Tag: hospitals

Why Donors should halt all COVID-19 Aid to the government of Malawi until there is full accountability regarding the usage of funds

by Sang N., posted in Corruption, embezzlement, Malawi, Opinion
COVID-19 statistics for Malawi as of 12th February 2021. Source: PHIM
  • US$1 = MWK 780.22  – Source: xe.com (13th Feb 2021)
  • Officials in Malawi, including people at the Department of Disaster Management Affairs(DODMA), have misappropriated the majority of K6.2 Billion (US$7.948 million) of Government funds which were earmarked for fighting Covid-19 and issued to government appointed Covid-19 Cluster committees- which are made up of civil servants.
  • According to credible reports from several sources, in one instance out of K85 Million ($109,000) earmarked for the purchase of Personal Protective Equipment(PPE) for Blantyre district, only K10 million was used for PPE, with K59 million being used for allowances. In Machinga, K30 million was spent on allowances with nothing on PPE. In Chitipa K22 million was spent on allowances, and nothing on PPE. In Chikwawa district for example K16 million was spent on allowances, with a meagre K4 million being spent on PPE.
  • There were several instances where significantly more money was spent on fuel than on PPE.

If you were looking for the perfect excuse not to waste your country’s citizens’ taxes to help the citizens of some poor country in East Afriica, one where officials have the nerve to steal COVID19 funds, now you have the perfect excuse.

Officials in Malawi have been accused of misappropriating a significant chunk of K6.2 billion meant for fighting Covid-19. The scandal now informally named COVIDGATE has revealed just how rampant, insensitive and endemic corruption continues to be in Malawi, and how little accountability there is in Government spending.

Despite the rhetoric from the Tonse Alliance government that they are serious about fighting corruption, or “clearing the rubble” to use President Lazarus Chakwera’s own words, the scandal has revealed just how little in practical terms the government has actually achieved towards that end. And how a lot more needs to be done.

Commenting regarding the scandal, one Malawian I talked to noted:

“If they can steal billions while Malawians are dying of COVID19 every day in our hospitals, while the hospitals are ill-equipped and overwhelmed and struggling to cope, while we have an acute shortage of PPE, what else won’t they do? What does that tell you about the kind of rot that we have in the civil service in this country? I understand poverty but these people are heartless, their brothers and sisters are dying everyday and they’re still stealing?!! They don’t deserve any mercy. Every single one of them needs to be fired!”

These people are heartless they don’t deserve any mercy

One Malawian commenting about the K6.2 Billion scandal.

Another commenter said: “If you donate to the government, your donation will end up into a politician’s stomach.”

Malawians on social media are equally enraged:

Meanwhile the office of the Director of Public Prosecutions in Lilongwe has ordered the Inspector General of Malawi Police Service to commence criminal investigations into the scandal. How long that process will take remains to be seen. However, historically such type of corruption or embezzlement cases in Malawi tend to take a long time. And in previous adminstrations, there were allegations that the lack of urgency and speed in prosecuting people who have embezzled Government funds pointed to a lack of political will.

The leader of opposition in Malawi’s p
Parliament Kondwani Nankhumwa MP

The leader of opposition in parliament Kondwani Nankhumwa MP has called for a forensic audit to ascertain weather DODMA and other Government officials misappropriated the funds.

However, until all the culprits are brought to book, and until there is total transparency regarding expenditure of Government funds, and until allowances on matters such as healthcare emergency spending are banned (all of which may take some time), I believe donors and international agencies working in Malawi should with immediate effect route all COVID19 aid funds either via charities and NGOs or via the COVID19 Private Citizens Response initiative (which so far has had an excellent record of transparency and of accounting for each and every single penny that has been donated).

Such a drastic action will focus minds within the Government of Malawi to do something decisive and to do so urgently against the scourge of corruption in Malawi.

Malawians are tired of being abused and taken advantage of like this. They want to know who was responsible for the embezzlement, how much was stolen by each official, and to see those people not only prosecuted and jailed, but also named and shamed, and forced to return the stolen funds back to the Government. And if they can’t return the misappropriated funds, then assets of each guilty person equivalent to the misappropriated funds should be confiscated. There has to be a very strong deterrent to stop this kind of thing happening over and over again.

The Governments of Britain, Germany France, the US and the EU should take note of this sad case of embezzlement, and be firm with officials in Malawi. This is an opportunity to force through much needed accountability and transparency in public service.

President Chakwera has on numerous occasions said he wants his leadership style to be a servant leadership style. This wanton embezzlement of emergency healthcare funds unfortunately frustrates such noble sentiments, and must be met with a tough response.

Nkhalidwe wonunkha kwambiri uwu. This behaviour must end now.

Letter to the Editor – Daily Times july 15, 2015

by Sang N., posted in Opinion

Letters to the editor- Daily Times July 15,2015

Dear Editor,
Government has the audacity to blow 300 million Kwacha when lives of mothers and children are being lost due to a dysfunctional referral system. Almost all District a Health Offices have not received their funding and this has crippled referral systems in out public health facilities.

Between Thursday July 2 and Sunday July 2 and Sunday July 5 a case happened in Mangochi at Mpondasi Health Centre. There was obstructive labour which was reported to the DHO for Mangochi but all ambulances at the district hospital are grounded because they have not received funding.

In trying to save the life of the mother, the DHO decided to use his personal car to travel to Mpondasi to conduct Caesarian section right there. Our current health care service delivery structure does not provide such services at a health centre. These are desperate efforts by a professional clinician who understands that he or she is there to save lives. Unfortunately, by the time he arrived, the mother and baby had both died.

The views of Patseni Mauka:
According to the letter, this is happening in many places. An example is Area 25 clinic failing to pick patients to Kamuzu Central hospital. This government must review its priorities. It’s a disgrace for people to die of preventable and curable health cases while the government wastes money on parties!

African leaders must stop seeking medical treatment overseas

by Sang N., posted in Development, Health, Opinion

You can be a Christian, Muslim, Hindu, Budhist or Atheist, or none of these, but one thing you will all agree to is this: that there is no justification whatsoever for a leader of a country (his family, his ministers and families) to go overseas to a wealthy country to seek medical treatment, while his country’s people – who elected him to power, and most of whom are poor – make do with underresourced, understaffed and in some cases dangerous hospital facilities at home.

Yet this is what has been happening in Africa for at least 50+ years. Yes, thats right: 50 bloody fat years. Dictators and the anti-colonialist strongmen of the colonial and post-colonial era did it, at considerable public expense. Now their successors – politicians of governments in multiparty democracies who like to dress up in expensive western clothing and are accustomed to lavish lifestyles are doing exactly the same. While their poor countries continue sliding down, becoming poorer.

To the list of Zimbabwe, Malawi, Ethiopia and Zambia, add all the others you know of,  whose leaders are guilty of this behaviour.

Emmanuel Fru Doh, in his book Africa’s Political Wastelands:The Bastardization of Cameroon puts it like this:

‘Another area that shows how a people with resources end up exploited and deprived by their own government primarily, is health. Like Everything else in Africa, the health facilities have continued to shrink such that today one cannot even tell if anyone cares any longer about the system – its perpetrators and the victims, government officials and the public. One cannot help wondering then why all in Africa must keep rotting away in spite of the quality manpower and all else that the continent has to offer in every area of society, if not because of a system of government, borrowed from imperialists, that alienates instead of uniting the citizens. But then it dawns on one again, that this decay in the area of health is the case because the corrupt leaders can afford to fly to foreign nations for medical check-ups while the wretched of their nations are left to make do with sub-standard medical care. Why must a president, his clients, and members of the their families leave their country for medical consultation overseas instead of investing wisely by building and equipping hospitals that would benefit their nations? The answer is simple: most African leaders are not patriots and are unfortunately equipped with a weird sense of self-importance that only has meaning when they see others around them without the facilities they enjoy, albeit criminally in most cases. Ofcourse, but for greed, it would be easy for the World Health Organization and other international institutions making so much ado about helping poor African countries to start by making it impossible for African leaders to get medical treatment anywhere else but in their own countries. …’

Instead of trekking to Asia, Europe or the US for treatment, why not spend your country’s meagre resources upgrading its healthcare infrastructure, so that it is on par or better than the health services in Europe, Asia or the US? If Cuba can achieve that, with all the pressure their economy has been under the last 50+ years, why can’t African countries do the same.

DSC_0004_14

Surely, medical equipment is not the obstacle, because there are many sources of alternative approved medical equipment which is cheaper yet just as functional as much of the equipment in first class hospitals around the world.

Money also is not the issue because most of these governments lose hundreds of millions (if not billions) to corruption and other factors, meaning the money is there, it’s just being mismanaged.

So what then is the problem? Ian Taylor, Extraordinary Professor at the University of Stellenbosch, South Africa, writing on the South African Foreign Policy Initiative (SAFPI) website has this to say:

Of the ten African heads of state that have died of natural causes in office since 2000, only two actually passed on in their own countries. And of these two, both had been receiving medical care abroad and effectively returned home to die. In other words, not a single African head of state who has died in the last ten years of natural causes had any confidence in his own country’s healthcare.

The phenomena of African presidents dying abroad is truly a disgrace and reflects the failure of Africa’s leadership to seriously invest in healthcare provision. Quite simply, in many African states the elites have not bothered to provide public health leadership and management, have not invested in sufficient health-related legislation and the enforcement of such laws, have proven inefficient in resource allocation and use, and have systematically undermined the provision of adequate national health information and research systems.

A failure to invest in national healthcare systems has then led to extreme shortages of health workers, exacerbated by inequities in workforce distribution (with a strong urban bias) and subsequent brain drain.

Leaders haven’t bothered to fix hospitals or bring in legislation that will protect those hospitals, to ensure that they are well resourced and well-funded, or otherwise up to scratch. Taylor goes on to note that:-

Rampant corruption in procurement systems and inefficient supply systems then combine with unaffordable international prices to produce shells of “hospitals” where one has a greater chance of contracting something extra than being cured of one’s existing ailment.

So then, why haven’t African people taken their leaders to task about all this? Taylor again:

Elite survival comes from access to rents to distribute to patronage networks and thus retain key support, not on investing in services. Investment in such national infrastructure and the advancement of policies that benefit broad swathes of the population is not required in many of Africa’s neo-patrimonial regimes.

This has a direct impact on policy formulation. Why bother spending money on building and maintaining hospitals (or schools or universities) when one can fly to European hospitals to be treated—or send one’s kin abroad for education? Within the logic of many extant African regimes, it makes no sense to invest in public ventures. That’s what the gullible donors are for!

So African politicians know that even if they don’t fix hospitals or bad infrastructure, so long as they pay chiefs and other power brokers who help them maintain popular support, their hold on power is not threatened. Further, their irresponsible logic takes their people for granted by assuming that donors should be the ones fixing the hospitals?  As if the people in those countries voted for donors…

But if not impunity and contempt for their own people, what else explains leader’s like Mugabe’s  actions (see this silly speech here, which he gave after returning from a holiday in Asia – where he and with his family received medical check-ups and underwent treatment)?

What explains Mugabe’s behaviour when others, including one ZANU PF politburo member and former Midlands governor, Cephas Msipa, have refused to seek medical treatment abroad:

“Do we really have to go outside the country for treatment? We should be proud of our own health care services,” he said during the official handover ceremony of a US$1 million casualty ward at Gweru Provincial Hospital last year. He went on to say that:-

“Our doctors and nurses are capable and compete well with other health professionals in other countries. There is no need for people to go to India and other countries to seek medical attention because our own practitioners are equally competent.”

Now, I’m not saying that circumstances will not arise that necessitate the expertise of an overseas specialist in a particular medical area to be sought. Indeed expertise from specialists in various medical fields must be sought. But that’s not what is happening across Africa.

Another commentator who goes by the name Dr Given Mutinta says that medical trips abroad are ‘used as an opportunity to thank ‘good’ bootlickers to the big shots in government.’ Writing on the Zambian Watchdog he says:

If truth be investigated, how many government officials would want to use personal money to pay for medical treatment abroad when they leave office, if at all they would still have the money they are stealing? Besides, how many before coming into power sought medical treatment abroad? What has changed in the past three years they have been in power that they cannot be treated locally?’ noting that ‘These medical vacations are also a scheme government officials are using to embezzle public funds‘ an allegation I have encountered numerous times. He poses the question: ‘What are the kingpins at the Minister of Health, Dr. Joseph Kasonde and Dr. Chitalu Chilufya doing to promote local capacity, strengthen the health sector, improve fiscal policy on medical equipment and monitor medical tourism?’

DSC_0005_10I think Africans must ask such questions to their public officials. Upcoming and progressive African leaders need to take note of these repugnant anomalies in African politics, and find effective and sustainable ways of preventing what is not only a wanton waste of public resources, but also a violation of the trust of African people. To do this obviously means enacting legislation that will not only protect the healthcare sector, but will ensure that doctors and nurses are paid living wages that remunerates them adequately.

 

 

 

 

 

 

 

 

Infrastructure

by Sang N., posted in Economy, Inspiration, Opinion, Public Policy, Research, Thoughts

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While you’ll find several references to Infrastructure on this site, I think this time around I’ll leave it to the experts to do the convincing. Paja akulu anati mutu umodzi siwusenza denga…

And if one takes time to browse through the cited references below (some of which are straight off page 1 + 2 of Google), it’s hard to argue against the fact that Infrastructure is one of the essential drivers of economic development. In this sense, and for the avoidance of doubt,  infrastructure is not limited to roads, railways, airports and buildings (for hotels, schools, Universities, hospitals, business centres, research facilities, etc), but also includes for example a good telecommunication network (internet, voice, data and the like) and power supply.

Infrastructure for sustainable development – European Commission

Intro reads: ” Good quality infrastructure is a key ingredient for sustainable development. All countries need efficient transport, sanitation, energy and communications systems if they are to prosper and provide a decent standard of living for their populations. Unfortunately, many developing countries possess poor infrastructure, which hampers their growth and ability to trade in the global economy. “

Infrastructure’s value to economic growth – Richard Lee, Partner, KPMG (via BBC)

which includes the statement : “…In fact, a recent KPMG International survey found that an overwhelming majority – 90% – of business executives said that the availability and quality of infrastructure affects where they locate their business operations…”

Needs For and Benefits of Infrastructure Connectivity – Asian Development Bank Institute
which includes the statement: “… The rapid economic and population growth of Asian economies in recent years has put huge pressure on its existing infrastructure, particularly in transport and energy, but also in communications. Asia’s infrastructure is world-class in parts, but is generally below the global average. This is a bottleneck to future growth, a threat to competitiveness, and an obstacle to poverty reduction.”
which includes the following statement: – “…An adequate infrastructure is a prerequisite to economic development. Transportation and communications are important in developing and strengthening social, political, and commercial ties. These ties must be developed before trade can be handled on a regular basis.”
Why Is Infrastructure Important – David Alan Aschauer, formerly Senior Economist, Federal Reserve Bank of Chicago, and now (at the date of writing/publication) Elmer W.Campbell Professor of Economics, Bates College
Infrastructure and Poverty – The Global Poverty Project
the Intro reads: “Infrastructure – physical resources like roads, telecommunication networks, schools and drains – is necessary for a society to function: people can’t access healthcare if there are no hospitals; trade can’t take place if there are no roads on which to transport goods to markets. Infrastructure facilitates the basic functions of a society that are necessary to transport resources and people, produce and trade goods, provide essential services and ultimately reduce poverty.”
it follows with ” Lack of infrastructure also leads to lack of employment by acting as a disincentive to investment. Companies who struggle to produce and sell goods in an area with inadequate roads, electricity or water supply do not want to set up the factories or businesses that could potentially generate employment, improve living standards and reduce poverty. “
and “Lack of infrastructure can also lead to poor health and high mortality. Where there are no clinics or hospitals available, or where lack of roads or bridges makes them inaccessible, people cannot access the medical services that they require to be healthy and productive. A villager in Mozambique explains “The most dangerous thing is that [cholera] has always appeared during the rainy season, and it is then that the river is in spate and boats cannot cross.”
The Broader Benefits of Transportation Infrastructure – Ian Sue Wing, William P. Anderson and T.R. Lakshmanan, Center for Transportation Studies and Dept. of Geography & Environment, Boston University [similar article here]
uses the term Meso-scale to describe their approach. A slide from their presentation is quite appropriate in summarising some of the developmental + ‘equilibrium’ impacts, and worth replication:-
infra-messo
Finance and Infrastructure: The Economic Benefits of Infrastructure Projects Procured with Private Finance –  Andrew W Morley, International Congress Washington, D.C. USA, April 19-26 2002.
Infrastructure – Engineers Against Poverty
Intro reads as follows: “Without significant progress in the provision of infrastructure services it will be impossible for many countries to significantly achieve the Millennium Development Goals (MDGs). Globally, more than 1 billion people have no access to roads, 900 million do not have safe drinking water, 2.3 billion lack reliable sources of energy, 2.5 billion have no sanitation  facilities and 4 billion are without modern communication services.”
which contains the paragraph “When it comes to infrastructure development, Thailand has done very well compared with some other Southeast Asian neighbors. In fact, appropriate infrastructure, including access to power and water, has helped Thailand fuel rapid economic growth during the past three decades. Good infrastructure has made Thailand attractive to foreign investment, helped facilitate international trade, and improved the efficiency of everyday business activities. All of these led to more jobs, and more jobs led to more income for the poor. For some not-so-poor people, good infrastructure also helps them improve productivity or fulfill their lifestyles.”
RURAL INFRASTRUCTURE AND ECONOMIC DEVELOPMENT –  Dr. Mohammad Tarique, Lecturer, University Dept. of Economics, B.R.Ambedkar Bihar University, Muzaffarpur.
Abstract reads: “Infrastructure development has a key role to play in both economic growth and poverty reduction. Failure to accelerate investments in rural infrastructure will make a mockery of efforts to achieve the Millennium Development Goals in poor developing countries while at the same time severely limit opportunities for these countries to benefit from trade liberalisation, international capital markets and other potential benefits offered by globalisation”
Private Sector Participation in Infrastructure:the case of Thailand – Deunden Nikomborirak – Asian Development Bank Institute Discussion Paper No. 19
Road Funding: Time for a Change :- Economic Growth Benefits of Transportation Infrastructure Investment – Dr. John C. Taylor,  Associate professor of marketing and logistics at Grand Valley State University and a senior policy analyst with the Mackinac Center for Public Policy in Midland, Michigan.
which contains the statement “…No, the key benefit and reason for transportation investment is from helping to make businesses and individuals more productive, across the geographic landscape. We rely on our transportation investments to increase the economy’s overall productivity – both in terms of making individual travel (business and personal) faster and more reliable, and in terms of the productivity benefits of making freight flows faster and more reliable…”
World Bank — Malawi’s infrastructure: A continental perspective: Vivien Foster; Maria Shkaratan, ISSN: 1813-9450.

As you can see, the above papers + articles present a credible argument that a good and functional infrastructure is essential for economic development.
But that’s not to say that there are no credible counter arguments against infrastructure. That’s not what I’m saying. I’m sure one can cite the prevention of deforestation or preservation of natural habitats as factors against excessive infrastructure. Also, there is the issue of encouraging tourism which could probably mean encouraging greater biodiversity, creating / preserving forests  and wildlife reserves (but even in such circumstances, you still need a world-class airport for a good first impression (the kind of impression you get when you first land at Hong Kong International); functional roads (at least 3 lanes on each side between major cities) that minimises journey times; and world-class hotels and resorts. Why should you give tourists (who in large numbers can be the source of much-needed forex revenue) less than what they are accustomed to, and expect that they will return to your country, or recommend a visit to their friends?). Never mind recommendation, how can you compete on the global stage, when your facilities are substandard? Further, why shouldn’t it be possible to build modern factories with reduced carbon footprint (see Marks & Spencer’s ‘eco-factories’ initiative here) side by side with wildlife/forest reserves?
So, considering all this, I find it hard to imagine a credible setting in which arguments against infrastructure may find pre-eminence, over arguments for infrastructure; especially for a poor country whose majority infrastructure was built  50-year ago; whose roads are littered with pot-holes, with virtually no world-class business centres; that has old airports – with poor facilities including smelly badly looked after toilets; a country that experiences intermittent blackouts almost every week; that is struggling to attract significant investment from abroad; a country where 74% of the population live below the poverty line; which is heavily reliant on agriculture and dwindling tobacco exports + has negligible industrial output; has few natural resources; has a large relatively unskilled young population and suffers widespread corruption and cronyism, even in the upper echelons of its government.

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My question to you then is: why are the leaders of such countries not investing heavily (sooner than later) into major infrastructure projects, when it is in fact a determinant factor in economic development and a serious game changer? Is it because they are in fact not cut out for the job and would be better followers instead of leaders?