Access to Health Care: How Governance Plays a Role

By Intern Rachael Thorn

World Camp’s work focuses on helping the people of Malawi access health care. There are many challenges to health access in Malawi and issues surrounding governance are a starting point to help us understand lasting and sustainable solutions for communities. 

Malawi’s government decreases its capacity to provide fundamental services to its citizens through poor governance that would ultimately only strengthen Malawi as a whole. The 2014 report of the Corruption Perception Report ranks Malawi as 110 out of 174 (with number 1 being the country with the least amount of corruption). Its score is 33 on a scale of 0 (highly corrupt) to 100 (not at all corrupt) (Transparency International).

Corruption Perceptions Index 2014
The perceived levels of public sector corruption in 175 countries/territories around the World:

What does this have to do with access to health care? Let’s take a look at Malawi’s government. Malawi appears to have a patronage system, which means the government rewards contacts in the private sector for their support or in exchange for furthering their political advantage. Between a patronage system and the large income disparity present in Malawi, we begin to see a vicious cycle of poverty and stagnation for lower classes. As there is less room for reward in sectors like education and health, for government officials and companies, less money is put into these underfunded sectors. Largely, a system has been put in place that is beneficial for some, but not for those who depend on the state to provide fundamental public services.

The 1998 Local Government Act was an attempt to introduce a framework that diminished instances of corruption. This was implemented “to further the constitutional order based on democratic principles, accountability, transparency and participation of the people in decision making and development processes” (Commonwealth Local Government Forum). However, Malawi’s rule of law lacked the ability to enforce this accountability that would come from the democratic process, because it was proposed without outlining methods to constrain the patronage system already in place. Thus, the pedestal of democracy did not have the legs to stand on and the tradition of patronage continued to dictate the priorities of the public sector.

We must remember that it is difficult to talk about the corruption in any country because it is only the perception of corruption that it is verifiable. Thus, to quantify it, such as the Corruption Perception Report does, only tells us part of the story. It is more important to understand that the citizens perceive this corruption based on the quality of life in their daily experiences and accessibility to public services. World Bank’s “survey results suggest that users (households and businesses) regard public institutions as delivering generally inferior quality services or alternatively that none of the public institutions listed are performing exemplary public service in Malawi. The performance and the perceived honesty/integrity of institutions are highly correlated” (eldis). It may be difficult to view public institutions as reliable for many citizens after the 2013 Cashgate scandal in which over 70 people were arrested in regards to illegitimate payments from the government that were being paid to civil servants who had previously supported political players.

Why is understanding corruption in state governance important? Where do we go from here? One major form of change comes through social mobilization that comes out of education, awareness and empowerment. World Camp is working towards all of these things. We face the systemic problems everyday and have to continue to believe that they are not unchangeable. The first step in mobilization is understanding where the foundation is cracked and how that crack trickles down to affect almost every aspect of society. The first of the World Bank suggestions for moving towards progress says: 

“In fighting corruption not only must the approach be holistic, but it must also be carried and supported by all stakeholders in the society” (Governance and Corruption Diagnostic Survey in Malawi). 

Continuing support of our work to include all citizens of Malawi in having an empowered voice can lead to improved access to health care and education. Our holistic programs reflect the suggestion of the World Bank and looking towards the future, the hope instilled in our partner communities can become empowerment—and empowerment can become change. 

Risky Business: Malawi's Youth and Tobacco

In the past decade, Malawi has become one of the worlds five largest tobacco producers. (Aljazeera) As a result of Malawi’s high-nicotine, low-cost tobacco, many major cigarette brands are including Malawian tobacco in their blend. More than 90% of Malawi’s tobacco is bought by U.S.-based leaf buyers Universal Corporation and Alliance One International. These companies resell to tobacco firms, amongst these firms are such big names as Phillip Morris (Marlboro) and British American Tobacco (Lucky Strike) (The Guardian). Malawian tobacco can be found in the blend of nearly every cigarette smoked in the west. 

At first glance the industry may seem good for Malawi, being that it is one of the least developed nations in the world, ranking 153 of 169 countries in the human development index. (Aljazeera) Unfortunately, however, the tobacco industry has done little to improve the situation for Malawians and much to improve the payout for the large western companies that purchase the incredibly cheap “green gold”. The price of this tobacco is kept low for big business in a multitude of ways. There are low tariffs on unmanufactured tobacco imports and a low labor cost. The labor cost is often kept so low by employing child laborers.  

Photo: The Guardian

Though the minimum age to work in Malawi is officially 14, it is common to see children as young as five picking tobacco alongside their parents. It is estimated that 20% of children aged 5-14 in Malawi are working. (Bureau of International Labor Affairs) Many of these children drop out of school to work in tobacco farms and other industry and are unable to return to school or only able to attend school sporadically. Child laborers are especially susceptible to work-related injury and illness. When working with tobacco, large amounts of nicotine can be absorbed through the skin causing nicotine poisoning, an incredibly common ailment amongst child tobacco workers. Large tobacco industries claim not to support farms that employ child laborers, but often do little to actually prevent child labor. In addition, the legal framework to prevent child labor in Malawi is weak. 

The most effective method thus far for preventing child labor is pressure on the companies that purchase the tobacco, in turn putting pressure on the government as well as farms. Other groups suggest improving the school system to attract children and families to enroll and stay in school. This is problematic, however, since many families need the children to work in order to support the family. An improved education, though valuable, would not immediately help support the family. The main groups making headway within the farming system and the government are small NGO’s and other grassroots programs that support both the children and the family. Still, with tobacco sales comprising 70% of Malawi’s income and Malawi being one of the most child labor-intensive economies in the world, it is unlikely much will change as long as companies can keep the tobacco cheap.

This blog was written by Zoey Ponder

Happy International Women's Day!!

In honor of International Women’s Day, we thought we would look at how women in Malawi are striving to improve their situation. From a female president to local mothers working to support area youths, Malawian women shape their communities and are increasingly fighting for more rights and better livelihoods. 

For many women living in Malawi, the appointment of Joyce Banda as president has been an exciting indicator of change to come in the next few years for women in Malawi. More than ever, the country’s women are striving to achieve greater access to education, healthcare, opportunity and human rights. Historically, women have suffered an unequal status in society. Joyce Banda’s pledge to strive for women’s empowerment and rights reflects her own past that mirrors the situation of many women in Malawi. Banda was able to escape an abusive marriage and move on to a new life, job, and marriage, but she realizes that many women do not have access to the same opportunities as she.

“Two years later I got married again to my husband who was a high court judge in Malawi. For the next two, three years I moved from zero to hero: I was running the largest business owned by a woman in Malawi, in industrial garment manufacturing. But when I looked back his fingerprint was all over: if I wanted training, he paid; if I wanted a loan, he came with me. Because of his status in society everything was easy for me, so I had succeeded but I had succeeded because I was privileged. And that's when it began to worry me. I began to think about those that were in my situation that were not able to walk out of an abusive marriage, or maybe those that did not know where to go, that were in a single headed marriage, or widows.”

Women all over Malawi suffer similar conditions every day. But in realizing their shared situation, women have been rising up to improve their personal conditions and access to assistance.

As seen in this article, Malawi’s women have recently been standing up for improved healthcare and their rights concerning HIV/AIDS. For instance, the main antiretroviral (ARV), a drug taken to prevent the onset of HIV after one is infected with it, provided by the Malawian government is D4T. However, D4T contains harmful chemicals that results in physical disfiguration and even eventual death. Malawian women have been campaigning against the provision of these drugs and demanding more effective treatments.

In a separate event, a health clinic in the town of Chipoka was closed because it did not have sufficient staff to remain open. HIV-positive patients seeking ARVs on a Thursday were told they could not get them until Tuesday. Female activists, knowing this could be detrimental for the HIV-positive individuals, protested and spoke with officials, and managed to have the clinic reopened 7 days a week as originally intended. (Note: Taking ARVs sporadically or inconsistently can lead to drug resistance, rendering a particular drug or drug cocktail useless.)

“We are going to challenge the government to make a policy to ensure a sustainable ART [antiretroviral treatment] regimen regardless of whether donors are here or not. And we also need the government to make sure that [HIV] positive women have their own resources like savings loans and fertilizers [for farming]. It’s our responsibility to fight for these things,” stressed rights activist Ms. Sibongile Chibwe

In other parts of Malawi, many women’s groups and mothers’ groups have been coming together to monitor the enrollment of girls in school, as well as their attendance and retention. These groups realize that increasing education for girls will in turn decrease the poverty rates in a society – raising the overall productivity of that community. UNICEF published a short piece on a Mothers’ Group that has helped coax girls back to school at Mnjolo Primary School. There are many cases such as this in which these groups have been successful in increasing enrollment by providing things that very poor families cannot afford for school, like uniforms.

There is growing hope for the women of Malawi as they rise up to change their own conditions. In taking this stance, women are empowering themselves and making the first steps of changing century old attitudes, habits, and situations that have deprived women everywhere. Today we salute these women and hope to be able to support them in their efforts.
 

A Return Journey to Malawi

A Return Journey to Malawi

When I arrived in Malawi this January it was 8 years to the day since I had first set foot there. I had always hoped to return to Malawi but never fully expected it to happen. How could I be so lucky as to set off on such an adventure more than once in a life? 

After a quick change of clothes (it was balmy in Lilongwe unlike DC in January), and Customs, I met my partner in crime, and guide to all things Malawi, Michael Kumwenda, our Country Manager. I was admittedly exhausted after the trip from DC but I was exhilarated on the drive from the airport to our house in Area 3. I had absolutely forgotten just how beautiful Malawi is – particularly in the rainy season. As before, the side of the highway was as congested as the roadway itself, filled with men transporting goods on the back of bicycles; whole families piled onto a single bike; small groups of school children walking in single-file lines; vendors selling all manner of things, from bricks, to tire scraps to puppies.

January is typically a time of great activity for World Camp. This particular January we were hosting a study abroad trip for a group of students from Appalachian State University. They, however, had departed for safari in Zambia the morning I arrived. It had been a long time since I had seen our house or any of our staff there, but it all came back so easily: the big, open space of the living room; the enormous kitchen (with its crazy cabinetry); and wonderful John and Angoni. 

The majority of my time in-country was spent working hand-in-hand with Michael to learn more about our day-to-day operations in Malawi. I attended many of our World Camp Club meetings, stakeholders’ meetings, and met with the community based organizations with which we work. Because the ASU group was there for the first half of my trip I was also able to do an overnight homestay in Mchezi and enjoy some of the fun trips our volunteer groups take.

My time in Malawi was half a chance to learn, half an exercise in remembering. I was reminded of the deep generosity and kindness of every Malawian I have met, the joy of driving down a dirt road and waving to everyone you pass. Being in Malawi feels like being in the biggest small town despite its rapidly growing population. Getting to spend a second month in Malawi, I was able to learn so much more about the country, its people, and customs. I was also reminded just how good Garlic Nali really is.

My time in Malawi has been and will be instrumental in the expansion of World Camp’s programming. I was able to learn vast amounts about Camp Hope (which is quickly approaching!), see first-hand how our World Camp Clubs are progressing, get to know our staff, and collaborate with them on many tasks and programs. I am excited to see what all will come of my trip. We have already refined processes, re-assessed program roll-out, and developed concrete measurement tools as a result of my time in Malawi.

I am grateful to have had the chance to return to Malawi and excited by the prospect of returning this summer. I know that the more amazing trips to Malawi I am able to take, the more I will grow, and the more World Camp will benefit.