Can Malawi’s poor afford free tuberculosis services?
Patient and household costs associated with a tuberculosis diagnosis in Lilongwe
This paper in the Bulletin of the World Health Organization assesses the relative costs of accessing a tuberculosis (TB) diagnosis for the poor and for women in urban Lilongwe, Malawi, a setting where public health services are accessible within six kilometres and provided free of charge. The paper assesses patient and household direct and opportunity costs from a survey of 179 TB patients.
It finds that on average, patients spent US$ 13 (18 days income) and lost 22 days from work while accessing a TB diagnosis. For non-poor patients, the total costs amounted to 129 per cent of total monthly income. For the poor, this cost rose to 248 per cent of monthly income. When a woman or when the poor are sick, the opportunity costs faced by their households are greater.
The paper concludes that patient and household costs of TB diagnosis are prohibitively high even where services are provided free of charge. In scaling up TB services to reach the Millennium Development Goals, there is an urgent need to identify strategies for diagnosing TB that are cost-effective for the poor and their households. [adapted from authors]
Full text of document
Tuesday, 21 August 2007
Tartan imperialism
Scotland’s historical role in Malawi contradicts attempts to present itself as an ‘oppressed’ nation, writes Neil Davidson
It has the seventh lowest life expectancy, the fifth lowest GDP per head and the third lowest level of purchasing power in the world. But it also has the ninth highest level of consumer price inflation and the ninth highest prevalence of HIV/Aids.
Clearly this is a former British colony.
These statistics refer to Malawi, whose citizens are no doubt recovering from news that their future British high commissioner is to be Jack McConnell – the former Scottish first minister before the SNP victory in May.
McConnell’s interest in Malawi emerged, suddenly and suspiciously, in the run-up to the Make Poverty History demonstrations in 2005. Shortly after this he visited Malawi and set up a charity to “tackle poverty”.
In general this shows one of the ways in which the ideology of contemporary imperialism works in relation to former colonies. If Iraq epitomises the murderous violence directed at the disobedient, Malawi demonstrates the patronising charity displayed towards those considered helpless but unthreatening.
More specifically, however, it continues a specifically Scottish imperial role in the country.
This point cannot be made strongly enough in the face of the pervasive fantasy on the Scottish left that Scotland is an oppressed nation, rather than a leading component of the British oppressor.Certain place names of modern Malawi stand out – Livingstonia, named after the Scottish missionary David Livingstone, and Blantyre, named after his birthplace.
A centralised political state was formed in what is now central and southern Malawi by the late 15th century, ruling a mainly agricultural society based on the intensive cultivation of corn, cassava and rice.
But like many other African states, internal development was severely affected by external pressure – from the 1790s onwards by the slave trade and then by British occupation in the 1880s.
Scottish Christian missionaries and their Islamic rivals both started arriving in the 1850s, but the former were backed up by a state power which the latter lacked. By the 1880s the Scottish missionaries were increasingly squeezed between Arab slave traders and Portuguese imperialists based in Mozambique.
The British state might in any case have intervened on their behalf, but the decisive catalyst was the threat that Germany might occupy Nyasaland. A deal was done.
The British handed Heligoland to the Germans in return for agreement that they might grab Nyasaland (and three other “protectorates”) for themselves. Needless to say the inhabitants were not consulted.
There have been three great revolts by the oppressed of Malawi.
Following the British occupation, white settlers began to establish their own plantations by dispossessing the native population.
A rising in 1915 was the first in British Africa. One of the colonists targeted by the rebels was Livingstone’s grandson, Alexander Bruce, who owned a plantation of 169,000 acres that was the biggest in the colony.
The second revolt, and the triumph of the national liberation movement, came after the British merged Nyasaland with Northern and Southern Rhodesia (Zambia and Zimbabwe) in 1953, against the wishes of the population.
They attempted to bring the white racist regime in Southern Rhodesia under tighter control, by diluting their authority within a broader area directly ruled by the colonial office.
Precisely because it seemed to extend the influence of the Rhodesians into new areas, the federation gave great impetus to the nationalist movement in Nyasaland, where a series of violent demonstrations led to the establishment of the independent state of Malawi in 1964 under Hastings Banda.
The role of religion and of church organisation are important and complex. The rising in 1915 was led by the Reverend John Chilembwe, originally educated by the Free Church of Scotland. At this stage the church itself was still profoundly racist.
By the 1950s, however, the Scottish churches tended to support African independence.
During the struggle for independence a state of emergency was declared by the British in 1959 which resulted in 1,500 arrests and 50 deaths, all of them black. Around 700 of those arrested were members of the Church of Central Africa – not just the leadership. Banda himself was a Christian doctor trained in Edinburgh.
In 1992 there was a third great revolt of the Malawi people, this time against the corruption and oppression of the post-colonial regime. Strikes, demonstrations and riots forced Banda to concede a referendum on the one party system, which ultimately led to multi-party elections and the end of Malawi Congress Party rule in 1994.
As the figures quoted at the beginning of this piece suggest, the people of Malawi still need revolutionary change in their conditions.
But their history of struggle shows that they themselves will be the agents of that change, not the condescending representatives of the imperial powers who they have had to free themselves from.
Neil Davidson is a visiting research fellow at the University of Strathclyde and the author of The Origins of Scottish Nationhood and Discovering the Scottish Revolution, 1692-1746
It has the seventh lowest life expectancy, the fifth lowest GDP per head and the third lowest level of purchasing power in the world. But it also has the ninth highest level of consumer price inflation and the ninth highest prevalence of HIV/Aids.
Clearly this is a former British colony.
These statistics refer to Malawi, whose citizens are no doubt recovering from news that their future British high commissioner is to be Jack McConnell – the former Scottish first minister before the SNP victory in May.
McConnell’s interest in Malawi emerged, suddenly and suspiciously, in the run-up to the Make Poverty History demonstrations in 2005. Shortly after this he visited Malawi and set up a charity to “tackle poverty”.
In general this shows one of the ways in which the ideology of contemporary imperialism works in relation to former colonies. If Iraq epitomises the murderous violence directed at the disobedient, Malawi demonstrates the patronising charity displayed towards those considered helpless but unthreatening.
More specifically, however, it continues a specifically Scottish imperial role in the country.
This point cannot be made strongly enough in the face of the pervasive fantasy on the Scottish left that Scotland is an oppressed nation, rather than a leading component of the British oppressor.Certain place names of modern Malawi stand out – Livingstonia, named after the Scottish missionary David Livingstone, and Blantyre, named after his birthplace.
A centralised political state was formed in what is now central and southern Malawi by the late 15th century, ruling a mainly agricultural society based on the intensive cultivation of corn, cassava and rice.
But like many other African states, internal development was severely affected by external pressure – from the 1790s onwards by the slave trade and then by British occupation in the 1880s.
Scottish Christian missionaries and their Islamic rivals both started arriving in the 1850s, but the former were backed up by a state power which the latter lacked. By the 1880s the Scottish missionaries were increasingly squeezed between Arab slave traders and Portuguese imperialists based in Mozambique.
The British state might in any case have intervened on their behalf, but the decisive catalyst was the threat that Germany might occupy Nyasaland. A deal was done.
The British handed Heligoland to the Germans in return for agreement that they might grab Nyasaland (and three other “protectorates”) for themselves. Needless to say the inhabitants were not consulted.
There have been three great revolts by the oppressed of Malawi.
Following the British occupation, white settlers began to establish their own plantations by dispossessing the native population.
A rising in 1915 was the first in British Africa. One of the colonists targeted by the rebels was Livingstone’s grandson, Alexander Bruce, who owned a plantation of 169,000 acres that was the biggest in the colony.
The second revolt, and the triumph of the national liberation movement, came after the British merged Nyasaland with Northern and Southern Rhodesia (Zambia and Zimbabwe) in 1953, against the wishes of the population.
They attempted to bring the white racist regime in Southern Rhodesia under tighter control, by diluting their authority within a broader area directly ruled by the colonial office.
Precisely because it seemed to extend the influence of the Rhodesians into new areas, the federation gave great impetus to the nationalist movement in Nyasaland, where a series of violent demonstrations led to the establishment of the independent state of Malawi in 1964 under Hastings Banda.
The role of religion and of church organisation are important and complex. The rising in 1915 was led by the Reverend John Chilembwe, originally educated by the Free Church of Scotland. At this stage the church itself was still profoundly racist.
By the 1950s, however, the Scottish churches tended to support African independence.
During the struggle for independence a state of emergency was declared by the British in 1959 which resulted in 1,500 arrests and 50 deaths, all of them black. Around 700 of those arrested were members of the Church of Central Africa – not just the leadership. Banda himself was a Christian doctor trained in Edinburgh.
In 1992 there was a third great revolt of the Malawi people, this time against the corruption and oppression of the post-colonial regime. Strikes, demonstrations and riots forced Banda to concede a referendum on the one party system, which ultimately led to multi-party elections and the end of Malawi Congress Party rule in 1994.
As the figures quoted at the beginning of this piece suggest, the people of Malawi still need revolutionary change in their conditions.
But their history of struggle shows that they themselves will be the agents of that change, not the condescending representatives of the imperial powers who they have had to free themselves from.
Neil Davidson is a visiting research fellow at the University of Strathclyde and the author of The Origins of Scottish Nationhood and Discovering the Scottish Revolution, 1692-1746
IFC to work with Malawi bank in lending funds to small businesses
The US-based International Finance Corporation (IFC) on Tuesday announced an agreement to work with the Malawi’s New Building Society (NBS) Bank on its programme to increase lending to smaller businesses in the country.
According to the IFC director for sub-Saharan Africa, Thierry Tanoh, the IFC’s advisory services to the NBS will focus on expanding the bank’s range of loan products, raising its credit risk management practices and helping it increase its reach to smaller businesses.
"Small and medium enterprises drive the economies of many African countries, and increasing support to them is one of the IFC’s strategic priorities in the region," he said.
He said their support to the NBS would help entrepreneurs in Malawi realise their potential and provide new opportunities for smaller businesses.
Tanoh added that loans would be drawn from a financing facility of up to US$200 million that has been approved by the IFC’s board, and US$3 million is provided under an IFC programme that boosts lending to smaller businesses across sub-Saharan Africa by investing in and providing advisory services to local banks.
NBS Bank’s Chief Executive John Biswick said his bank constantly strived to offer an innovative range of products to its clients.
"Our collaboration with IFC will enable us to better serve micro, small and medium enterprises and reach a larger number of businesses across Malawi," he observed.
The local bank is the second to work with the IFC under the programme following an agreement in March 2007 with Burkina Faso’s Banque Agricole et Commerciale du Burkina.
IFC, which fosters sustainable economic growth in developing countries by financing private sector investment, is currently considering 20 banks in sub-Saharan Africa in the first round of the initiative.
The IFC is a member of the World Bank Group.
According to the IFC director for sub-Saharan Africa, Thierry Tanoh, the IFC’s advisory services to the NBS will focus on expanding the bank’s range of loan products, raising its credit risk management practices and helping it increase its reach to smaller businesses.
"Small and medium enterprises drive the economies of many African countries, and increasing support to them is one of the IFC’s strategic priorities in the region," he said.
He said their support to the NBS would help entrepreneurs in Malawi realise their potential and provide new opportunities for smaller businesses.
Tanoh added that loans would be drawn from a financing facility of up to US$200 million that has been approved by the IFC’s board, and US$3 million is provided under an IFC programme that boosts lending to smaller businesses across sub-Saharan Africa by investing in and providing advisory services to local banks.
NBS Bank’s Chief Executive John Biswick said his bank constantly strived to offer an innovative range of products to its clients.
"Our collaboration with IFC will enable us to better serve micro, small and medium enterprises and reach a larger number of businesses across Malawi," he observed.
The local bank is the second to work with the IFC under the programme following an agreement in March 2007 with Burkina Faso’s Banque Agricole et Commerciale du Burkina.
IFC, which fosters sustainable economic growth in developing countries by financing private sector investment, is currently considering 20 banks in sub-Saharan Africa in the first round of the initiative.
The IFC is a member of the World Bank Group.
Malawi to donate, sell maize surplus - president
Malawi will sell its surplus maize or donate it to food-short neighbours, President Bingu wa Mutharika was quoted as saying on Monday.
Malawi is enjoying its second surplus harvest in a row, with a crop of 3.4 million tonnes, 1.3 million more than the national requirement.
But the opposition has questioned plans to donate food aid to neighbours when two of the country's own districts are suffering from shortages after their output was destroyed by floods.
Officials have said they have started distributing food to these regions but communities say they see little evidence of that.
Mutharika said his government, which has already sold 400,000 tonnes of the staple grain to Zimbabwe, would donate 10,000 tonnes of maize Lesotho and Swaziland.
"Is it wrong giving this maize to people who require food," Mutharika said in The Nation newspaper on Monday.
Malawi is enjoying its second surplus harvest in a row, with a crop of 3.4 million tonnes, 1.3 million more than the national requirement.
But the opposition has questioned plans to donate food aid to neighbours when two of the country's own districts are suffering from shortages after their output was destroyed by floods.
Officials have said they have started distributing food to these regions but communities say they see little evidence of that.
Mutharika said his government, which has already sold 400,000 tonnes of the staple grain to Zimbabwe, would donate 10,000 tonnes of maize Lesotho and Swaziland.
"Is it wrong giving this maize to people who require food," Mutharika said in The Nation newspaper on Monday.
Retiring Malawi archbishop leaves divided church
Anglican Archbishop Bernard Malango of the Province of Central Africa is due to retire in September, but some church members say he has failed to end a bitter rift in the Diocese of Lake Malawi over the 2005 election of a bishop who supports gay clergy.
An extraordinary synod of the Lake Malawi diocese did send a message to Malango, who became Archbishop of Central Africa in 2000, wishing him well and thanking him for his leadership.
The diocese, however, continues to be roiled by bitter divisions over the 2005 decision of the Ecclesiastical Court of Central Africa to block the consecration of Nicholas Henderson, a British theologian said to be in favor of allowing homosexuals to be ordained priests. He was to replace the late Bishop of Malawi, Peter Nyanja.
In July 2005, electors in the Malawi diocese voted overwhelmingly for London-based Henderson, who had worked closely with the diocese for 18 years, and had visited regularly and raised funds for religious and humanitarian projects.
Henderson was preparing to leave his west London parish for Malawi when he learned the Court of Confirmation had vetoed his appointment. At the time, Malango, a leading evangelical who is opposed to gay priests, said Henderson, "has actively demonstrated that he was not of good faith." Malango put the retired Bishop of Zambia, Leonard Mwenda, in temporary charge of the Malawi diocese.
The decision led to violent clashes between supporters and opponents of Henderson. In April 2007, British missionary Canon Rodney Hunter, 73, an opponent of Henderson's appointment, died of poisoning. Police arrested Hunter's cook and charged him with murder, and were reported to be investigating allegations that supporters of Henderson had arranged the murder. As Malango leaves office, pro- and anti-Henderson factions remain deeply divided, using the same church buildings but praying separately.
An extraordinary synod of the Lake Malawi diocese did send a message to Malango, who became Archbishop of Central Africa in 2000, wishing him well and thanking him for his leadership.
The diocese, however, continues to be roiled by bitter divisions over the 2005 decision of the Ecclesiastical Court of Central Africa to block the consecration of Nicholas Henderson, a British theologian said to be in favor of allowing homosexuals to be ordained priests. He was to replace the late Bishop of Malawi, Peter Nyanja.
In July 2005, electors in the Malawi diocese voted overwhelmingly for London-based Henderson, who had worked closely with the diocese for 18 years, and had visited regularly and raised funds for religious and humanitarian projects.
Henderson was preparing to leave his west London parish for Malawi when he learned the Court of Confirmation had vetoed his appointment. At the time, Malango, a leading evangelical who is opposed to gay priests, said Henderson, "has actively demonstrated that he was not of good faith." Malango put the retired Bishop of Zambia, Leonard Mwenda, in temporary charge of the Malawi diocese.
The decision led to violent clashes between supporters and opponents of Henderson. In April 2007, British missionary Canon Rodney Hunter, 73, an opponent of Henderson's appointment, died of poisoning. Police arrested Hunter's cook and charged him with murder, and were reported to be investigating allegations that supporters of Henderson had arranged the murder. As Malango leaves office, pro- and anti-Henderson factions remain deeply divided, using the same church buildings but praying separately.
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