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Is Malawi prepared for the post-pandemic era?

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By Kumbukani Kuntiya:

Peter Mutharika

The World Health Organisation (WHO) declared the Covid-19 outbreak a pandemic on March 12. On March 20, President Peter Mutharika declared Covid-19 a national disaster. On April 2, Malawi registered the first three cases of Covid-19 and as of Monday, the cases have reached 41 with 3 deaths and nine recoveries.

The Ministry of Health and its partners continue in their efforts to ensure Malawians are protected from the coronavirus outbreak and that the country is able to detect and respond to any cases that may arise.

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In line with this, on April 8, the government launched a K157 billion ($213 million) National Covid-19 Preparedness and Response Plan whose main objective is to prevent, rapidly detect and effectively respond to any Covid-19 outbreak thereby reducing morbidity and mortality.

Currently, five laboratories countrywide are reported to have the capacity to test for Covid-19. These are the National Health Reference laboratory in Lilongwe, College of Medicine laboratory, and Malawi Liverpool Wellcome Trust in Blantyre, Mzuzu Central Hospital laboratory and Mzimba South district hospital laboratory.

Despite this, it is beyond doubt that every effort is currently being made by the government to prepare for the worst-case scenario and where possible, avoid the Italy scenario.

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Crippled health system

The Covid-19 situation has reconfirmed that Malawi’s health system is derailed as in shortages of staff, medical equipment and supplies. Malawi being one of African Union member states, committed itself to allocate at least 15 percent of its total government budget to the health sector.

According to Unicef, since 2012/13, the Malawi government has on average allocated nine percent of its budget towards the health sector.

Within the period, the health sector has ranked among the top four national budget recipients along with education, agriculture and debt repayment.

With the Covid-19 budget being pegged at K157 billion, at almost 12 percent of the current national budget, it immediately shows we have a widening budget deficit and a looming financial distress.

This might further cripple our health care and social spending if government or concessional donor support does not fully close remaining external financing of the Covid-19 budget.

Since almost the entire Malawi’s public health system is financially tied to free-service model and fee-for-service payment model within the Christian Health Association of Malawi and privately owned facilities, such a financial disaster remains our unfortunate best hope.

Way out

While engaged in the combat against the Covid-19 pandemic, Malawi needs to address the potential financial distress and preparedness for a Covid-19. A recent nationwide sit-in by health workers shows that our health workers have been strained for a long time and not just due to the extra work needed to use personal protective equipment on every single patient.

At the rate the global community has responded to the crisis, eventually, Malawi too will be through this crisis by picking a few lessons. To achieve this, several issues need to be attended to.

The health sector ceiling needs to be reviewed upwards in line with overall changes in government budget, if the country is to progressively move towards the Abuja Commitment to allocate at least 15 percent of total budget to health.

With additional Covid-19 resources from Unicef, WHO, the World Bank, the International Monitory Fund and others, wastage and abuse needs to be addressed by strengthening reporting and accountability systems.

Related to this, Malawi needs to consider lowering operational costs whilst maintaining high-quality healthcare.

Malawi needs to take a bold step by reconsidering ‘fee for service’ model in the public hospitals with a view to improve health services without penalising poor Malawians. This needs to be complemented with a nationwide health insurance scheme.

The government should also consider continued recruitment and adequately compensating key health personnel, including community health workers. Beyond this, all the district hospitals need to have the capacity to test for Covid-19 within their laboratories beyond the current five labs.

For years now, Baobab Trust and other innovators have piloted digital health solutions. It is now necessary to scale up such interventions.

Conclusion

With more effort and support towards the entire health system, Malawi can test more people and flatten an eventual curve and save more lives. However, if we are to succeed in this endeavour, Malawi should start now to address the next phase, Covid-19.

The nationwide practice of social distancing and continuing discussion around nation-wide lockdown is central to this. The ultimate goal should not simply be to save lives now, but to continue to do so once the crisis passes.

Kumbukani Kuntiya is a public health practitioner and enthusiast

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