Friday, February 20, 2009

Sharing Justice

It is World Day of Justice, not just justice as in court of law but also as in accessing benefits from state resources, medicines being one of them.

Usisya in Nkhata Bay in the North of Malawi is a food secure area. There has not been relief distribution in the area for the past 10 or so years.

But people have problems with access to health facilities and, therefore, access to medicines because Usisya is a mountainous area. In fact, it is so mountainous that mobility is a big problem, according to Tonderai Manoto, programme manager for Temwa.

Temwa is a reproductive health organisation with administrative offices in Mzuzu and a field office in Usisya where it is running, among other programmes, a mobile voluntary counselling and testing (VCT) and home based care (HBC).

"Without the mobile VCT," says Manoto, "I don’t know what people of Usisya would have been doing to access health services."

There is one road from Mzuzu, teh capital of Northern Malawi, to Usisya and it is a bad road that needs 4x4s. And when the road’s condition moves from bad to worse, service providers have one option: water transport.

This means Manoto and his team have to board Illala at Nkhata Bay district headquarters and go to Usisya on a Sunday and return to Nkhata Bay eight days later, because they can’t spend on hired boats using project funds which must, as much as possible, be spent on beneficiaries.

The people of Usisya are lucky to have Temwa which goes about the place, following people in their homes and areas. People of Nsanje and parts of Thyolo that border Nsanje and Chikwawa in Southern Malawo are not so lucky. They are far from any health centre. They are far from the Holy Trinity Hospital at Muona, a Catholic health institution in Nsanje.

Transport is a problem on this part of the Shire Valley also called East Bank. Like in Usisya, it is 4x4s that are safe on the East Bank Road.

But people have to travel, especially to hospital. Luckily, somehow, the road has been rehabilitated but with rains it tends to get damaged. Added to that, floods and swelling rivers often cut off whole villages from health institutions like Holy Trinity.

Such people cut from health institutions are, in a way, being denied justice by natural causes, of course—but they are still being denied justice. There are two forms of justice, says Edge Kanyongolo, a respected law academic with the University of Malawi’s Chancellor College in Zomba.

The first is distributive justice which refers to distribution of advantages and disadvantages or benefits and burdens. Roads are benefits, meaning state resources towards construction of roads should be distributed equally in a country. So, too, medicines which are an example of a benefit or an advantage.

The second form of justice, says Kanyongolo, is corrective which is premised on the assumption that every society has equilibrium, some point of accepted norms and that when a person behaves differently, in a deviant way, he or she must be corrected and brought back to the accepted behaviours at the assumed equilibrium.

This is what happens when people are sent to reformatory centres like Chichiri Prison for adults and Mpemba Reformatory Centre for boys.

It is the first form of justice—distributive—that the Malawi Healthy Equity Network (MHEN) is concerned with and wants to highlight today on the World Day of Justice. The organisation is insisting on access to medicines as they relate to issue of equity and health rights.

MHEN is talking about essential medicines like co-trimoxazole for opportunistic infections in antiretroviral therapy (ART) clients and malaria treatment at a time the disease is the number one killer of children under the age of five.

This is from a background of a drug availability survey MHEN conducted with parliamentary committee for health and population in 2004, four years after the formation of MHEN.
"The findings formed the basis for the network’s advocacy and campaign for the availability of drugs in public health facilities at a time when drug [shortage] was the order of the day," says Martha Kwataine, MHEN national coordinator.

The target of the advocacy supported Oxfam is to gain equitable and improved access to medicines by 2010. And MHEN is not doing this out of the blue.

"This access to medicines campaign relates to Millennium Development Goals, especially those relating to maternal mortality, infant mortality and reversing the spread of HIV, tuberculosis and malaria," says Kwataine. "In Malawi, Congoma leads the Malawi Coalition on the Millennium Development Goals. MHEN, which is also a member of the civil society taskforce on MGDs in Malawi, will work with Congoma in launching and taking forward the access to medicines campaign in Malawi."

The launch was done in October last year. Now, MHEN is implementing its plans to benefit especially people in rural corners of Malawi. Even those in urban areas because there are thousands who can’t afford private health facilities and end up at government health centres.

Tereza Ramusa of Namonde Village, T/A Nkalo in Chiradzulu, Southern Malawi, is an 82-year-old woman widowed when her husband was killed gruesomely last month. She is now hopeless, in a way, except for government which should provide her access to medicines, among other needs.

The nearest health facility for her is Chonde Health Centre in Mulanje. But in case of a big hospital, she has to travel to Nguludi which is a paying hospital—of course, being a mission hospital it is cheap but she cannot afford. Otherwise, she has to travel to Mulanje District Hospital because Chiraduzlu District Hospital is far away from her home.

She is old and in need of help. She is not the only one. There are thousands like her who need access to medicines. And this is not just availability of drugs at government hospitals and health centres, but even travel: how do poor people, especially the old, travel from home to hospital?

This is a big question that may appear simple in the comfort of sofas and televisions and cups of tea/coffee and biscuits. But for the poor, it remains crucial in terms of access to medicines.

But it is important to acknowledge that there has been success in access to Aids, TB and malaria treatment and support services aimed at attaining MDGs relating to health. This is so because of Indian generic medicines.

"The concern is that increasing resistance to first line ARVs, SP as first line drug for malaria and the emergency of the multi-drug resistant strains of TB poses serious challenges," says Kwataine. "This has the potential to upward spiral of the cost of managing these conditions of public health significance when second line-patented drugs have to be used. Whilst ARVs may be relatively available, simple drugs to treat opportunistic infections linked to HIV and Aids like cotrimoxazole are often not readily available in most facilities."

Beyond this, there have been reasonable attempts at prevention of malaria, for example. Treated mosquito nets have been distributed to hundreds of women. Their proper use is another story.

What does Malawi need to do now? One, build and spread success to all parts of Malawi, sharing benefits. Two, increase medicines budgetary allocation, demands MHEN. People, says MHEN, must realise that health rights are human rights and essential medicines are, therefore, human rights.

Perhaps after realising this, people of Usisya in the North will begin to demand their fair distribution of justice in the form of access to health facilities and medicines.

That will be a rare moment for Malawi and a meaningful story to share on World Day of Justice in the next years.

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