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. 

Loving the Warm Heart of Africa

By World Camp Intern Zoey Ponder

It is my eleventh day here in Malawi and I am growing to love “ The Warm Heart of Africa” more and more. In just 11 days, I have experienced two trips to Camp Hope as well as adventures to Dedza and around Lilongwe. Lilongwe is the capital of Malawi and home to the World Camp house, which has quickly come to feel like home to me. Each time we return, I am always excited to get back to our evenings of dinner and chatting and days full of trips to various markets and other spots around the city.

Everywhere you go, there are vendors along the side of the road with all sorts of goods from sugar cane to woven furniture and everything in between. On the trip home from Camp the other day we even saw members of the Gule Wamkulu, a secret cult that performs dances at ceremonies, walking along the roadside.

One of my favorite parts of coming “home” is the men who work around the house. John is the House Manager and one of my favorite people to chat with. Each morning when I wake up John can usually be found in the kitchen and makes my mornings a delight (which for me is no easy task) his big smiles and mannerisms can cheer up anyone’s day; not to mention that he makes one mean shepherd’s pie! Ngoni is the Grounds Manager and he is always bringing in beautiful eggplant and tomatoes that he grows in the yard and greeting us at the gate with the enthusiasm of seeing a much missed friend. He makes coming home feel like a celebration regardless of how long I’ve been gone.

During our trip to Dedza and Camp you get to drive past some beautiful scenery, mountains which stick up out of the ground so sharply it is as if someone dropped them down from the sky. Baobab trees that stand broad and tall against the backdrop of villages with tall grass fences and roofs. Kids drive cattle carts alongside the road and roving bands of goats stress Emily out by always lingering too close to, if not in, the road.

In our trip to see the ancient rock paintings near Dedza we got to hike up one of the mountains to a cave with 2,000 year old paintings of animals and people on the ceiling. There is a chameleon, a duck, a person, a lion, a bull as well as other animals painted in black and white and still very visible after all this time. On the way back down the mountain to view even older rock art, we even saw some monkeys hanging out in nearby trees.

Closer to the village, there is rock art done by Pygmies that is 10,000 years old. The Pygmy rock art is red and reaches impressively high up, the Pygmies used ladders or stood on each other’s shoulders to paint all sorts of scenery including a nearly 20ft tall giraffe which was my personal favorite.

The longer I stay in Malawi, the more I see how beautiful this place is. Whether it is the beauty in the culture of kindness or the incredibly cute kids at Camp and everywhere else or in the breathtaking sunsets every evening, I cannot stop marveling at Malawi. In the next few weeks, I have no doubts I will continue being amazed as we travel to the Lake and as we start work on our different programs that will kick off in September and October.