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

World News: Current Events from Malawi

 Check out the latest news from Malawi:

Women’s empowerment project launched

            Joyce Banda has launched a K4.1 billion project titled the Gender Equality and Women Empowerment program, which will work to “contribute to the acceleration of efforts towards the advancement of gender equality and equity as a human right for the reduction of HIV and AIDS and poverty.”  Equality of both sexes will undoubtedly lead to greater development, economic growth, and an improved society.  The project, which will be overseen by the Ministry of Gender, Children, and Social Welfare, will be implemented in 13 districts based on numerous factors, including poor socio-economic statistics, cultural practices that promote inequality, and high rates of HIV.  Banda has promised to “work tirelessly in improving the conditions and welfare of girls and women in the country.”

Source: http://www.nyasatimes.com/malawi/2012/07/10/jb-launches-k4-1bn-gender-womens-empowerment-programme/

EU and Malawi sign a grant agreement in response to the kwacha devaluation

            This past Monday, Malawi and the European Union signed a K40.7 billion grant agreement to support Malawi’s poor in light of the recent kwacha devaluation.  The money will be spent on multiple programs, including a social cash transfer program, rural income program, and rural infrastructure development program.  Alexander Baum, the EU ambassador to Malawi, praised President Banda’s efforts to decrease abuse of donor funds, which is a common problem faced by many governments.  Malawi’s Finance Minister, Ken Lipenga, promised that any public officials found abusing public resources will face consequences by the Banda administration, which does not accept corruption.

Source: http://www.malawivoice.com/2012/07/10/devaluation-response-eu-malawi-sign-k40-7-billion-grant-agreement-for-the-poor-40975/

Malawian chiefs against oil drilling in Lake Malawi

Local chiefs in the Nkhata Bay district are adamantly voicing their concerns about drilling for oil in Lake Malawi.  Surestream Petroleum Company, based in the United Kingdom, has been given permission from the Malawian government to begin drilling in the lake from Karonga to Nkhotaota.  Local leaders argue that the drilling will negatively affect the lives of many Malawians.  Not only do thousands of people rely on Lake Malawi’s fishing industry for jobs, but the fish also provides Malawians with a source of inexpensive and protein-rich food.  The chiefs have formed a petition highlighting their concerns and are giving the government until July 30^th to respond.

Source: http://www.nyasatimes.com/malawi/2012/07/10/chiefs-against-oil-drilling-on-lake-malawi/

New Olympic stadium to be built in Lilongwe

            President Joyce Banda has decided to relocate the Olympic stadium that was previously being built in Blantyre by the Mutharika administration back to its original location in Lilongwe.  Banda explained the move, stating the importance of the capital and its central location in Malawi.  The stadium will have a seating capacity of 40,500 and will feature a synthetic running track, conference rooms, shopping and exhibition rooms, press galleries, and many other amenities.  China will be funding the project through a $65 million loan.  The stadium is expected to be finished in two years.

Source: http://www.nyasatimes.com/malawi/2012/07/12/jb-lays-foundation-stone-for-malawis-new-olympic-stadium/