CHRR; CEDEP and other concerned CSOs petition to MPs on budget allocation to health and hiv and aids

CONCERNED CIVIL SOCIETY ORGANISATIONS’ PETITION TO MPs ON BUDGET ALLOCATION TO HEALTH AND HIV AND AIDS

PREAMBLE

We, concerned Civil Society Organisations in Malawi working in the Public Health and HIV and AIDS Management Sector, call for the immediate review and action by Members of Parliament (MPs) on the persistently inadequate National Budget allocation to the health Sector. 

This public petition represents a call on MPs’ moral conscience to take a hard look at the underfunding of the health sector and how this is increasingly putting the lives of their constituents and the citizenry of Malawi in danger. Ultimately, we hope that our efforts will move the legislators to impress upon the Minister of Finance to realign the national budget and allocate funds—even if it means redirecting money from within the current resource envelop such as taking part of the K33 billion earmarked for local travel in FY2013/14—towards the national health budget, which is currently looking bleak and unable to constructively strengthen the Malawi health system. We believe that other resources should come from the Farm Input Subsidy Program (FISP) which is increasingly becoming inefficient, nepotistic and fertile ground for corruption as well as a gravy train for political bootlickers, ruling party financiers and a campaign tool masquerading as a pro-poor welfare initiative that is bankrupting the country and which has failed to pull out its targeted beneficiaries out of the poverty trap as envisioned in 2006 when it started. Our concerns also touch on the increasing marginalization of small businesses when it comes to tax incentives in favour of the so-called Foreign Direct Investors (FDIs) who largely come to Malawi as resource and market hounds instead of being partners in development. The tax breaks that the FDIs and some few Malawian conglomerates have been offered in the 2013/14 National Budget are illogical and immoral given how the same fiscal plan continues to burden the working class to shoulder the burden of an efficient tax regime and the politically motivated but unsustainable welfare programs. 

BACKGROUND

The Government of Malawi (GoM) has formulated the Malawi Growth and Development Strategy II (MGDS II) as the country’s second medium term national development blue-print. This strategy was formulated to attain long term development aspirations. The Health Sector falls under Theme Two of the MGDS, which is Social Development. The Government, through the Strategy, has isolated Public Health and HIV and AIDS Management as one of its nine key priority areas. Apart from the commitments in the MGDS, GoM has also agreed to meet certain regional and international obligations pertaining to Health and HIV and AIDS Management. Some of these include the 2011 United Nations General Assembly Political Declaration on HIV/AIDS, the 2001 Abuja Declaration and Millennium Development Goals (MDGs). By being part of these obligations, the GoM undertook to meet specific targets, including funding allocations and performance benchmarks. We expect Government to take these obligations seriously and it is our considered view that MPs should also hold the administration accountable on these obligations which, while agreed at international level, have a direct bearing on the people of Malawi.

CONCERNS ON THE 2013/14 BUDGET ALLOCATION

1. We commend the Government on the 31% (K10 billion) in health Sector allocation of K42.4 billion as allocated in FY 2013/14. This is a recognizable increase from FY 2012/13. While this nominal increase is commendable on one hand, we appeal to government to show more political will in increasing this allocation, especially given the depreciation of the Malawi kwacha and the ruling double digit inflation rate that has eroded the local currency’s buying power over the last 12 months.
2. We furthermore note that since FY 2012/13, the total percentage of the annual allocation to the Health Sector remains at 12 percent. What remains worrisome is that based on the Medium Term Expenditure Framework (MTEF) estimates, it is projected that this percentage will remain within this range in FY2013/14 and FY 2014/15.
3. This is a worrisome reversal considering that in 2011; Malawi was one of only six African countries to reach the 15 percent mark (percentage) of national health budget allocation as per continent’s leaders’ commitment in the 2001 Abuja Declaration. The others being Rwanda, Botswana, Niger, Zambia and Burkina Faso. If 12 percent stays the new allocation trend, there is the risk that as the national response to HIV and AIDS will reach its defining moment in Malawi, and thus the reduction to the Health Sector budget allocation could reverse the gains made so far.
4. The Government of Malawi is commended for moving swiftly to deal with drug shortage crises that for years, has plagued Malawi’s healthcare delivery system. The K14 billion that Government has set aside to procure essential life-saving  drugs in FY 2013/14 and the additional K7.6 billion it has mobilized from various Development Partners (DPs) will go a long way in easing the pressure that the country’s health care system has been under. These funds will also assist to soften the suffering of millions of Malawians, especially given that more than 50 percent of the population of Malawi is poor and lives on less than $1 per day.
5. We would like to applaud DPs such as the UN, US Government Global Fund and those under the umbrella of the Common Approach to Budget Support (CABS) comprising the African Development Bank (AfDB), European Union, Germany, Norway, United Kingdom and the World Bank for their committed support to Malawi.
6. It has also been noted that resources to the Department of Nutrition, HIV and AIDS and the National Aids Commission (NAC) have been increased from K13.4 billion in 2012/13 as per revised estimates to K23.7 billion in FY2013/14, this represents an increase of over 76 percent. This positive development notwithstanding, it is observed with concern that the resource envelop for this area are projected to fall sharply to K13.5 billion in FY 2014/15 and FY K14.5 billion in 2015/16, respectively. We fear that with this reversal trend to a much needed sector, Malawi may not meet its targets, especially the 10 targets for the 2011 political declaration on HIV and AIDS, which include:

o   Reduce sexual transmission of HIV by 50% by 2015.

o   Reduce transmission of HIV among people who inject drugs by 50% by 2015.

o   Eliminate new infections among children by 2015 and substantially reduce AIDS-related deaths maternal deaths.

o   Reach 15 million people living with HIV with lifesaving antiretroviral treatment by 2015.

o   Reduce tuberculosis deaths in people living with HIV by 50% by 2015.

o   Close the global AIDS resource gap by 2015 and reach annual global investment of US$22-24 billion in low and middle-income countries.

o   Eliminate gender inequalities and gender-based abuse and violence and increase the capacity of women and girls to protect themselves from HIV.

o   Eliminate stigma and discrimination against people living with HIV through promotion of laws and policies that ensure the full realisation of all human rights and fundamental freedoms.

o   Eliminate HIV-related restrictions on entry, stay and residence.

o   Eliminate parallel systems for HIV-related services to strengthen integration of the AIDS response in global health and development efforts.

Honourable Members of Parliament may wish to know that a mid-term review of the 2011 declaration offers mixed results. While some targets are on course to be achieved others are likely to be missed. We are concerned that should this happen, it will be a tragic outcome.

OUR APPEAL

Your petitioners respectfully request that the Honourable House take the following actions as a matter of urgency:                                                                                                                                                           

We, therefore, call upon Honourable Members of Parliament to:

1.      Review the 2013/14 allocation to Public Health and HIV and AIDS, to ensure that this sector received its well-deserved 15 percent of total expenditure. This is taking into consideration that a healthy Malawi is a productive Malawi and that the health of the population is a critical ingredient to national progress.

2.      Ring-fence crucial social spending to protect pro-poor votes such as Health.

3.      Move a motion binding the Government of Malawi to its international and regional obligations as well as set targets on Public Health and HIV and AIDS Management.

4.      Using its oversight architecture, ensure zero tolerance for mis-procurement, corruption and theft in drug procurement, management and distribution.

5.      Realise that the nation fund on its own cannot adequately respond to the HIV and AIDS issues in Malawi. Reinforce that the Abuja declaration of 15% of the total government budget spending towards health care, including a national health system strengthen plan, is non-negotiable order to support the provision of universal and integrated health care services.

6.      The current budget for health, HIV and AIDS is mainly supported by donors instead of the Malawi government. It should be reinforced that the progress recorded on our Country in the areas of treatment, prevention of new infections, strengthening health systems and engaging communities in supporting delivery of care has been made possible largely through increased human and financial resources made available through various domestic and international funding mechanisms, but that a bold national response and shared responsibility will sustain the gains Malawi has made thus far and rests in our Government taking the leading role. It is because of this that we urge the government to mobilize and put more resources in the new ARV regime that is to be introduced in July since PEPFAR will only run it for a year. This will ensure sustainability.

7.      The government should also put more resources in women’s health, HIV and AIDS programs because, as in many cases, such programs are the least funded and yet women carry the most burden of HIV and AIDS because of gender roles and expectations.

CONCLUSION

Healthy people contribute to healthy nations.  It is healthy people who will fully contribute to the development of this nation. Therefore, investing in health is one sure way of accelerating the development of the nation of Malawi. This is why the need to attain the 15% national budget allocation, including a clear strategy to strengthen health systems can never be overemphasized. It also appears that there is a reduction in HIV and AIDS funding because many believe a lot has been done already in terms of the national response and it is time we looked at other critical issues. However, the government needs to realise that HIV and AIDS in addition to other health related hitches remain biggest challenges for Malawi that require continued adequate financing.