Analytical summary - Partnerships for health development
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The Government of Malawi has put in place sector working groups in all ministries in recognition that better coordination of aid and alignment to Government systems enhances efficiency and effectiveness, reduces duplication and ultimately improves health outcomes.
At national level, the Health Sector Review Group is mandated as the coordinating body for the sector to enhance partnership for health development. The administrative and operational responsibility for health at the district level has been delegated to local government with its governance structures.
These structures have the potential to better engage communities in health sector planning and implementation. However, the full potential of a decentralized system will not be achieved without clearer governance structures between all levels (centre, zone, district, health facility and village).
However, the functionality of the structures is variable. In some cases members are not familiar with the roles and responsibilities of these committees, as they are rarely oriented on the functions of the committees. Strategies should therefore be put in place to ensure that these structures are functional.
While acknowledging that the Ministry of Health is the major provider of health services, there are also other partners playing an important role in the provision of services, especially the private sector.
The partnership with some partners such as the Christian Health Association of Malawi is quite strong, while that with the private for-profit sector is weak. There is a need to create and strengthen partnerships through the development of policy and guidelines to provide a framework under which intersectoral collaboration will be promoted.
In 2011, the Malawi Parliament passed the Public-Private Partnership Bill, which aimed at promoting partnership between the public and private sector in the delivery of services, including health. Within that context the Ministry of Health will develop policy and guidelines to promote intersectoral collaboration.
Despite the availability of the strategy, awareness and interpretation of the international initiates such as the Millennium Declaration at community level is low. It is important that a comprehensive communication strategy is developed to cover all aspects of health.
One of the core objectives of the health sector is to ensure that all Malawians have access to basic health services, especially in rural areas. This is enshrined in the current health sector strategic plan and the preceding plans. In 2004, the Ministry of Health made a policy commitment to institute service-level agreements (SLAs) as one of the strategies to improve access to health services, especially by the rural poor.
Over the period that SLAs have been in operation, facility-reported data indicate an increased utilization of health services covered by the SLAs, reflecting positive developments pertaining to SLA design intentions. None the less, a more exhaustive and consolidated analysis is warranted to get a full picture of the effect of SLAs.
During implementation of SLAs, various challenges have been cited by the contracting entities, reflecting perspectives of both parties, including:
- escalating costs of SLAs as utilization increases
- suspicion of overcharging and duplicate charging, leading to conflicts in various SLAs
- lack of monitoring for SLA implementation, both at operational level and central level
- non-functionality status of SLA steering committees in many SLAs affecting effective implementation of SLAs
- delay and/or inability to honour reimbursement costs for SLA services offered.
Within the context of south–south cooperation, Malawi has established Joint Permanent Commission of Cooperation agreements with its neighbouring countries, including Mozambique, South Africa, Zambia and Zimbabwe. The Joint Permanent Commission of Cooperation covers many areas, including those related to health development. Implementation of the Joint Permanent Commission of Cooperation has been varied. Some of the areas of cooperation date back to the 1980s and are still active, while others are relatively new.
Malawi has benefited from the South–South cooperation mostly in patient care referrals, especially cancer cases which are referred to India, South Africa, United Republic of Tanzania and Zambia.