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FUNDING PROBLEMS IN HOSPITALS: DHOs fail to meet donor conditions

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Some district hospitals have gone for four months or more without funding from the Health Service Joint Fund (HSJF) due to failure to submit expenditure reconciliation reports to the donors.

Ministry of Health has confirmed this development saying it is entirely the responsibility of District Health Offices (DHOs) to ensure meeting all requirements in order to get funding from the donors under the HSJF.

This has led to the more misery of the already over-stretched health budget as the health offices have been forced to use funds from their Other Recurrent Transactions (ORT) budget.

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Since the ORT funding is also inadequate for their basic needs, hospitals have resorted to return to the old habit of making partial payment and thereby accumulating debt.

Our snap survey has established that Blantyre, Chiradzulu, Dedza, Rumphi and Ntchisi are some of the districts that have not been benefiting from the funds under the arrangement.

Rumphi has not had the funding since February this year. Its spokesperson, Bwanalori Mwamlima said there has been no communication but the office was asked to submit some financial reports more than a month ago.

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Ntchisi DHO spokesperson, Sydney Paulo said they had last funding in June.

“We have not had any communication to this effect. But the donors raised a concern to all districts that DHOs were not sending expenditure report which is required to process funds. We did that but until now we have had no funds,” he said.

On December 2, 2015 Malawi Government and development partners comprising Norway, the United Kingdom, Flanders and Germany entered into an agreement whereby the donors would be paying for utility bills for DHOs as one way of reducing pressure on the ORT and improving service delivery.

The donors committed K12.1 billion in the first year of operations December 2015 to December 2016.

They immediately established a Fiscal Agent office whose duty has been to verify and co-sign payments for HSJF expenditures at Ministry of Health (MoH) headquarters and the National Local Government Finance Committee (NLGFC).

Chief of Health Services in the Ministry of Health, Charles Mwansambo said the ministry is aware of this but was quick to say it is the DHOs that are in charge and not the ministry or the donors.

“They are just supposed to do as the requirements demand and some of them have not been doing that. This is why they have not had funding,” he said.

Second Secretary for Royal Norwegian Embassy, Kari Hansen could not be drawn to give reasons for the alleged payment delays but disclosed that in order to receive their share, districts have to adhere to a set of rules.

“Government regulations require that they report through their Accounting system to the NLGFC on a monthly basis. Reconciled accounts and the adherence to the monthly reporting cycles trigger the disbursement,” she said.

Hansen said that Norway is currently financing a fiduciary agent in reviewing and approving all disbursements from the HSJF to secure that disbursement follows the regulations set.

The funds are channeled through commercial bank accounts. The development partners finance a fiduciary agent and a procurement agent who oversees procurements made with HSJF funds.

“These mechanisms are set up to secure sufficient control of and transparency into the use of the HSJF….The flexibility of the mechanism means that where one district is unable to meet the requirements on time for disbursements to be made, this does not affect the overall mechanism; districts that do, do receive their funding. From the Embassy’s point of view this setup works well,” she said.

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