale, is equally worried.
“The issue of health staff asking for money in order to provide services to poor people has been around for some time in Malawi. The Ministry of Health and us, as Parliament, condemn this behaviour.
“The problem is that there is often little or no evidence because these practices are perpetuated underground, such that it becomes difficult to address the problem,” Ngwale said, resignedly.
“I have an idea. The solution lies in vigilance on the part of hospital administrators. The other solution is the installation of CCTV cameras in areas where these crimes are committed,” Ngwale added.
For Nancy, though, what is needed is an immediate solution.
“And that solution is the adherence to medical ethics, which is part of medical practice.
“I am afraid that he healthcare service system has some bad apples that throw ethics to the wind. It is these apples that are giving it [the health sector] a bad name,” she concludes.
Whatever the case, there could be a silver lining for poor patients if action were taken on bad apples. There are no two ways about it.
