Public service paying wards draw mixed feelings

When Ministry of Health and Sanitation allowed district hospitals to introduce optional paying services, improved service, convenience and mobilisation of domestic resources loomed large but the arrangement has ended up compromising service delivery. The Nation spot-checks established that in 46 percent of district hospitals, the paying services generate between K2 million and K12 million monthly. Authorities have hailed this as a step in the right direction.

But on the flipside, the facilities are short on infrastructure such that they are using structures meant for free services, thereby creating congestion in non-paying wings. Inadequate staff and skyrocketing costs of drugs and medical supplies further complicate the situation. In some of the district hospitals, the paying services have been suspended due to queries on use of resources while some patients also allege that the facilities are paying more attention to those in paying wards than the poor seeking free services.

From our findings, Chikwawa District Hospital generates an average of K12 million per month from paying services while Phalombe makes K7 million, Nkhata Bay is at between K5 million and K12 million while Machinga rakes in K9 million, Mulanje and Rumphi K4 million each, Salima brings K3.5 million, Karonga makes K2 million and Thyolo earns K1.5 million. Chikwawa district director of health and sanitation services (DHSS) Dr. Grace Momba said in an interview that the district hospital, whose total monthly budget is K68 million, introduced paying services in April 2022.

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She said: “Revenue collection systems have been strengthened, including signing of contracts with medical schemes. “Funds generated have been used for the procurement of drugs and medical supplies, supporting minor infrastructure maintenance and staff. The revenue has helped to improve morale and motivation for health workers.” In Phalombe, DHSS Dr.

Sam Sibakwe said in the context of constrained government funding, the paying wing has become a financial backbone, especially supporting procurement of essential drugs. Phalombe District Hospital, renamed John Chilembwe Hospital, is a new hospital and was pre-designed with a special paying wing with self-contained rooms, air conditioning systems and refrigerators. Said Sibakwe: “It [the revenue] also helps cover key operational costs such as fuel, electricity, cleaning materials and other emergency service as required.

It also supports locums, pay stipends for additional part time nurses and clinicians. “At the moment, the council is on a campaign to make sure all members of staff, some traditional leaders and councillors are on Masm [Medical Aid Society of Malawi] scheme so that they pay and we hope will boost revenue generation.” The hospital has a monthly budget of K55 million, he said. Nkhata Bay District Hospital provided the most detailed data with a report from its Accounts Department, sourced through DHSS Dr. Topsy Mdolo showing that the paying services are made up of 21 revenue streams.

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