A Memorandum of Understanding (MoU) between Malawi and Mozambique on delivery of health services is contributing to bringing Nsanje district health operations on their knees as Mozambicans now make up almost half of the total number of patients treated in the district’s facilities annually.
In 2007, the governments of Malawi and Mozambique entered an agreement for their people in the border districts to access health services in either country’s facilities.
But it appears that Malawi is the only one providing the services as health facilities in Mozambique are located far away from the border and that services there are not for free, leading to Mozambicans flocking to Malawi to access the free services.
In 2011, the number of Mozambicans that accessed health services in the district constituted 21 percent of the total number of patients. But the figure has almost doubled and has been at 40 percent in the past two years, with many refusing to disclose whether they are Mozambicans.
And officials confirmed the district is teetering on the edge with its perennially inadequate resources which are allocated based on the population of the district.
While there are several border districts in Malawi that face the same problem, Nsanje’s case could be worse off as it is the only one that is surrounded by a foreign country in all but one direction – the north.
Mozambique does not have any health facility near the border; the nearest one in its territory is located about 75 kilometres away, it is said.
Yet Mozambique, it is less than a kilometre from the border in the east to Nsanje District Hospital, 30 kilometres from the border in the South and 25 kilometres from the border in the west to Nsanje District Hospital.
District Health Officer Medson Matchaya said the situation is made even worse by the fact that Nsanje is always hit by all manner of natural disasters.
When there are adequate rains, the district suffers flooding and its resultant health problems and when there is drought it suffers from high malnutrition cases.
“In addition, we are also far from where government business takes place. Our referral hospital is Queen Elizabeth Central Hospital [a distance of about 152 kilometres]. Malawi Blood Transfusion is in Blantyre.
“Most of the meetings that we have to attend happen in Blantyre or in Lilongwe [which is about 450 kilometres]. We also do not have shops here for our hospital procurement needs, so we have to go to Blantyre. All this has a serious implication on costs,” said Matchaya.
The washing away of Chiromo Bridge in the 1990s also means the district is stretched further in terms of delivering health services.
The district hospital and health office are in the West Bank. To service facilities in the East Bank, staff have to travel through Chikhwawa covering a total distance of about 500 kilometres.
In 2011, the district health office estimated that it would need at least K300 million to be able to adequately meet some of its challenges at that time but it had been allocated K142 million.
In the 2011/12 budget, it received K245 million. In the 2012/13 budget, it was allocated K242 million and in this financial year, it has been allocated K244 million.
“It’s really hard to cope. We have to cut on other expenditures so that we at least attend to critical ones. But working continually in a situation of inadequate resources can be frustrating to staff.
“We have been lobbying with the National Local Government Finance Committee to consider this and all we can do is to hope.
“As for the foreigners, we cannot turn them away because this was agreed upon by the two governments and we are only implementing what was agreed. What we do here is to record them for our own planning,” said Matchaya.
The district, which has also been smarting from the effects of hosting thousands of refugees fleeing the civil war in Mozambique in the 1980s, has a population of 238,000, according to the 2008 National Population and Housing Census.
Malawi Health Equity Network (Mhen) said it was wrong in the first place for Malawi to enter into such an agreement with Mozambique.
Mhen Executive Director Martha Kwataine said Malawi should have taken into consideration issues of location of health facilities and how Malawi’s free health services would work to the disadvantage of the country.
“The health facilities have no choice but to give the services to the Mozambicans but we are punishing our own people.
“First our people scramble for the medical resources with foreigners and may not find them sometimes. Secondly our taxpayers are paying to service non-Malawians. This just isn’t right,” Kwataine said.
She said government officials are aware of this problem. They are also aware that it does not only hit Nsanje and they know the answers to it but deliberately choose to sit on their hands in taking a proper action.
“One of the solutions is to introduce user fees in our facilities. With that in place the Mozambicans will either see no point of coming here or if they do come, they would be shoring up our resources and therefore ease Malawian taxpayers’ burden,” she said.
However, the Ministry of Health, while saying it was aware of the problem, ruled out revocation of the agreement. The ministry’s spokesperson Henry Chimbali said the matter has been discussed at the ministry for a review of the terms of the agreement.
“We do not think revoking the MoU is a solution because diseases do not see boundaries as humans do…. While we may think our relationship with Mozambique is one sided on health, there is a lot that has to be looked into on this matter because there is so much that we share with Mozambique besides health care,” Chimbali said.
He said Mozambican health officials were in the country two weeks ago to discuss the same matter.
“Our approach on this matter is [that this agreement] is mutually beneficial and they [the Mozambican counterparts] are positive on some of these contentious matters. We are hopeful this problem is to be sorted out soon,” he said.
Apart from Nsanje, some of the districts that have reported previously as servicing foreigners include Likoma, Ntcheu, Mulanje, Dedza, Mangochi and Thyolo.
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