Analysis of the Public Health User Fee Reforms in Malawi

Analysis of the Public Health User Fee Reforms in Malawi RESEARCH PROPOSAL Research title: The political economy analysis of the implementation of public health user fee reforms in Malawi. BACKGROUND AND BRIEF LITERATURE REVIEW The economic crises of the 1970s and 80s led many countries to undergo structural reforms that called for reduced public expenditure for basic services. The reforms resulted in the introduction of cost sharing on the part of beneficiaries (Lucas 1988). In several countries, user fees were imposed as a means to address recurrent costs problems and an extra source of revenue for previously â€Å"undervalued† services of professional providers. Countries responded differently to the introduction of user charges depending on domestic political risk and institutional capacity to efficiently administer the fees. With the reforms, public financing of health declined in many countries, and in some cases, private service providers seized the opportunity to fill the gap (Romer, 1986). Although the involvement of private service providers helped to meet demand for those able to pay, it limited access of the poor to the same services due to the prohibitive costs. Over the past ten years, research on economic growth has demonstrated that human capital is a powerful force in the development process (Becker 1990). In consequence, a sustained increase in this form of capital is crucial for poverty reduction in low-income countries and for an ever rising standard of living. Health is one of the commonly used proxies for human capital an unobservable magnitude or force that is part and parcel of human beings (Schultz 1960). Developing countries are struggling to improve the lives of people living in both rural and urban areas. The big challenge in these countries is lack of resources and problems in allocating the scarce resources. Various governments have prioritized different sectors depending on the needs and demands of the people. Some have prioritized primary education and agriculture while others have prioritized mining and health sector. Developing countries have come up with different interventions purposed to cushion people and be able to manage the risk. Some interventions have taken the form of subsidy while others have taken the form of user fee exemption to mention but two (Schultz 1961). These interventions sometimes are driven by politics, that is why for one to effectively intervene needs to understand the interplay of politics and economics in the developing countries. Depending on policy makers, some would prefer to implement subsidy programmes while others would have user fees exemption or both. User fees are charges one pays at the point of use. The stated interventions are good for the people but to the larger extent over burden the already struggling economy of the developing countries, (Litvack et al 1993). Consequently, government sectors suffer due to being underfunded which has resulted to poor service delivery defeating the whole purpose of subsidy or user fee exemption. Some countries, thus, they have resorted to meet the deficit through the introduction of user fees. For example, in respective of health for all, Malawi government offers free public health services to everyone in the country (ibid). Through observation, the public health services in Malawi particularly those in bordering districts such as Mchinji, Nsanje, Mwanza and Mulanje face very stiff competition on health resources because the hospitals in these districts serve even those from the neighboring countries such as Zambia and Mozambique. Currently with the growing population, government is failing to meet the demand of the free public health services which is manifested through the lack of medical resources in the hospitals. Lack of resources might be because the government has a limited tax base to finance the public health services. For instance, in Daily Times of 18th August, 2014 carried a story that Kamuzu central hospital had suspended all the booked surgeries because the hospital had no medical resources required to carry out operations in the theaters. Burns unit department also suffered the same. In such circumstances the introduction of user fee in public hospitals becomes not an option but a necessity. The user fees may therefore, help in three aspects within health service sector: improving efficiency by moderating demand, containing cost, and mobilize more funds for health care than existing sources provided PROBLEM STATEMENT The aim of free public health services in Malawi was to bring equality and equity in accessing health services. It has been argued that with user fees in accessing public health services, the poor people could be disadvantaged. Axiomatically, healthy people make healthy nation and participate actively in the development activities. Defeating the aim of free public health services, it is the same poor people who are now struggling while the better off and even politicians use the private hospitals. Every person has got the right to good quality health, but the poor people in Malawi are now voiceless and spend painfully on the services that were meant to be free. The situation begs a question that are the public services in Malawi really free at all when a person is told to buy aspirin tablets in private hospitals or pharmacies while the public hospitals have given the medicine to undeserving individuals such as those coming from other neighboring countries e.g. Mozambique just because public hospitals in Malawi are free. Poor people are also voiceless and lack responsibility on the hospital resources for it is given to them for free. Hospital workers have been frustrated because their working environment is not conducive since they are forced to work even when they do not have resources and are sometimes frustrated due late or nor payment at all for the extra hours rendered. Provision of quality health services is one of the social indicators of development. However, looking at the persistent resource shortages in the public health sector, Malawi as a country is far behind the expectation. Optionally, national policy makers in some countries such as Kenya and Mozambique thought to enlarge government revenue base through the introduction and implementation of user fee with an aim of improving services, for example, by improving drug availability and the general quality of health care and extending public health coverage. Therefore, the current study aims at undertaking the political economy analysis of the implementation of public health user fee reforms in Malawi. The study will be guided by the following sampled questions: What are the challenges towards the implementation of public health user fees in Malawi? What is the reaction of policy makers towards public health user fee implementation? Is user fee good option to finance public hospitals Can Malawi manage to embrace user fee policy (in terms of attitudes, willingness and capacity) How much is raised from the paying ward in the central hospitals, are the services different from the non-paying ward? If they are different, how do they differ? And how is money used. Has it brought any change? What are the problems that public hospitals meet? OBJECTIVES Main objective: to undertake the political economy analysis of the implementation of public health user fee reforms in Malawi. SPECIFIC OBJECTIVES Exploring the historical discourse of public health user fee in Malawi. Determining the reasons of government failure to introduce and implement user fee in public hospitals. Analysing how people have been deprived of good health services through free public health services in Malawi. Comparing the challenges in managing the resources faced in the CHAM hospitals and public hospitals. Analysing stakeholders’ attitude, willingness and ability to embrace public health user fee implementation policy. HYPOTHESIS Poor quality of public health services can motivate public willingness to pay towards some improvement of the services Inadequate funding leads to poor public health services in Malawi Malawians are deprived of quality public health services through free public health services. User fee reform in public health services can lead to efficiency and equity in public health resources in public hospitals. Politicians wish to introduce public health user fee reform but are deterred by the fear of losing popularity METHODOLOGY STUDY DESIGN AND METHODS The study will mainly use qualitative descriptive and analytical cross sectional approach. Objective 1 and 2 on public health user fee trend and government failure to introduce and implement the same respectively will use qualitative descriptive approach. Whilst objectives 3-5 on analysis of people’s deprivation of good health, comparison of challenges in managing resources and analysis of stakeholder’s attitudes respectively will employ qualitative analytical approach. STUDY SETTTING The study will take place in Malawi, population n of people; the ministry of health headquarters in Lilongwe, Malawi’s four central hospitals, n number of district hospitals n community hospitals and n health centers. There are also CHAM facilities, private hospitals and NGOs (both local and international) that support health system. The study will focus in all central hospitals because they provide tertiary management care. The ministry of health, because it is the headquarters, some selected CHAM facilities in four regions and few selected NGOs in Malawi. TARGET POPULATION Objective 1-2 will target key informants at the headquarters and in the central hospitals and the reviews of available literature in Malawi. Objective 3 will target the discharged patients in the central hospitals and some community around the selected hospitals. Objective 4 will target the health workers in CHAM and central hospitals. Objective 5 will focus on key informants in NGOs which work with health sector. SAMPLING STRATEGY Since the study will employ qualitative design, hence, participants will be selected purposively. DATA COLLECTION PROCESS Before data collection, consent will be obtained from the ministry of health head-quarters and all in-charges of the facilities where the study is going to take place. The research will be explained to the participants to seek their informed consent. Data collection tools will be pre-tested, these will include interview guide for 1) discharged patients to find out any deprivation of their care, 2) health care workers to assess the challenges in resources 3) key informants to analyse their attitudes. And checklist to assess challenges faced by health care workers and patients deprivation of care. ETHICAL CONSIDERATION In carrying out the proposed research, the concept of research ethics will not be ignored. All people involved in this research will have to give consent. No one is going to participate against his or her will but the research would prefer to have full participation from the participants and not partial. Attention will be deployed to make sure that people’s rights are not violated through this research. Participants will be told the aim of the research and everything crucial so that they should be able to give informed consent. Participants’ identity will not be revealed in the data presentation and analysis. However, upon request, some participants predominantly NGOs will have the copy of the research findings. DATA MANAGEMENT Data will be transcribed from Chichewa to English then themes will be developed from which quantitative data will be analysed while quantitative part will be managed by SPSS. Data will be kept confidential unless strict measures are taken to access the same. PRESENTATION OF DATA The data will be presented through quotes and where necessary tables and graphs will be used for the part of quantitative. THEORETICAL FRAMEWORK The nature of the research demands SIDA’s Power Analysis framework. The introduction and implementation of public health user fee involves power of various stakeholders who have different powers of influence. The research then aims to analyse and gauge how much power Do these stakeholders have towards the introduction and implementation of user fees in public health services, (Shaw RP et al, 1995). SIDA’s power analysis focuses on understanding structural factors impeding poverty reduction as well as incentives and disincentives for pro-poor development. Thus, health sector is a hub to development of which the poor have to be targeted. SIDA power analysis tool also serves to stimulate thinking about processes of change in terms of what can be done about formal and informal power relations, power structures and the actors contributing to it. The framework seeks to either deepen knowledge, facilitate dialogue, foster influence or feed into policy developing and programming of which in this case will be the introduction and implementation of user fee in public hospitals (Shaw RP et al, 1995). In the same vein, political economy analysis also looks at the interaction of formal and informal institutions. The collected data will also be subjected to the critical analysis under the interaction of informal and formal institutions (ibid). 8.0 JUSTIFICATION OF THE RESEARCH The current research is of paramount importance to the people of Malawi. The study will facilitate the improvement of public health services throughout Malawi. The big problem in the health sector is inadequate resources, consequently, the research is purported to carry out analysis of how public health user fee can be an alternative to financing public hospitals. The improvement in public health services entails healthy people who can actively participate in development activities. The success in the implementation public health user fee will help not to over burden the government because public health hospitals will be able to meet some needs through user fee, hence, the government will be able use the part of budget allocated to the health sector in other sectors of priority. The study will provide an insight of development health sector and bring satisfaction to people especially those who use public health services. The study assumes that if the public health user fee reform is implemented, people will access the services of higher quality compared to the current situation in which patients are told to buy the prescribed medication in the private pharmacy because hospitals have no medicine. In this then, the implementation of user fee reduces the cost of accessing public health services in Malawi. No country can develop if the health services are poor. The vitality of the current study cannot be over emphasized, if it will be well done, Malawi as a country will register good health and social development. REFERENCES Becker, Gary (1991). A Treatise on the Family. Cambridge, Massachusetts, Harvard University Press. Lucas, Robert, E. (1988). On the Mechanics of Economic Development. Journal of Monetary Economics 22(1): 3-42. Pritchett, Lant and Lawrence H. Summers (1996). Wealthier is Healthier. The Journal of Human Resources XXX(4): 841-68. Schultz, Theodore W (1960). Human Capital Formation by Education, Journal of Political Economy 68(6): 571-83. Schultz, Theodore W (1963). The Economic Value of Education. New York: Columbia University Press. Schultz, Theodore W (1961). Investing in Human Capital. The American Economic Review 51(1): 1-17. Romer, Paul (1986). Increasing Returns and Long Run Growth. Journal of Political Economy 94. Shaw RP, Griffin C. (1995), SIDA power analysis Washington DC: World Bank Sophie Witter (2010) Mapping user fees for health care in high-mortality countries: evidence from a recent survey ; HLSP institute Audibert M, Mathonnat J. 2000. Cost recovery in Mauritania: initial lessons. Health Policy Plan: Chawla M, Ellis RP. 2000. The impact of financing and quality changes on healthcare demand in Niger. Health Policy Plan: 76-84. Lucy Gilson ()The Lessons of User Fee Experience in Africa Center for Health Policy, Department of Community Health, University of Witwatersrand, South Africa, and Health Economics and Financing Programme, London School of Hygiene and Tropical Medicine, United Kingdom. Litvack J, Bodart C. ( 1993) User fees plus quality equals improved access to health care: results of a field experiment in Cameroon. Social Science and Medicine. Mbugua JK, Bloom GH, Segall MM (1995). Impact of user charges on vulnerable groups: the case of Kibwezi in rural Kenya. Social Science and Medicine. Moses S, Manji F, Bradley JE, Nagelkerke NJ, Malisa MA, Plummer FA (1992). Impact of user fees on attendance at a referral centre for sexually transmitted diseases in Kenya. Lancet

The Two Shopkeepers- Kantian Ethics and Consequentialism

Liza G Prof. Williams Ethics 21 November 2011 The Two Shopkeepers One of the several topics covered in Kant’s Groundwork for the Metaphysics of Morals is the issued of two shopkeepers. One shopkeeper is honest with his customers in order to maintain a positive reputation and improve profits. The second one is honest because he thinks it is right and exercises his respect for the moral law. The first shopkeeper is motivated to be honest by the rewards of a positive reputation and profit. The second is motivated by respect for morally right action. Taking these motivations into consideration from the standpoint of Kantian ethics, it is clear which shopkeeper is acting right. Kant believes that actions that are consistent with moral law, yet motivated for desires for happiness or pleasure are absent of moral worth. One reason he concludes this can be seen in Groundwork where he introduces the idea of the categorical imperative. This idea contains two formulas, the first one states that one ought to â€Å"act only according to that maxim by which you can at the same time will that it should be a universal law† (Singer 274). In other words, if ones principle, or maxim, behind what they are doing is something they would be willing to make a universal law, it is a good action. The first shopkeeper’s motivation to be honest is inconsistent with this formula, as their maxim of being honest is purely selfish, and it would not be effective if willed to a universal law. This is because it fails the concept of reversibility, for in an ideal society one would want others to treat him according to what the other person is doing. In this case, society would not function in the sense of moral rightness because if everyone acted honest to each other for solely their benefit, no one could trust anyone else or assume they are acting out of respect for the moral law. Since the first shopkeeper’s action fails the notion of reversibility, it also fails the universalizability test in which actions can be willed into a universal law. Secondly, the first shopkeeper is not acting in compliance with Kant’s second formula of the end in itself. This notion of respect for persons has to do with treating people as having intrinsic value in and of themselves. The first shopkeeper is only acting to reward himself through the means of his customers. The fact that he is not rewarding customers with honesty, but complying with the moral law in order to reward himself with a good reputation and profit makes it so that he is not acting rightly. The second shopkeeper, however, is acting in accordance with Kant’s categorical imperative. This shopkeeper acts in accordance with the first formulation of universalizability. Unlike the first, the second shopkeeper is honest because he knows it is morally right. And this passes the universalizability test since an ideal society would inhabit people who act based on the sense of right and wrong, according to Kant. The keeper’s honesty is also reversible, because if others in a society acted out of respect for the moral law like he is, everyone would be acting right towards one another. He complies with the second formulation by his honesty with customers out of respect for the moral law. He is not only using the treatment of his customers as a means for honesty, but also as an end respect for the moral law. In other words, being honest with his customers is not only enabling him to act morally right, but allowing him to be evaluated as respecting the moral law (Singer 274-275). Now, a consequentialist thinker would not judge the shopkeepers moral intentions, but would judge the acts they do by the consequences they produce. Consequentialism is a normative ethical theory where actions are right or wrong based on the consequences that result from action. This contradicts Kant’s notion of evaluating the moral intentions of the action, regardless of the consequence it produces. This theory often adopts ideas seen within utilitarianism, where an action is good or right considering how many people it benefits. For example, a consequentalist may say murder of one person to save one hundred people is right simply because of its consequence. But a non-consequentialist, or deontologist, such as Kant would conclude that killing someone is always morally wrong regardless of the consequence. Applying the consequentialist theory to the shopkeepers’ actions, one can conclude that neither of the shopkeepers is acting in accordance with the ideas of consequentialism. Evaluation of their actions through the mind of a consequentialist will explain this conclusion. Considering the utilitarianist approach within the theory of consequetialism, neither of the shopkeepers is acting rightly. This is because a utilitarianist judges a situation based on how many people it will produce the best consequences for. Since the first shopkeeper is simply benefitting himself, he is not acting in accordance with this process of judgment, but rather benefiting his own ego. And the second shopkeeper is also not acting in accordance with this process because, if anything, he is only benefitting himself with the feeling of acting morally right since he acts in respect for moral law. His honesty may allow him to feel confident that he is doing the right thing, but it fails to benefit anyone else in a sufficient way. Personally, I see the situation from the consequentalist point of view to be closer related to my own perception of the shopkeepers’ actions. I say this because I tend to cast consideration for other people aside. That is to say, the respect for persons and passage of the universalizability test are not as important in determining my actions. I see consideration for the greater society as well as for myself of more importance than acting in accordance with moral law. For instance, I perceive killing one person for the greater good of one hundred as a more realistic and commonsensical than refraining from benefiting all of those people because killing is morally wrong. The fact that I label myself as a realist also greatly affects which viewpoint I see fit. The realistic view to have for the sake of the betterment of society is definitely that of a consequentialist, as acting solely for respect of moral law can sometimes harm humanity. This especially applies to cases where morally right thinking contradicts logical thinking, like in the example of sacrificing one for the sake of many.

Why Everybody Is Talking About This I Believe Essay Topics...The Simple Truth Revealed

Why Everybody Is Talking About This I Believe Essay Topics...The Simple Truth Revealed Using This I Believe Essay Topics If you are searching for top essay writing companies, try out the mentioned above. Take a look at our writing services reviews and find out how top rated essay writing companies get the job done. The increasing number of essay writing services is totally overwhelming. Explaining how to spend less by utilizing open-source texts and internet textbook rental websites would result in an extremely informative essay. Eliminate any mistake spelling troubles and ensure there's a flow in the writing of the essay. You've got to compose an informative essay. The success of your essay is in the suitable selection of the topic. You are going to have the chance to read the essay and create your own changes to it. I Believe Essay Topics Secrets Individuals may want to disregard it. Religions are taught through texts, including the Bible, which are believed to spell out precisely how a greater power wants humans to live. Some religions opt to worship more than one God but I don't understand this theory. Conflicts between individuals of different religions. Regardless of what genre you would like Business Studies, Microeconomics, Business Management and Financial Accounting, we're here to serve your needs. Without thinking of misfortunes you could not really feel any issues. In doing this, attempt to prevent the next points. Where to Find This I Believe Essay Topics If at all possible, the writing needs to be in a position to bring the reader into believing on the specific theme used despite their beliefs. Custom writing means a significant company with high standards. You need to provide your readers enough information so that they fully realize what you're writing about. Writing is a present that comes naturally. This I Believe Essay Topics - Dead or Alive? Your essay might incorporate the explanations for teen pregnancy and talk about the recent rates of teen pregnancy and potential solutions. While doing a study of relationships and marriage you may teach young people how they need to approach marriage so they can prepare t hemselves for their upcoming mate. You might narrow this extensive topic to go over poverty in your community or a particular region. There are lots of other cases in which a President might have wanted to go into a nation but they followed the suitable protocol. Key Pieces of This I Believe Essay Topics No matter your needs are, they wish to provide help. You may want to incorporate a succinct history of plastic surgery and why it has gotten so popular. The most important ingredient of stardom is the remainder of the team 4. The shorter the length, the larger the concentrate on the central belief in somebody's life. Make certain you aren't just listing your successes and achievements, but showing what sort of person that you are. The review is going to teach you whatever you want to understand and then you are able to place your purchase confidently. Your list is only going to supply you with a headache if you don't locate a remedy to end your problems. It takes only 5 minutes to read a review and discover out whatever you should know about that business. The 30-Second Trick for This I Believe Essay Topics An individual's core belief in a guide is the topic of the composition. It isn't important how his opinion is going to be understood afterwards, since such written work doesn't claim to define the reality. Regardless of a person's background, many of us believe in an organized religion of some type. Since it's such a huge subject, you're going to want to narrow your paper down to a particular angle. Choosing Good I Believe Essay Topics Music has the capability to do anything. It w ill be one of the things you will depend on for a time. A Secret Weapon for This I Believe Essay Topics Second, stating an undertaking is also important so the user is aware of what they should do. You are able to even check out several reviews and after that opt for the business that most suits your requirements and inexpensive budget. Also, guarantee that the tasks which you're designing are in line with what you wish to learn. Don't neglect to get a Kibin editor review your final paper to be certain it's on the right path.

William Shakespeare s Romeo And Juliet - 923 Words

Romeo and Juliet Analysis William Shakespeare often has a reputation among modern audiences as being antiquated and archaic. The first things that many people think of when contemplating Shakespeare are ancient locales, Early Modern English which is difficult to understand, and elaborate codpieces. Even modern productions, which often attempt to place the action in a more contemporary context, often can alienate prospective audiences with strange conceptual design choices. But, despite these preconceived notions and prejudices, many of Shakespeare’s plays still have much to offer us. Romeo and Juliet, Shakespeare’s great tragic romance, is one such play. Through its close examination of youthful love and long-standing hate, and the potential tragic consequences of each, it can still manage to speak to us today. Romeo and Juliet is, at its heart, a play about young love. When we first meet Romeo, he is depressed and pining away after an unrequited love, Rosaline. After being convinced to crash a Capulet party by his friends, however, Romeo spots Juliet and all thoughts of his previous love are forgotten. Upon seeing her for the first time he states, O, she doth teach the torches to burn bright† (1.5.44). He follows this with several declarations of Juliet’s beauty, all of which are extremely humorous considering that only a few scenes earlier he was swearing that there were none as beautiful as Rosaline. Juliet also falls quickly for Romeo, and it is only less than a dayShow MoreRelatedWilliam Shakespeare s Romeo And Juliet1287 Words   |  6 PagesLizzy Baginski English Composition 2 Mr. Spera March 10, 2015 Romeo and Juliet Research Paper The movie Romeo and Juliet is a modern classic film that took place in 1996. Overall this is a timeless story that everyone should go and watch. 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Throughout the play, their actions show how ridiculous love is, and how it is a danger to anyone who become twisted in its choking grasp. However, in the death of the youth and survival of the elders, an alternative explanation for the tragic events may be found. Although Shakespeare seems to be mocking love throughout the play, itRead MoreWilliam Shakespeare s Romeo And Juliet1279 Words   |  6 Pagesour lives. The great, classic writers teach timeless, valuable life skills. Shakespeare was the greatest writer of all time. His writings mainly consisted of dramas and sonnets. Romeo and Juliet, as well as, A MIdsummer Night’s Dream were written about the same time period. He was able to inter relate everything that wrote. For example, the tale of Pyramus and Thisbe could possibly be an advertisement for Romeo and Juliet. The basic structure of the two dramas is the same; two forbidden lovers meet