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. 

Connecting Community Engagement with a Global Mission

By World Camp Intern Rachael Thorn

World Camp’s United States headquarters are located in Asheville, NC, a small city known for its active local engagement and progressive ideas centered on community. As our focus lies on Malawian communities, it is necessary to understand how to motivate a tight-knit local community to become active in a far away community. Many people become more invested in projects when they are directly affected. For example, issues concerning climate change are more likely to be addressed when adverse effects are noticeable and affect one’s every day life. So, how do we connect community engagement with a global mission? What gets people passionate in engaging with an organization whose outcomes benefit those living in different parts of Malawi?

We should consider that the three aspects of community engagement involve decision-making, capacity building, and relationship development (Bang the Table). While these three facets are not mutually exclusive, a broader engagement relies most heavily on relationship development to engage citizens at a local level. Since the local community does not directly see the benefits of engagement, it is necessary for the lens to be widened to include a global vision and to redirect what a successful outcome looks like.

This is difficult, as modern psychology shows that humans are generally insensitive to scope. This means if you could save 1,000 birds by giving $80, you would not increase that amount proportionately if you were saving 10,000 birds. Since individuals are rather unaware of scope, the next approach to successful community engagement is outreach. If more people can become excited about the global vision, then the cumulative engagement will be more powerful than from a few individuals who will not be more driven to give by an ever increasing need. This is relationship development.

 Engagement through relationship development can come about by combining a few tools. These include: accessibility to information, clarity of mission and vision, providing welcoming and approachable events, implementing reward systems, and engaging with already present community staples. One of the best ways to keep the local community engaged is to make progress visible and current. Luckily, our globalized world can provide the reward of seeing the effects of donations or involvement almost instantly as pictures, videos, and online posts can keep donors updated on the successes that are happening everyday.
Stay connected to World Camp’s programs and projects, not only through this blog, but also on Facebook (World Camp Inc.) and Instragram (@worldcamp_Malawi).

Graphics from Bang the Table