Detractors of development: Quality of health services


Both leaders and active citizens of this country must face the one depressing reality that overall the quality of the national population is poor – be it in education, health or just attitude – to facilitate development sustainably.

Pessimistic you might say, yet absolutely true!

Ours is a roundly disease-burdened population, much worse for rural communities and the low cost densely populated urban communities. Women and children are most affected.


Malaria alone, says World Health Organisation, accounts for 34 per cent of all outpatients; 40 per cent of hospitalisation of under-5 children and 40 per cent of all hospital deaths.

Further, 33 per cent of adults aged 25-64 are hypertensive, 5.6 per cent are diabetics and over 5,000 annually are diagnosed with cancers.

To this you add the debilitating effects of alcoholism; growing drug and alcohol abuse; and mental illness.


To-date just half of one million eligible people are on ART leaving a heavy backlog with potential both for high transmission and morbidity. Meanwhile 55,000 people yearly contract HIV as funders dis-invest in prevention.

Pregnant mothers are at constant risk of death. While maternal health initiatives have yielded good results 460 of every 100,000 women dying in childbirth is unacceptable. Child malnutrition is on the increase while stunting is an epidemic, hovering around 35- 40 per cent.

Well what has all this got to do with development?

Improved health is one of the most significant benefits of development and development sustained over time invariably improves health services – both in scope and in quality – making life more dignified and liveable

More and more people acquire health literacy, the skill and motivation to access and use health services; to access and use information in ways that promote good personal health.

Directly or indirectly it is education that influences determinates of good health such as risk avoidance, disease prevention, timely access to treatment, and adherence to treatment. Those with more years of schooling tend to be in better health and demons t rate more positive health seeking behaviour.

Indeed good education not only makes people health conscious; it reduces the need for frequent health care; the costs associated with dependence on services; lost earnings due to illness and generally human suffering.

Part of the change in health behaviour emanates from increased income; scientific advances in tackling diseases; and effective use of available human resources.

However, in the present state of economy this is hardly the case for most Malawians. Because large numbers of children leave school still illiterate health literacy is low; risky behaviours are widespread and fatalistic attitudes abound.

Our situation is such that few healthy, productive, tax-paying people have to support a large number of unproductive and dependent populations of young and elderly people because of the joint dis-empowering impacts of ill health and illiteracy.

But ill-health also has other long term complex impacts:

Poor health during childhood impacts negatively on capacity to earn later in adulthood. For example stunting – which is over 35 per cent – retards intellectual development; reduces quality of learning; and compromises creativity.

Childhood malnutrition alone could reduce future adult earnings by over 30 per cent both through incapacity to attain in school and through contribution to other health problems in adult hood.

Sustainable development is therefore not just a matter of planning and leadership; it is also a factor of good health for only a healthy people can grow economies. Health services are vital in preventing disease, treating disease and keeping people in production.

To take a more familiar example, HIV positive workers on Aids therapy will work more hours, report less absenteeism and earn more than those who are sick but not on treatment. Without good health business, services, individual earnings and livelihoods deteriorate.

At the household level, ill-health means few hours of farm or business work, reduced productivity in all economic activities and low direct returns of real value. It means ‘children on free range’ and exposed to abuse. It means discriminatory decisions in the household regarding who goes to school and for how long.

Ill-health is costly to people and to economies. Malaria alone has been a great strain on national budget, not least maternal morbidity; under-5 disease burden; and not to talk of Aids. Households and government alike have to divert resources that could otherwise be invested in directly productive areas.

Unfortunately, this won’t change any time soon as the total number of illiterates, semi-literates, unskilled and dependent people continues to grow.

Notwithstanding, leaders must face the ethical imperative to bequeath a healthy and fulfilled life to the citizenry and to future generations. Leaders must dare to advance in spite of shortfalls in funds, stunted technological development and weak human resource capacity.

Ours is a population weakened by ill-health; without an inclusive basic education system good enough to prepare citizens for meaningful development action ‘where they are’ for the good of all.

Yes we talk of health for development, but good health must be a goal in its own right as ill-health comes with grave human suffering while healthy lives are more fulfilling of human rights and personal ambitions to achieve the best in life.

In any case, the benefits of good health are not limited to productivity. Good health – coupled with good basic education – has the effect of reducing family size when countries roll out effective reproductive health programmes.

Additionally good health programmes particularly targeting women contribute to tackling gender based inequities; supports women empowerment and by extension assures improved approaches to child development and education.

This is our collective challenge. It is a challenge to the leadership. And yet this is the basis for development and to improved and fulfilling life.

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