CSOs trash public health facilities’ fees


Eleven civil society organisations (CSOs) including some international nongovernmental organisations under a coalition on Universal Health Coverage (UHC) have called on the government of Malawi to end all payments for health services in public health facilities.

A statement from the organisations, that include Oxfam, Action Aid, Médecins sans Frontières, Malawi Network of People Living with HIV (Manet +), Centre for Human Rights and rehabilitation (CHRR), National Association of People Living with HIV/Aids in Malawi (Napham), Save the Children and ActionAid, among others, says a lot of poor and vulnerable Malawians risk dying of curable diseases as they cannot afford to pay hospital fees at public hospitals.

Recently, government announced that the Ministry of Health had introduced paying wings and introduced bypass fees in all central hospitals and is now attempting to introduce payments for services in district hospitals.


The directive according to government is part of efforts to supplement the insufficient health budget.

Government also said the extension of paying services to all district hospitals which is expected to commence by July this year, is part of the ongoing reforms in its departments.

But the organisations say the directive is contrary to the country’s commitments to achieve its Universal Health Coverage targets.


“We are calling on the government to reverse the decision to introduce out of pocket expenses for patients in district hospitals and abolish all existing fees in central hospitals – including bypass fees and paying services,” reads part of the statement released on Tuesday.

The statement also says the introduction of the bypass fees is unjust and fails to take into account challenges faced by primary health service delivery institutions.

“In the 1990s, many countries introduced user fees for health services, often as a result of World Bank/ IMF loan conditions. Malawi resisted this pressure, putting the needs of its citizens first. As a result, Malawi has outperformed many of its neighbours in achieving the health MDG [Millenium Development Goal] on reducing child mortality,” the statement reads.

And in an interview, Centre for Human Rights and Rehabilitation’s executive director, Timothy Mtambo, questioned the way government wants to start implementing the paying service without any legislative approval.

“I feel this creates a two-tier system, where the poorest people will be left with the lowest quality of healthcare and the longest waiting time to access poor quality services, and such a system means that money will start to speak louder than Malawians’ real health needs,” said Mtambo.

Oxfam’s country director to Malawi, John Makina, said the directive is a violation of the right to health of the citizens, who are currently struggling to even put food on their tables.

“The government must abolish all user fees in public health facilities, and instead focus its energies on mobilising additional public funds for health. It must honour and spend 15 percent of its annual budget to the health sector for a start as committed in the Abuja Declaration,” he said.

But Ministry of Health spokesperson Adrian Chikumbe said the fees government is extending to district hospitals are not compulsory and that they will not be introduced in health centres.

He said the system is already working in central hospitals hence the need to extend it to district hospitals as they also have the capacity to provide these services.

“Government remains committed to the current free health services in its hospitals, that is why we are saying that the user fees are only for those people who are willing to pay for special attention in parallel paying wings,” said Chikumbe adding that “The services will remain the same, the only difference will be that the queues in the parallel wings will be shorter.”

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