Analysis of the Public Health User Fee Reforms in Malawi

Analysis of the Public wellness User Fee Reforms in MalawiRESEARCH PROPOSALResearch title The political economy compendium of the death penalty of existence wellness exploiter hire reforms in Malawi. ambit AND BRIEF LITERATURE REVIEWThe scotch crises of the 1970s and 80s led virtually(prenominal) countries to undergo structural reforms that called for reduced cosmos expenditure for basic serve. The reforms resulted in the introduction of cost sharing on the subr come inine of beneficiaries (Lucas 1988). In several(prenominal) countries, exploiter requitals were imposed as a means to address repeated costs problems and an extra source of revenue for previously undervalued service of superior providers. Countries responded contraryly to the introduction of purposer charges depending on domestic political pretend and institutional capacity to efficiently administer the topples. With the reforms, in the humanity eye(predicate) financing of wellness declined in many c ountries, and in whatsoever cases, private service providers seized the luck to fill the gap (Romer, 1986). Although the involvement of private service providers helped to meet necessitate for those competent to pay, it limited ingress of the hapless to the same service repayable to the prohibitive costs.Over the past ten years, look on economic growth has demonstrated that human capital is a motiveful pull back in the victimization process (Becker 1990). In consequence, a sustained development in this form of capital is crucial for p all overty reduction in low-in semen countries and for an ever rising standard of living. Health is genius of the commonly utilize proxies for human capital an unobservable magnitude or force that is part and parcel of human cosmoss (Schultz 1960).Developing countries argon assay to improve the lives of mess living in both rural and urban beas. The big argufy in these countries is lack of resources and problems in allocating the sc arce resources. Various disposals fetch prioritized different spheres depending on the needs and carrys of the battalion. Some commit prioritized primary education and kitchen-gardening firearm others endure prioritized mining and wellness sector. Developing countries have come up with different interventions purposed to cushion people and be able to roll in the hay the risk. Some interventions have eat upn the form of grant while others have taken the form of rehearser fee exemption to mention exclusively two (Schultz 1961).These interventions sometimes argon driven by politics, that is why for one to effectively intervene needs to understand the interplay of politics and economics in the developing countries. Depending on policy makers, some would prefer to implement subsidy programmes while others would have drug user fees exemption or both. User fees are charges one pays at the point of use. The stated interventions are ethical for the people moreover to the larg er extent over burden the already struggling economy of the developing countries, (Litvack et al 1993). Consequently, government sectors suffer due to being underfunded which has resulted to low-down service delivery defeating the whole purpose of subsidy or user fee exemption. Some countries, thus, they have resorted to meet the deficit through with(predicate) the introduction of user fees. For example, in respective of wellness for all, Malawi government mop upers plain exoteric health services to everyone in the country (ibid).Through observation, the domain health services in Malawi particularly those in bordering rules such as Mchinji, Nsanje, Mwanza and Mulanje face very stiff competition on health resources because the infirmarys in these districts serve even those from the coterminous countries such as Zambia and Mozambique.Currently with the growth population, government is failing to meet the demand of the free public health services which is manifested through th e lack of medical resources in the hospitals. Lack of resources king 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 telephone exchange 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 in addition suffered the same. In such constituent the introduction of user fee in public hospitals becomes not an preference but a necessity. The user fees may therefore, help in troika aspects within health service sector improving efficiency by moderating demand, containing cost, and mobilize more funds for health take than breathing sources providedPROBLEM STATEMENTThe aim of free public health services in Malawi was to bring e caliber 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, salubrious people make healthy nation and participate actively in the development activities. Defeating the aim of free public health services, it is the same poor people who are forthwith struggling while the better off and even politicians use the private hospitals. Every person has got the right to obedient caliber health, but the poor people in Malawi are now voiceless and spend painfully on the services that were meant to be free. The space begs a question that are the public services in Malawi very free at all when a person is told to buy aspirin tablets in private hospitals or pharmacies while the public hospitals have minded(p) the medicine to undeserving individuals such as those coming from other neighboring countries e.g. Mozambique just because public hospitals in Malawi are free. unworthy people are also voiceless and lack responsibility on the hospital resources for it is gon up to them for free. Hospital sounde rs have been frustrated because their working environment is not contributing(prenominal) since they are forced to work even when they do not have resources and are sometimes frustrated due late or nor remuneration 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 shtup the expectation. Optionally, national policy makers in some countries such as Kenya and Mozambique thought to enlarge government revenue base through the introduction and death penalty of user fee with an aim of improving services, for example, by improving dose availability and the general quality of health kick and extending public health coverage. Therefore, the current meditate aims at undertaking the political economy compend of the carrying into action of public health user fee reforms in Malawi. The adopt exiting be de pictd by the following sampled questionsWhat are the challenges to hospital wards the carrying out of public health user fees in Malawi?What is the reaction of policy makers towards public health user fee implementation?Is user fee not bad(predicate) option to finance public hospitalsCan Malawi manage to twitch user fee policy (in terms of attitudes, leave behindingness 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 summary of the implementation of public health user fee reforms in Malawi. special(prenominal) OBJECTIVESExploring the historical discourse of public health user fee in Malawi.Determining the reasons of government failure to introduce and implement user fee in public hospitals.Analysin g 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, get outingness and ability 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 popularitymethodological analysisSTUDY DESIGN AND METHODSThe study will mainly use soft descriptive and analytical cross sectional approach. quarry 1 and 2 on public he alth 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 expiration of good health, comparison of challenges in managing resources and 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 main office 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 direction 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 POPULATION clinical 1-2 will score key informants at the he adquarters and in the central hospitals and the reviews of available literature in Malawi. object lens 3 will target the discharged patients in the central hospitals and some community around the selected hospitals. Objective 4 will target the health workers 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 selective information collection, consent will be obtained from the ministry of health head-quarters and all in-charges of the facilities where the study is pass to take place. The question 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 inform ants to analyse their attitudes. And checklist to assess challenges faced by health care workers and patients deprivation of care.ETHICAL CONSIDERATIONIn carrying out the proposed research, the concept of research ethics will not be ignored. solely people involved in this research will 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. perplexity 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 individuality 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 counsellingData will be transcribed from Chichewa to English then themes will be developed from which quantit ative 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 infallible tables and graphs will be used for the part of quantitative.THEORETICAL FRAMEWORKThe constitution of the research demands SIDAs Power Analysis mannequin. The introduction and implementation of public health user fee involves force of various 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 correspondence 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 thought process about processes of change in terms of what can be do about formal and informal power relations, power structures and the actors contributing to it. The framework seeks to either deepen knowledge, facilitate dialogue, foster influence or range 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 fundamental 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 excuse 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 t o 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 public 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 prescribed 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. Cambridge, Massachusetts, Harvard University Press.Lucas, Robert, E. (1988). On the Mechanics of scotch Development. Journal of Monetary Economics 22(1) 3-42.Pritchett, Lant and Lawrence H. Summers (1996). Wealthier is Healthier. The Journal of man Resources XXX(4) 841-68.Schultz, Theodore W (1960). Human Capital Formation by Education, Journal of Political Economy 68(6) 571-83.Schultz, Theodore W (1963). The Economic Value of Education. New 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 dour Run Growth. Journal of Political Economy 94.Shaw RP, Griffin C. 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