In June 2019, Thanzi partners in Malawi hosted a visit by Thanzi researchers Dr Tara Mangal (Imperial College London) and Dr Wiktoria Tafesse (University of York). This followed a successful Thanzi la Onse workshop in Lilongwe in January, where the need for stronger links between UK and Malawian researchers / policy-makers was noted. Tara and Wiktoria attended meetings with researchers, policy makers and representatives from key programme areas, such as HIV/AIDS and TB.
The purpose of Tara’s visit was to strengthen these existing links between relevant partners, learn about the health system in Malawi, and how people interact with and use healthcare services, and seek expert guidance on the development of Theme 1’s epidemiological models. The aim of Wiktoria’s visit was to learn more about how the government is paying health care providers and whether there is scope for improvement. Additionally, the trip provided an opportunity to communicate research findings from joint work with Martin Chalkley (University of York) and Gerald Manthalu (Ministry of Health, Malawi) on the effects of contracting-out of health care to Christian Health Association of Malawi (CHAM). This area of research stems from Work Package 4 concerning markets and incentives in health care within the Theme 2 Health Economics stream of Thanzi.
Tara spent one month working alongside colleagues in the College of Medicine and conducting consultations with Ministry of Health personnel (Gerald Manthalu and Pakwanja Twea); experts in HIV, TB, malaria and schistosomiasis; international research teams led by Mia Crampin and Mena Hosseinipour; clinicians; healthcare workers; nurses; and surveillance teams.
These discussions have been extremely valuable in designing the model of the health system, and understanding how the treatment and referral cascade works across different levels of the health system. One important outcome, from this extended visit, was the development of a statistical model of healthcare-seeking behaviour of Malawians, developed with Wingston Ng’ambi, and which has since been accepted for presentation at the SPEED Project (Supporting Policy Engagement for Evidence-based Decisions for Universal Health Coverage in Uganda) symposium, co-organised by the Ministry of Health in Uganda.
During her two weeks in Malawi, Wiktoria met with Thanzi partners at Health Economics Policy Unit (HEPU) and Ministry of Health (MoH), as well as representatives from CHAM, Department of International Development, and the German Development Agency. Wiktoria’s participation in the HEPU policy lab meeting also constituted a great chance to learn more about ongoing projects and priorities at the College of Medicine at the University of Malawi and at MoH, and to present and get feedback on Thanzi research conducted in York.
In discussions related to the design of payment mechanisms in health care, all stakeholders agree that the most significant aims are to improve health outcomes, such as child and maternal survival, to reach the Sustainable Development Goals. At the same time, financial sustainability in the long term needs to be guaranteed due to the risk of volatile donor funds. Implicitly, this means that quality improvements, increased efficiency, and emphasis on pro-poor aspects of any health care policy are of large importance.
Consultations also revealed that policymakers and donors are very keen on learning more about immediate practical solutions in how to make health care providers act in line with the priorities of MoH. On the other hand, it is also clear that there is a need for research to analyse fundamental questions regarding the optimal payment design, which can inform about investments in the health care system in the long run. Therefore, research applying tools from economics of industrial organisation can help in ‘ex ante’ to design a payment system which can ‘get more bang for the buck’. The same goes for the need of applying econometric techniques to learn ‘ex post’ about what actually happened from any change in policy and to fill evidence gaps often answered by anecdotal knowledge. As Thanzi la Onse offers expertise in a wide range of areas in health economics, it is important for researchers to join forces to produce complementary research outputs which can respond to evidence demand both in the short and long term.
Wiktoria and Tara are very thankful for the warm welcome by HEPU and for the enthusiasm in the organisation of the meetings with everyone involved. It was clear during the time spent in Malawi that all partners are keen to remain engaged and to continue working with Thanzi researchers, following the equitable partnerships ethos of the project.
By: Tara Mangal & Wiktoria Tafesse | 30th July 2019