BRIEFING WITH PARLIAMENTARY COMMITTEE FOR HEALTH ON UNIVERSAL HEALTH COVERAGE AND SUSTAINABLE FINANCING
Date: 1st September 2020
Venue: Malawi Parliament
Facilitators of Community Transformation (FACT), together with Malawi Network of AIDS Service Organizations (MANASO), Journalists Association Against AIDS (JournAIDS) and Christian Aid are jointly advocating for a project called sustainable health financing for universal health coverage. MANASO in its role as coordinators of CSOs in Malawi held an engagement meeting with Parliamentarian Committee For Health On Universal Health Coverage and Sustainable Financing on the 1st of September, 2020 in collaboration with FACT, Journal AIDS and Christian Aid. The meeting was held at parliamentarian building from 9:30 pm to 11:00pm and the core objective of the meeting was to engage with the Parliamentary committee on Health regarding access to health care services in Malawi towards achieving Universal Health Coverage (UHC). The project is being implemented in the context of the proposed health financing reforms as outlined in the 2017-2022 Health Sector Strategic Plan. The project has been designed to build multi-stakeholder engagement to enhance citizen engagement and dialogue on health financing policies and reforms. For instance, the proposed creation of the National Health Fund and the National Health Insurance Scheme which are all vital towards moving to UHC.
At present, Malawi’s sustainable health financing reforms are taking shape slowly, while many CSOs are not effectively participating due to lack of capacity, while there is a general lack of awareness on health financing reforms such those being carried out by Government. For instance, turning all central hospitals into autonomous bodies (trusts), creation of a national health fund and the NHIS. The project is very critical taking into account that Malawi’s health sector faces a lot of challenges due to wastage of financial resources due to corruption, inefficiency. The particular project is very unique as it seeks to bring the UHC/health financing reforms closer to the general public and the civil society.
Even the smallest fee for healthcare can have a catastrophic impact on people living in poverty. For some, user fees necessitate the selling of household assets to pay for vital care, jeopardizing their livelihoods. The Ministry of Health has argued that Malawi’s healthcare fees will remain optional and that the poorest patients will therefore be protected from their impacts. Yet situations where user fees are in effect compulsory are already widespread. Lilongwe city has small number of primary healthcare centres serving an estimated total population of one million people. Each centre shuts in the afternoon, leaving patients with no choice but to pay fees for hospital-based care outside of clinic opening hours, or go without treatment altogether. For patients living close to fee-charging facilities only, bypass fees are seen simply as ‘a punishment or abandonment’
It is against the given background that a consortium of CSO’s led by Mr Maziko Matemba held a briefing with the parliamentary health committee on the following topics/subject
- Malawi Health Financing
- Accountability on UHC
- Access to Health Services and Inclusion
- UHC Youth Involvement
1.3 Achieved Outputs and Deliverables
- Support was pledged to influence policy reform that would increase domestic financing on health inorder to achieve UHC
- There would be in increased accountability on the national budget as the parliamentary committee on health pledged to lobby for the government to make the national budget statements easily accessible online in a timely manner. This would in turn enhance budget accountability for UHC.
- Support was pledged by the parliamentary committee on health to set a motion in parliament to increase the national response to non-communicable diseases (NCD’s) through increasing budget allocation to NCD response mechanisms
- The parliamentary committee on health also pledged to lobby for the government to increase the availability of youth friendly services at health facilities such as youth corners, mental health facilities etc. and employ more youthful health personnel so that the youth are not excluded from UHC.
- There should be a review of the health act.
Strengthening Civil Society and Parliamentary TB Caucus response towards effective national TB Policy development, Implementation and oversight, necessary for the reduction of TB among Children in Malawi
TB is the world’s deadliest communicable disease. In 2017 alone, 1.7 million people died from TB (compared to 1.2 million from HIV, and 450,000 from Malaria). 10.4 million People fell ill including 1 million children globally. TB is in the top ten causes of death worldwide. It also predominantly affects people of working age, so has a serious impact on families and communities and is the largest killer of people living with HIV.
TB is a major challenge in child health in Malawi, Over half (55%) of the estimated 1 million children with TB of age 0-14 years were reported in 2017. In 2016, Malawi registered 16,959 TB cases and childhood TB made up 8.6% of these cases. Childhood TB policy is available and the world health organization oversees the implementation of the policy, however affected communities and CSOs were not fully engaged in the policy development process which has created a gap in the implementation. The policy stipulates that the need to diagnose TB in children earlier enough for early treatment initiation using child friendly formulations. The NTP rolled out GeneXpert machines, recommended by WHO as the initial test for pediatric TB diagnosis, which will significantly improve diagnosis of TB in children compared to the old and less sensitive method based on microscopy, however this is failing to reach optimum utilization and scale up due to domestic financing challenges and weak policy implementation mechanisms, compounded by the lack of demand for accountability by the affected communities.
In addition, there exist plans by the Ministry of Health of progressing the current first-line formulation of pediatric TB drugs to a new, child-friendly formulation. However, additional support is needed to rollout these innovations, including ensuring new pediatric formulations both for active and latent TB infection are ordered, available in clinics and used. It is common knowledge that if the community affected by TB had adequate information they would be able to lobby for strong TB policies, adequate resources and development of effective community oriented programs, sufficient to addressing the needs of people affected by TB particularly children. Annually Malawi is estimated to be missing 12000 cases of TB and only diagnosis 49% of all active TB cases (national Tuberculosis annual program report 2017). This means that there still exists a lot of infections happening within the community. The recent MDR-TB outbreak in prison is evidence enough to validate the existence of MDR-TB and TB infections within the community. Health equity in TB programming will not only contribute to the achievement of Universal Health Coverage but also improve the social economic status of communities. Communities affected by TB in Malawi often lack information regarding TB – its prevention, treatment and diagnosis. This is because Civil Society coordination platforms have not been well capacitated to take up social mobilization, awareness, education and advocacy around TB.
Therefore FACT intends to implement a project with support from EGPAF to strengthen Civil Society Organizations and Parliamentarians in response to effective TB management. Moving forward FACT is planning to convene CSOs and affected communities to develop Pediatric TB and TPT policy advocacy and monitoring strategy in 7 districts.
- Convening CSOs and affected communities to develop Pediatric TB and TPT policy advocacy and monitoring strategy in 7 districts.
Overall Project Goal:
FACT proposes to carry out a demand creation and advocacy project to address the gaps that have been highlighted above with the goal to:
- Strengthening development and implementation of effective TB policies on management of Childhood TB, TPT implementation and scale up through implementation of tailored demand creation strategies among parliamentary committees, TB CSOs and affected groups by end of the project.
- Building an effective team of 70 CSO and community advocates that will roll out robust pediatric TB, TPT and TB policy advocacy strategy development and identification of key priorities.
- 70 CSOs oriented on existing pediatric TB policies and TPT
- A community mobilization and advocacy strategy on TPT and childhood TB developed