Development of a Health Care Policy
Development of a health care policy is one of the ways through which developing nations can be influenced to take actions that promote public health and reduce mortality rates, especially in countries where health inequality is a common problem. The Nature of health policy developed largely depends on specific health care problems that exist in a country at any given time.
Furthermore, one has to consider various social determinants of health in a country before developing and implementing a health policy (Kumar and Preetha, 2012). According to Kumar and Preetha (2012), social factors such as demographic patterns, political and economic changes, cultural issues, and learning environments are believed to influence health situations of many countries around the world.
A health policy that is aimed at reducing health inequality can be effective in promoting public health, and can greatly be supported by a country whose health is negatively impacted by disparities in health care. This paper explores the concept of health policy development and implementation about health inequality while giving special consideration to Malawi.
Health Care Policy: Rationale for Selecting Malawi
Malawi has been chosen for this case study because it is one of the world’s developing countries whose public health is negatively impacted by health inequality and lack of health policy to guide proper health care delivery. According to Daire and Khalil (2015), failure to access primary health care is one of the causes of high death rates among children aged below five years in Malawi.
Daire and Khalil (2015) further assert that health care for socio-economic barriers largely face Children in Malawi that policy makers in the health sector must address to promote positive child health in the country. Children who are born to low-income families in Malawi are highly likely to experience limited access to health care as compared to those who come from wealthy families. The main reason for the high infant mortality rates among low-income families in Malawi is a lack of primary health care policy.
According to Makaula, Bloch, and Muula et al., (2012) and Ustrup, Ngwira, and Fischer, et al., (2014), Malawi continues to experience low life expectancy because it currently lacks a primary health care policy to guide health care access among poor families with children aged below 5 years. Now, Malawi utilizes the Essential Health Package (EHP) program to implement primary health care.
This has impacted negatively on health care access among poor households and a significant reduction in life expectancy in the country. In this regard, Malawi is one of the developing countries that are experiencing high rates of infant deaths due to lack of primary health care policy and would; therefore, attract the attention of health policy makers (Daire and Khalil, 2015).
Social Determinants of Health in Malawi and Why they should be Addressed
There are two major social determinants of health in Malawi that need to be addressed. According to Kumar and Preetha, (2012), social determinants of health refer to factors in the social setting that influence the ability of a country’s population to obtain care at any given time. Examples of social determinants of health include socio-economic factors, family patterns, cultural beliefs and attitudes, learning environments, and demographic patterns.
In Malawi, the two social determinants of health that should concern policy makers are; economic affordability and geographic accessibility of health care facilities. These two social determinants are highly rampant among residents of rural Malawi. Rural populations in Malawi cannot access quality health care due to limited finances and high concentration of health care facilities in urban areas (Ustrup, Ngwira, and Fischer, et al., 2014).
In a study conducted by Ustrup, Ngwira, and Fischer, et al., (2014), the researchers have found that health care facilities are mainly located in urban Malawi, and this makes households based in rural Malawi to travel to the urban areas to seek for care. Ideally, rural Malawi does not only lack adequate health care facilities, but it also has poor roads that make it difficult for occupants to reach urban areas.
The long travel time coupled with high costs of transport prevent children from low-income families from receiving quality care, hence the observed high infant mortality rates in the country (Makaula, Bloch, and Muula, et al., 2012). Furthermore, variation in economic affordability among affluent and low-income families determines the nature of care that these two groups of populations can receive in Malawi.
Families in rural Malawi with either small or lack of basic income are faced with the challenge of obtaining care for their children as opposed to those in wealthy regions with high basic income. For this reason, limited economic affordability among residents of rural Malawi presents significant economic burden which prevents families from obtaining quality care for their children (Ustrup, Ngwira, and Fischer, et al., 2014; & Makaula, Bloch, and Muula, et al., 2012).
There is a great need to address social determinants of health about economic affordability and geographic accessibility of health care facilities to increase access to care for families in rural Malawi. As Daire and Khalil (2015) explain, one of the ways through which health inequality in Malawi can be solved is by addressing those factors that hinder citizens from accessing health care.
It is only by addressing these social determinants of health that Malawi will be able to reduce infant mortality and to achieve the Millennium Development Goals. Health care accessibility in Malawi will greatly be improved if the ability of low-income families to meet health care costs and to access health care facilities is enhanced (Daire and Khalil, 2015).
Potential Public Issues that might be encountered
Two major public issues may be faced in Malawi in an attempt to influence health policy development in the country. The possible general issues that may be encountered are related to the level of cultural awareness and health literacy among the country’s population. Health literacy refers to the ability of individuals to comprehend basic health information and their capacity to utilize it in decision-making.
High health literacy is directly related to improved health outcomes while limited health literacy is associated with poor public health. According to Smith-Greenway (2015), high infant mortality rates in Malawi are largely attributed to limited health literacy among low-income families in rural areas. Residents of rural Malawi rarely receive health education, and the public sector has not initiated any programs in those areas to keep citizens informed about health.
Also, the majority of households in rural Malawi can only speak their local language, and they do not understand any information presented to them in pure English (Smith-Greenway, 2015). Lack of public health education and proper communication of public health information are the primary causes of limited health literacy in Malawi. Consequently, limited health literacy may impede successful development and implementation of health policy in Malawi (Ustrup, Ngwira, and Fischer, et al., 2014).
The other public issue that may be encountered during health policy development and implementation in Malawi is the level of cultural awareness among the country’s population. According to Daire and Khalil (2015), cultural knowledge in a country determines the possibility with which a new policy can be developed and implemented. In this regard, it becomes difficult to implement a health policy that goes against the cultural beliefs and values of a country’s population.
As Reiney, Watkins, Ryman, Sandhu, Bo, and Benerjee, (2011) explain, low cultural awareness is a big problem in Malawi because it negatively affects health utilization among the country’s population. Specifically, cultural beliefs and values of the country’s population largely influence the patterns of health utilization in the country in the sense that, health underutilization is common in rural Malawi where occupants do not believe in care that is being offered by health care organizations. Ideally, low cultural awareness among rural populations in Malawi may prevent successful implementation of health policy in the country (Ustrup, Ngwira, and Fischer, et al., 2014).
Relationship Between Health Inequality and Life Expectancy in Malawi
There is an inverse relationship between health inequality and life expectancy in Malawi. In this regard, high disparities in health are associated with low life expectancy while low disparities in health are related to high life expectancy in Malawi. Life expectancy is low when infant mortality rate is high while life expectancy is high when infant mortality rate is low (Deurzen, Oorschot, and Ingen, 2014).
According to the World Health Organization report of 2017, health disparity in Malawi is significantly higher than that of Japan. Furthermore, an infant born in Malawi is highly likely to die at the age of 47 while a child born in Japan will probably die at the age of 87. Therefore, when health inequality is high in Malawi, life expectancy in the country is significantly low, especially among the rural populations (World Health Organization, 2012).
The inverse relationship between health inequality and life expectancy among poor populations is supported by research evidence. In a study conducted by Deurzen, Oorschot and Ingen (2014) the researchers have found that the rate of infant mortality is higher among the poor than among the rich populations. Therefore, a policy that can reduce health inequality will help to reduce infant mortality rate and eventually raise life expectancy (Deurzen, Oorschot, and Ingen, 2014).
Current Efforts in Malawi to Reduce Health Inequalities
The government of Malawi has worked hard to reduce health inequalities in the country with the aim of reducing infant mortality rates that occur among its rural populations. These efforts are geared towards addressing two major social determinants of health: economic affordability and geographic accessibility of health care facilities. As Ustrup, Ngwira, and Fischer, et. al., (2014) explain, governments can increase geographic accessibility of health care facilities by constructing additional organizations in rural areas.
Between 2003 and 2010, the Government of Malawi constructed a total of 39 health centers in the rural areas. This has helped its rural populations to access health care and to save time and money that could have been spent in traveling to the urban areas to seek for health care. Additionally, Malawi has taken appropriate actions to mitigate financial barrier among its rural populations by increasing their ability to meet health care cost.
In the year 2010, the Government of Malawi signed an agreement with facilities that operate under the Christian Health Association of Malawi (CHAM) to allow free health care services for mothers and children. With free access to child and maternal health care services, Malawi has been able to record a decrease in infant mortality rate with a slight increase in life expectancy (Ustrup, Ngwira, and Fischer, et. al., 2014).
The best health policy to address health inequality in Malawi would be that which will get the support of the country’s population, considering the fact that residents of rural Malawi have limited health literacy and do not have trust in the care offered by health care organizations (Makaula, Bloch, and Muula, et al., 2012).
An example of a policy that might be developed to reduce health inequality in Malawi is the creation of a National Development and Social Fund to support programs that facilitate construction of health care facilities in the rural areas, while at the same time meeting the health care costs of mothers and children who reside in rural Malawi.
The Government of Malawi should set aside funds to facilitate implementation of this policy to ensure that both rural and urban populations have equal access to health care. Successful implementation of this policy will result in a reduction in infant mortality rates among the poor populations in Malawi, which will eventually translate into high life expectancy in the country (Ustrup, Ngwira, and Fischer, et. al., 2014; Dairen and Khalil, 2015).
Daire, J. & Khalil, D. (2015). Analysis of maternal and child health policies in Malawi: The methodological perspective. Malawi Medical Journal, 27(4): 135-139.
Deurzen, I. V., Oorschot, W. V. & Ingen, E. (2014). The link between inequality and population health in low and middle-income countries: Policy myth or social reality? PLoS ONE, 9(12): e115109. https://doi.org/10.1371/journal.pone.0115109
Kumar, S. & Preetha, G. S. (2012). Health promotion: An effective tool for global health. Indian Journal of Community Medicine, 37(1): 5-12. doi: 10.4103/0970-0218.94009
Makaula, P., Bloch, P…..& Muula, A. S. (2012). Primary health care in rural Malawi: A qualitative assessment exploring the relevance of the community-directed interventions approach. BMC Health Services Research, 12: 328. doi: 10.1186/1472-6963-12-328
Reiney, J. J., Watkins, M., Ryman, T. K., Sandhu, P., Bo, A. & Benerjee, K. (2011). Reasons related to non-vaccination and under-vaccination of children in low and middle-income countries: Findings for a systematic review of the published literature, 1999-2009. Vaccine, 29(46): 8215-8221. doi: 10.1016/j.vaccine.2011.08.096
Smith-Greenway, E. (2015). Are literacy skills associated with young adults’ health in Africa: Evidence from Malawi. Social Science and Medicine, 127: 124-133. doi: 10.1016/j.socscimed.2014.07.036.
Ustrup, M., Ngwira, B…& Fischer, T. (2014). Potential barriers to healthcare in Malawi for under-five children with a cough and fever: A national household survey. Journal of Health Population and Nutrition, 32 (1): 68-78.
World Health Organization, (WHO). (2017). Fact file on health inequality. Retrieved from http://www.who.int/sdhconference/background/news/facts/en/