Strengthening PPPs and inter-faith partnerships for UHC:

Example from Malawi

Dr. Mwai Makoka

Executive Director, Christian Health Association of Malawi

Presentation at ACHAP 7th Biennual Conference, Nairobi 25 February 2015

Background of CHAM

• Christian Health Association of Malawi (CHAM) was established in 1966

• CHAM is an umbrella association for both Catholic and Protestant churches’ health facilities

• Current membership includes: – 12 Christian denominations

– 40 hospitals

– 90 health centres with maternity

– 45 health centres with OPD

– 12 training colleges

Service delivery

• Provides 37% of health services

• Trains 80% of mid-level health professionals

• 90% of CHAM health facilities are located in rural areas, some of which are hard-to-reach

• CHAM is key partner to Government’s delivery of the Essential Health Package and UHC

Memorandum of Understanding between CHAM and MOH

• CHAM signed an MOU with Government in 2002

• The aim was to support attainment of MDGs by:

– Expanding access to quality health care

– Promote equity in access to health care

– Expanding pre-service training for health workers

Key provisions of the MOU

• Government pays salaries to CHAM staff • CHAM provides health services (especially EHP)

at minimal user fees • Government and CHAM should not open new

health facilities within 8km radius of each other • Government seconds tutors to CHAM colleges • Graduates are deploys 60% to Government and

40% to CHAM • Service level agreements (SLAs) are signed at

district level to close specific service delivery gaps

Government= Constitutional obligation Churches= Biblical mandate

Government

• Pays salaries for CHAM health workers and tutors

• Seconds tutors to colleges

• Provides health care and training with minimal fiscal burden (i.e., without meeting full capital and recurrent costs

CHAM

• Provides infrastructure and other assets

• Provides training and health services

• Provides operational management

• Receives subvention from Government (salaries)

• Charges some user fees

Shared responsibility, risk and benefits

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50

100

150

200

250

Impact of SLAs on service delivery Antenatal attendance at St Martin's H C (Molere)

The need to strengthen PPPs • Enactment of (a generic) PPP Act in 2010 necessitates

migration from the MOU to a PPP arrangement • Lack of continuous monitoring of the MOU and SLAs

with timely implementation of corrective measures has undermined the MOU

• Shrinking fiscal space making the Government look for an alternative arrangement with even less fiscal responsibility

• Free services in public facilities reducing people’s “willingness to pay” in CHAM facilities

• Dwindling direct support to CHAM facilities from overseas benefactors – more reliance on local resources

Way forward

• Amendment of PPP Act to address specific public health issues

• Support expansion of funding base for health care

• Expand Private-Private partnerships with for for-profit or non-profit organisations

• Support change of mindset on health financing and PPPs in both faith and public sector

Thank you

Dr. Mwai Makoka

Dr. Makoka was appointed Executive Director of CHAM in January 2014. He previously worked in the national HIV program in the Ministry of Health and the National AIDS Commission; and was also a member of faculty at the medical school.

He received medical training at the University of Malawi and did postdoctoral studies in medical and public health microbiology at the University of North Carolina, USA.

Dr. Makoka is passionate about access to, and quality of health care, medical education and sustainability of Christian health delivery models.