In Malawi primary healthcare services are provided for free at point of use in all government facilities and selected Christian Association of Malawi facilities through service level agreements). In practice, however, around 70% of the services provided at tertiary level are either primary or secondary services due to lack of a gate-keeping system (Ministry of Health, 2011). To limit the use of high level facilities for primary or secondary services, the government of Malawi introduced bypass fees in both district and tertiary level facilities. However, it was argued that bypass fees for hospitals cause major hardship by excluding poor people from accessing the healthcare they need and hence impede the government’s efforts to achieve UHC.
For so many ordinary Malawians, these bypass fees represent an effective ban on accessing hospital care. With primary healthcare facilities overwhelmed and barely functioning, this is a clear violation of Malawians’ right to health.
Safari Mbewe, Executive Director, MANET
This briefing note presents the results of interviews and suggests that Malawi’s experiment with hospital user fees was highly regressive which pushed the burden of financing the health sector onto the country’s poorest and vulnerable people.
