The Role of Church Health Units in Health Reforms

Presented at CCIH Annual Conference, May 29, 2005

Dr. Maono NgwiraSynod of Livingstonia Health CoordinatorP.O. Box 1000, MzuzuMALAWI +(265) 1 – 334-019ccaphealth@malawi.net

Malawi

Synod of Livingstonia ofChurch of Central Africa, Presbyterian

. Synod of Livingstonia – Formed by Free Church of Scotland in 1875.

• Three hospitals- Average capacity 150 beds.

• Provides about 20% of health services to a population of 1,300,922 of the northern region.

Current Station

Health Reforms in Malawi• Hospital Autonomy for referral central hospitals at

regional level- Improve efficiency.• Essential Health package (EHP).-Improve access

to services• Sector Wide Approaches (SWAPS) - Rationalize

use of funds• Decentralization-Empowerment,ensuring

resources get to the community.• Health financing- explore various options.

Role of Synod of Livingstonia in Reforms

(attributes of SOL Units that facilitate reforms)

• Some degree of independence

• Less bureaucracy

• Financial and experiential inputs from expatriate missionaries

• Commitment and accountability.

Synod of Livingstonia Areas of reforms at service level

1. Health Passports (Patient records)

2. Organization of Services

3. Health financing

4. Prevention of Mother to Child Transmission (PMTCT)

5. Provision of ARVs

Health Passports – Patient-kept record• Prior to development of

booklets, record keeping was poor.

• Problems; loss of medical records, poor filing, confidentiality, reliance on patient for medical history.

• Booklet “revolutionized “ patient care in Malawi. Frank Dimmock instrumental in its development in early 1990’s while with SOL as Health Coordinator.

Health Booklets

Organizational Structures• Ministry of Health: Main functions policy

formulation services, setting standards, monitoring and evaluation of lower level activities.

• Lower level units accountable to MOH.• In contrast CHAM units enjoy a certain degree of

autonomy. Accountable to their respective Health Boards. Management are more free to make decisions.

• Government has studied strides made by Churches in this area.

Health Financing

• Options are limited• Government funds for health are from treasury

and donors. Services are free but operate limited-scale paying sections.

• Church units operate cost-sharing initiatives.• Government has examined their operation. Church

units have vast experience in this area. Will government explore this further?

Prevention of Mother to Child

Transmission (PMTCT) • First rural institution to initiate this

programme in Malawi was Embangweni Mission Hospital a SOL unit.

• Government and other CHAM units have visited this unit since inception in 2001.

• Now government program• VCT services scaled-up to mobile

clinics an innovation in this program.

Provision of ARVs• ARVs limited to two referral hospitals for many years

on cost sharing basis. However unaffordable for many Malawians (K10000/month US$ 100).

• Two SOL institutions begin providing ARVs to staff and community at a cost in 2003. Purpose was to address need in Northern Malawi. Drugs obtained through funds from donors.

• ARVs become free in 2004 at National level• SOL unit experiences helps to develop the national

ARV programme. National AIDS Commission includes our personnel in its program.

Challenges in reform process (1)

• Accountability- SWAPs and EHP different systems and reporting

• Financial- free services vs. cost sharing (EHP)

• Promoted commodities such as condoms (EHP) - different view points.

Challenges in reform process (2)

• Human resource- reforms entail additional staff (EHP). Lead to un-healthy competition!

• Proposed Service level agreements (SLA) -enhance greater influence and control by government. Government already pays salaries.

Conclusion• Synod of Livingstonia (SOL) will continue to be

responsive to changing environment and will enhance government mandate to improve welfare of Malawians

• Church units can hasten reform process and are moving ahead in some areas

• Church units can initiate interventions at operational level which are reformist in nature.

• Reforms will augment the strength of the partners to the benefit of the communities we serve.

Key questions

• Survival (sustainability) as Church Health unit

• Identity as Christian institution?