Analysis of the Public Health User Rate Reforms in Malawi


Research title: The political economy evaluation of the execution of open public health user cost reforms in Malawi.


The economical crises of the 1970s and 80s led many countries to endure structural reforms that needed reduced public costs for basic services. The reforms led to the benefits of cost showing on the part of beneficiaries (Lucas 1988). In a number of countries, customer fees were enforced as a way to address repeated costs problems and an extra source of revenue for previously "undervalued" services of professional providers. Countries responded in another way to the advantages of customer charges depending on domestic politics risk and institutional capacity to efficiently administer the fees. Along with the reforms, public financing of health dropped in many countries, and perhaps, private providers seized the chance to fill the gap (Romer, 1986). Even though participation of private providers helped to meet demand for those in a position to pay, it limited access of the indegent to the same services due to the prohibitive costs.

Over days gone by ten years, research on monetary growth has proven that real human capital is a robust force in the development process (Becker 1990). In effect, a sustained increase in this form of capital is essential for poverty decrease in low-income countries and then for an ever increasing quality lifestyle. Health is one of the commonly used proxies for human being capital - an unobservable magnitude or pressure that is part and parcel of humans (Schultz 1960).

Developing countries are battling to increase the lives of folks living in both rural and urban areas. The big challenge in these countries is insufficient resources and problems in allocating the scarce resources. Various government authorities have prioritized different sectors depending on the needs and requirements of the individuals. Some have prioritized major education and agriculture while some have prioritized mining and health sector. Growing countries have come up with different interventions purposed to cushion people and be able to manage the chance. Some interventions have taken the form of subsidy while others have taken the proper execution of user fee exemption to mention but two (Schultz 1961).

These interventions sometimes are powered by politics, that is why for you to effectively intervene must understand the interplay of politics and economics in the expanding countries. Based on policy makers, some would like to use subsidy programmes while some would have user fees exemption or both. End user fees are charges one pays off at the point useful. The stated interventions are best for the folks but to the bigger level over burden the already struggling market of the producing countries, (Litvack et al 1993). Subsequently, government sectors suffer due to being underfunded which has resulted to poor service delivery defeating the complete purpose of subsidy or end user cost exemption. Some countries, thus, they may have resorted to meet the deficit through the benefits of individual fees. For instance, in individual of health for those, Malawi federal offers free open public health services to everyone in the united states (ibid).

Through observation, the public health services in Malawi specifically those in bordering districts such as Mchinji, Nsanje, Mwanza and Mulanje face very stiff competition on health resources because the private hospitals in these districts provide even those from the neighboring countries such as Zambia and Mozambique.

Currently with the growing populace, government is failing to meet the demand of the free general population health services which is manifested through having less medical resources in the hospitals. Insufficient resources might be because the government has a restricted tax bottom part to finance the general public health services. For example, in Daily Times of 18th August, 2014 transported a story that Kamuzu central clinic got suspended all the booked surgeries because a healthcare facility acquired no medical resources required to carry out businesses in the theaters. Burns up unit office also suffered the same. In such circumstances the benefits of user charge in public nursing homes becomes no option but essential. An individual fees may therefore, help in three aspects within health service sector: enhancing efficiency by moderating demand, comprising cost, and mobilize more money for healthcare than existing sources provided


The goal of free general public health services in Malawi was to bring equality and equity in being able to access health services. It's been argued that with user fees in accessing general population health services, the indegent people could be disadvantaged. Axiomatically, healthy people make healthy region and participate positively in the development activities. Defeating the purpose of free general population health services, it is the same poor people who are actually struggling as the better off and even politicians use the hostipal wards. Every person has got the right to good quality health, but the the indegent in Malawi are now voiceless and spend painfully on the assistance that were designed to be free. The problem begs a question that are the public services in Malawi really free by any means when a person is informed to buy aspirin tablets in hostipal wards or pharmacies as the public nursing homes have given the treatments to undeserving individuals such as those coming from other neighboring countries e. g. Mozambique because public hospitals in Malawi are free. The indegent are also voiceless and lack responsibility on a healthcare facility resources for it is directed at them for free. Hospital workers have been frustrated because their working environment is not conducive since they are forced to work even though they do not have resources and are occasionally frustrated due later or nor repayment at all for the excess hours rendered.

Provision of quality health services is one of the cultural indications of development. However, considering the persistent learning resource shortages in the general public health sector, Malawi as a country is very good behind the expectation. Optionally, national policy makers in a few countries such as Kenya and Mozambique considered to enlarge government revenue bottom part through the advantages and execution of user fee with an aim of enhancing services, for example, by improving drug supply and the overall quality of healthcare and extending open public health coverage. Therefore, the existing study aims at undertaking the politics economy research of the execution of general public health user charge reforms in Malawi. The study will be guided by the next sampled questions:

  1. What are the challenges on the implementation of public health individual fees in Malawi?
  2. What is the result of policy designers towards open public health user payment implementation?
  3. Is user payment good option to finance general public hospitals
  4. Can Malawi manage to embrace user fee policy (in terms of attitudes, determination and capacity)
  5. How much is brought up from the paying ward in the central hospitals, are the services not the same as the non-paying ward? If they are different, just how do they differ? And how is money used. Has it brought any change?
  6. What are the problems that general population hospitals meet?

Main objective: to attempt the political economy examination of the implementation of open public health user charge reforms in Malawi.

  1. Exploring the historical discourse of general population health user payment in Malawi.
  2. Determining the reasons of government failing to add and implement end user fee in public areas hospitals.
  3. Analysing how people have been deprived of good health services through free general population health services in Malawi.
  4. Comparing the issues in taking care of the resources experienced in the CHAM hospitals and public clinics.
  5. Analysing stakeholders' frame of mind, willingness and capacity to embrace public health user cost implementation insurance plan.
  1. Poor quality of public health services can inspire public willingness to pay towards some improvement of the services
  2. Inadequate funding leads to poor general population health services in Malawi
  3. Malawians are deprived of quality general population health services through free public health services.
  4. User payment reform in public health services can business lead to efficiency and equity in public health resources in public hospitals.
  5. Politicians desire to introduce general population health user payment reform but are deterred by worries of sacrificing popularity

The analysis will mainly use qualitative descriptive and analytical mix sectional approach. Objective 1 and 2 on general population health user cost trend and government failure to expose and apply the same respectively use qualitative descriptive way. Whilst objectives 3-5 on evaluation of people's deprivation of good health, contrast of troubles in handling resources and examination of stakeholder's attitudes respectively will use qualitative analytical procedure.


The study will take devote Malawi, inhabitants n of people; the ministry of health headquarters in Lilongwe, Malawi's four central hospitals, n range of district private hospitals n community nursing homes and n health centers. There are also CHAM facilities, private hospitals and NGOs (both local and international) that support health system. The analysis will focus in every central nursing homes because they provide tertiary management good care. The ministry of health, because it is the head office, some preferred CHAM facilities in four regions and few picked NGOs in Malawi.


Objective 1-2 will aim for key informants at the head office and in the central nursing homes and the reviews of available books in Malawi. Objective 3 will focus on the discharged patients in the central private hospitals plus some community across the selected nursing homes. Objective 4 will concentrate on the health employees in CHAM and central nursing homes. Objective 5 will focus on key informants in NGOs which use health sector.


Since the analysis will make use of qualitative design, hence, participants will be chosen purposively.


Before data collection, consent will be extracted from the ministry of health head-quarters and all in-charges of the facilities where the study will take place. The research will be told the participants to seek their informed consent.

Data collection tools will be pre-tested, these includes interview guide for 1) discharged patients to determine any deprivation of these care, 2) healthcare workers to evaluate the issues in resources 3) key informants to analyse their attitudes. And checklist to examine challenges experienced by healthcare workers and patients deprivation of care.


In undertaking the proposed research, the concept of research ethics will never be ignored. All people involved with this research will have to give consent. No one will participate against his / her will but the research would like to obtain full participation from the members and not partial. Attention will be deployed to make sure that people's protection under the law aren't violated through this research. Members will find out the aim of the research and everything crucial in order that they can give knowledgeable consent. Individuals' identity will not be revealed in the info presentation and analysis. However, upon need, some participants predominantly NGOs will contain the copy of the research findings.


Data will be transcribed from Chichewa to English then themes will be developed from which quantitative data will be analysed while quantitative part will be handled by SPSS. Data will be kept confidential unless demanding measures are taken to access the same.


The data will be provided through quotations and where necessary desks and graphs will be used for the part of quantitative.


The dynamics of the research demands SIDA's Vitality Analysis framework. The intro and implementation of general population health user cost involves power of various stakeholders who've different forces of influence. The study then aspires to analyse and measure how much electricity Do these stakeholders have for the introduction and execution of customer fees in public areas health services, (Shaw RP et al, 1995).

SIDA's power evaluation targets understanding structural factors impeding poverty decrease as well as bonuses and disincentives for pro-poor development. Thus, health sector is a hub to development of which the poor need to be targeted. SIDA electricity analysis tool also will serve to stimulate thinking about techniques of change in terms of what you can do about formal and casual power relations, power set ups and the stars adding to it. The framework looks for to either deepen knowledge, facilitate dialogue, foster affect or feed into policy developing and programming of which in cases like this would be the introduction and execution of user fee in public private hospitals (Shaw RP et al, 1995).

In the same vein, political economy analysis also talks about the relationship of formal and casual institutions. The collected data will also be put through the critical examination under the relationship of informal and formal institutions (ibid).


The current research is of paramount importance to the people of Malawi. The study will accomplish the improvement of general public health services throughout Malawi. The best problem in medical sector is inadequate resources, consequently, the study is purported to handle research of how open public health user cost is definitely an alternative to financing public private hospitals. The improvement in public areas health services entails healthy people who is able to actively take part in development activities. The success in the execution public health individual fee can help never to over burden the government because general public health hospitals will be able to meet some needs through end user fee, hence, the government will have the ability use the part of budget allocated to medical sector in other areas of main concern.

The study provides an insight of development health sector and bring satisfaction to people especially those who use open public health services. The analysis assumes that if the public health user cost reform is implemented, people will access the services of higher quality compared to the current situation where patients are told to buy the approved medication in the private pharmacy because hospitals have no medication. On this then, the execution of user fee reduces the price tag on accessing open public health services in Malawi. No country can form if the health services are poor. The vitality of the existing study can't be over emphasized, if it will be well done, Malawi as a country will register good health and sociable development.


Becker, Gary (1991). A Treatise on the Family. Cambridge, Massachusetts, Harvard University Press.

Lucas, Robert, E. (1988). In the Technicians of Economic Development. Journal of Monetary Economics 22(1): 3-42.

Pritchett, Lant and Lawrence H. Summers (1996). Wealthier is More healthy. The Journal of RECRUITING XXX(4): 841-68.

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Schultz, Theodore W (1963). The Economic Value of Education. NY: Columbia School Press.

Schultz, Theodore W (1961). Buying Individuals Capital. The American Economic Review 51(1): 1-17.

Romer, Paul (1986). Increasing Returns and LONG HAUL Expansion. Journal of Political Overall economy 94.

Shaw RP, Griffin C. (1995), SIDA power examination Washington DC: World Bank

Sophie Witter (2010) Mapping customer fees for health care in high-mortality countries: proof from a recently available review ; HLSP institute

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Moses S, Manji F, Bradley JE, Nagelkerke NJ, Malisa MA, Plummer FA (1992). Impact of user fees on attendance at a referral centre for sexually sent diseases in Kenya. Lancet

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