The 2nd Stakeholder Forum discussions on 14 Oct 2016 involving 12 Parliamentarians showed that the political support for NHI mainly rests on two pillars:
- Expectation that NHI will generate funding without restricting access for the poor
- Expectation that NHI will address an imbalance in the financing of the state by leveraging funding from the informal non-poor who currently do not participate
Both expectations are not being supported by the technical assessments presented at the Forum. Keeping in mind that UHC requires both, technical and political solutions, a subsequent discussion involving the CD, WHO/WR and GIZ led to the suggestion for developing a proposal to conduct a policy dialogue on the choice of health financing options in Malawi informed by available evidence and reflections on personal political positions and underlying values, beliefs and interests.
The idea of the proposal is to support decision-makers to reflect their positions on the choice of a health financing model for Malawi by clarifying assumptions, examining evidence, and discussing underlying values, beliefs and interests influencing the processing of information.
This is based on the rationale that different positions of decision makers are legitimate and to be respected if they are transparent in the assumptions made on technical issues (i.e. evidence-based) and normative judgments that influence the evaluation of the evidence (i.e. their political position). A deeper understanding of the underlying mental models that influence political positions and of other stakeholders’ views and perspectives creates the required space for dialogue and consensus building.