Analysis of the Public Health User Fee Reforms in Malawi

Analysis of the Public health User Fee Re strainings in MalawiRESEARCH schemeResearch title The political economy synopsis of the implementation of macrocosm tumesceness drug user topple reforms in Malawi.BACKGROUND AND BRIEF LITERATURE followThe economic crises of the 1970s and 80s led m either countries to undergo structural reforms that called for reduced exoteric expenditure for basic serve. The reforms resulted in the introduction of cost sharing on the part of beneficiaries (Lucas 1988). In several countries, user salarys were imposed as a means to address recurrent costs problems and an extra source of revenue for antecedently undervalued services of professional providers. Countries responded differently to the introduction of user charges depending on domestic political risk and institutional capacity to efficiently administer the fees. With the reforms, everyday finance of wellness declined in many countries, and in some cases, private service providers seize d the opportunity to fill the gap (Romer, 1986). Although the involvement of private service providers helped to meet engage for those open to pay, it limited access of the lamentable to the same services due to the prohibitive costs.Over the past ten years, interrogation on economic emersion has demonstrated that human capital is a powerful force in the development process (Becker 1990). In consequence, a sustained increase in this form of capital is of the essence(p) for poverty reduction in low-income countries and for an ever rising standard of living. Health is one of the commonly used proxies for human capital an unperceivable magnitude or force that is part and parcel of human beings (Schultz 1960).Developing countries ar struggling to improve the lives of flock living in both sylvan and urban areas. The big challenge in these countries is lack of resources and problems in allocating the scarce resources. Various governments crap prioritized different spheres depe nding on the inevitably and demands of the people. Some baffle prioritized indigenous education and agriculture while others have prioritized mining and health sector. Developing countries have come up with different interventions purposed to cushion people and be able to practice the risk. Some interventions have taken the form of subsidy while others have taken the form of user fee exemption to mention however two (Schultz 1961).These interventions sometimes are driven by politics, that is why for one to effectively intervene needs to understand the interplay of politics and economics in the create countries. Depending on policy makers, some would prefer to implement subsidy programmes while others would have user fees exemption or both. User fees are charges one pays at the point of use. The stated interventions are good for the people but to the larger extent over burden the already struggling economy of the developing countries, (Litvack et al 1993). Consequently, govern ment sectors suffer due to being underfunded which has resulted to poor service delivery defeating the whole purpose of subsidy or user fee exemption. Some countries, thus, they have resorted to meet the deficit with the introduction of user fees. For example, in respective of health for all, Malawi government offers bighearted open health services to everyone in the estate (ibid).Through observation, the semipublic health services in Malawi particularly those in bordering di inflexibles such as Mchinji, Nsanje, Mwanza and Mulanje face very stiff competition on health resources because the hospitals in these districts serve even those from the neighboring countries such as Zambia and Mozambique.Currently with the growing population, government is failing to meet the demand of the free public health services which is manifested through the lack of medical checkup resources in the hospitals. Lack of resources might be because the government has a limited tax base to finance the public health services. For instance, in Daily Times of 18th August, 2014 carried a story that Kamuzu inter miscellanea hospital had suspended all the booked surgeries because the hospital had no medical resources required to carry out operations in the theaters. Burns unit department also suffered the same. In such circumstances the introduction of user fee in public hospitals becomes not an option but a necessity. The user fees may therefore, help in three aspects within health service sector improving efficiency by moderating demand, containing cost, and mobilize more funds for health care than existing sources providedPROBLEM STATEMENTThe aim of free public health services in Malawi was to bring e timbre and equity in accessing health services. It has been argued that with user fees in accessing public health services, the poor people could be disadvantaged. Axiomatically, healthy people make healthy nation and participate actively in the development activities. Defeating the a im of free public health services, it is the same poor people who are now struggling while the better off and even politicians use the private hospitals. Every person has got the right to good quality health, but the poor people in Malawi are now voiceless and spend painfully on the services that were meant to be free. The situation begs a oppugn that are the public services in Malawi really free at all when a person is told to buy aspirin tablets in private hospitals or pharmacies while the public hospitals have given the medicine to undeserving individuals such as those coming from other neighboring countries e.g. Mozambique just because public hospitals in Malawi are free. Poor people are also voiceless and lack responsibility on the hospital resources for it is given to them for free. Hospital workers have been frustrated because their working surround is not conducive since they are forced to work even when they do not have resources and are sometimes frustrated due late or no r payment at all for the extra hours rendered.Provision of quality health services is one of the social indicators of development. However, looking at the persistent resource shortages in the public health sector, Malawi as a country is far behind the expectation. Optionally, national policy makers in some countries such as Kenya and Mozambique thought to have kittens government revenue base through the introduction and implementation of user fee with an aim of improving services, for example, by improving drug availability and the world(a) quality of health care and extending public health coverage. Therefore, the current take away aims at undertaking the political economy analysis of the implementation of public health user fee reforms in Malawi. The study allow for be guided by the following sampled questionsWhat are the challenges to defends the implementation of public health user fees in Malawi?What is the reaction of policy makers towards public health user fee implementa tion?Is user fee good option to finance public hospitalsCan Malawi manage to embrace user fee policy (in terms of attitudes, ordainingness and capacity)How much is raised from the paying ward in the central hospitals, are the services different from the non-paying ward? If they are different, how do they differ? And how is money used. Has it brought any change?What are the problems that public hospitals meet?OBJECTIVESMain objective to undertake the political economy analysis of the implementation of public health user fee reforms in Malawi.SPECIFIC OBJECTIVESExploring the historical discourse of public health user fee in Malawi. find the reasons of government failure to introduce and implement user fee in public hospitals.Analysing how people have been deprived of good health services through free public health services in Malawi.Comparing the challenges in managing the resources faced in the CHAM hospitals and public hospitals.Analysing stakeholders attitude, impartingness and a bility to embrace public health user fee implementation policy.HYPOTHESISPoor quality of public health services can motivate public willingness to pay towards some improvement of the servicesInadequate funding leads to poor public health services in MalawiMalawians are deprived of quality public health services through free public health services.User fee reform in public health services can lead to efficiency and equity in public health resources in public hospitals.Politicians wish to introduce public health user fee reform but are deterred by the fear of losing popularity methodologySTUDY DESIGN AND METHODSThe study will mainly use qualitative descriptive and uninflected cross sectional approach. Objective 1 and 2 on public health user fee trend and government failure to introduce and implement the same respectively will use qualitative descriptive approach. Whilst objectives 3-5 on analysis of peoples deprivation of good health, comparison of challenges in managing resources an d analysis of stakeholders attitudes respectively will employ qualitative analytical approach.STUDY SETTTINGThe study will take place in Malawi, population n of people the ministry of health headquarters in Lilongwe, Malawis four central hospitals, n number of district hospitals n community hospitals and n health centers. There are also CHAM facilities, private hospitals and NGOs (both local and international) that support health system. The study will focus in all central hospitals because they provide tertiary management care. The ministry of health, because it is the headquarters, some selected CHAM facilities in four regions and few selected NGOs in Malawi.TARGET commonwealthObjective 1-2 will engineer key informants at the headquarters and in the central hospitals and the reviews of available literature in Malawi. Objective 3 will target the discharged patients in the central hospitals and some community around the selected hospitals. Objective 4 will target the health worker s in CHAM and central hospitals. Objective 5 will focus on key informants in NGOs which work with health sector.SAMPLING STRATEGYSince the study will employ qualitative design, hence, participants will be selected purposively.DATA COLLECTION PROCESSBefore data collection, consent will be obtained from the ministry of health head-quarters and all in-charges of the facilities where the study is going to take place. The research will be explained to the participants to seek their informed consent.Data collection tools will be pre-tested, these will include interview guide for 1) discharged patients to find out any deprivation of their care, 2) health care workers to assess the challenges in resources 3) key informants to analyse their attitudes. And checklist to assess challenges faced by health care workers and patients deprivation of care.ETHICAL devotionIn carrying out the proposed research, the concept of research ethics will not be ignored. All people involved in this research wi ll have to give consent. No one is going to participate against his or her will but the research would prefer to have full participation from the participants and not partial. care will be deployed to make sure that peoples rights are not violated through this research. Participants will be told the aim of the research and everything crucial so that they should be able to give informed consent. Participants identity will not be revealed in the data presentation and analysis. However, upon request, some participants predominantly NGOs will have the copy of the research findings.DATA MANAGEMENTData will be transcribed from Chichewa to English then themes will be developed from which denary data will be analysed while quantitative part will be managed by SPSS. Data will be kept confidential unless strict measures are taken to access the same.PRESENTATION OF DATAThe data will be presented through quotes and where necessary tables and graphs will be used for the part of quantitative. su pposed FRAMEWORKThe nature of the research demands SIDAs Power Analysis framework. The introduction and implementation of public health user fee involves power of variant stakeholders who have different powers of influence. The research then aims to analyse and gauge how much power Do these stakeholders have towards the introduction and implementation of user fees in public health services, (Shaw RP et al, 1995).SIDAs power analysis focuses on understanding structural factors impeding poverty reduction as well as incentives and disincentives for pro-poor development. Thus, health sector is a hub to development of which the poor have to be targeted. SIDA power analysis tool also serves to stimulate thinking about processes of change in terms of what can be done about formal and informal power relations, power structures and the actors contributing to it. The framework seeks to either deepen knowledge, comfort dialogue, foster influence or feed into policy developing and programming of which in this case will be the introduction and implementation of user fee in public hospitals (Shaw RP et al, 1995).In the same vein, political economy analysis also looks at the interaction of formal and informal institutions. The collected data will also be subjected to the critical analysis under the interaction of informal and formal institutions (ibid).8.0 JUSTIFICATION OF THE RESEARCHThe current research is of paramount importance to the people of Malawi. The study will facilitate the improvement of public health services throughout Malawi. The big problem in the health sector is inadequate resources, consequently, the research is purported to carry out analysis of how public health user fee can be an alternative to financing public hospitals. The improvement in public health services entails healthy people who can actively participate in development activities. The success in the implementation public health user fee will help not to over burden the government because pub lic health hospitals will be able to meet some needs through user fee, hence, the government will be able use the part of budget allocated to the health sector in other sectors of priority.The study will provide an insight of development health sector and bring satisfaction to people especially those who use public health services. The study assumes that if the public health user fee reform is implemented, people will access the services of higher quality compared to the current situation in which patients are told to buy the positivistic medication in the private pharmacy because hospitals have no medicine. In this then, the implementation of user fee reduces the cost of accessing public health services in Malawi. No country can develop if the health services are poor. The vitality of the current study cannot be over emphasized, if it will be well done, Malawi as a country will register good health and social development.REFERENCESBecker, Gary (1991). A Treatise on the Family. Cam bridge, Massachusetts, Harvard University Press.Lucas, Robert, E. (1988). On the Mechanics of Economic Development. Journal of financial Economics 22(1) 3-42.Pritchett, Lant and Lawrence H. Summers (1996). Wealthier is Healthier. The Journal of Human Resources XXX(4) 841-68.Schultz, Theodore W (1960). Human Capital Formation by Education, Journal of Political prudence 68(6) 571-83.Schultz, Theodore W (1963). The Economic Value of Education. refreshing York Columbia University Press.Schultz, Theodore W (1961). Investing in Human Capital. The American Economic Review 51(1) 1-17.Romer, Paul (1986). Increasing Returns and Long Run Growth. Journal of Political Economy 94.Shaw RP, Griffin C. 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