A tale of two health care systems

20 February, 2009 | Health and Education For All
Antiretrovirals. Oxfam works with partners on minimizing transmission and impacts of HIV&AIDS in many countries around the world

Dorothy N'goma is Executive Director of the National Organization of Nurses and Midwives of Malawi. She is an Oxfam champion and is travelling around Europe to raise awareness of the need for more and better aid to support Malawi to improve health services for mothers, children and families living in poverty. In her blog she reflects on her experiences in Europe and from home.

This week I’ve had the chance to visit several hospitals in Germany, and it strikes me that the health care system here is one of the best in the world. I’m sure it’s not that easy to just die from common ailments, but that’s what we see in Malawi every day. I’m envious, especially with the numbers of doctors and nurses patrolling the corridors. In Germany there is 1 doctor for every 200 people while in Malawi there is 1 doctor per 65,000 people. I feel like asking half the doctors I see to come and help out in Malawi.

Whenever I visit Europe I’m always surprised, as people always want to question me about the value of aid. For me, there is no doubt that aid is making a difference to Malawi. For instance, money from the Global Fund has saved millions of lives, helping people to get treatments for illnesses like tuberculosis and malaria. This money has also meant more children have been vaccinated against measles and polio. Child mortality rates have reduced by almost half.

Also, thanks to this money the numbers of skilled health workers emigrating from Malawi to work in rich countries has decreased and the numbers being trained has doubled. In a country where 16 women die every day due to problems related to pregnancy and delivery, one of the highest numbers in the world, this extra money saves lives.

However, there are still lots of problems in the rural areas where much more needs to be done. I’ve visited nurses working alone and taking care of 80 to over 100 patients on shifts lasting up to 16 hours. This is too much and makes it impossible to give people quality care.

During my visit to Germany I’ve been part of passionate debates as people urge their politicians to do more to keep their promises on aid. The politicians think that the German public may not support the idea because of the current economic crisis, but I’ve been meeting civil society organizations who are confident that the public is willing to support the campaign for more aid.

I’ve seen what a huge difference aid can make to a country’s health system. I urge everyone to carry on campaigning and lobbying to let the politicians and the public know what a difference aid is making to the lives of people in countries like Malawi.

I hope that my country one day has as many trained health workers as Germany, and if we had some of the technology that is available here, I would be very happy. Tomorrow I will fly to Italy, and I’m really looking forward to meeting more civil society groups and supporting their campaign in the lead up to the Italian G8 summit.


Poor in the South and poor in the North

Hi, Dorothy, your article is very interesting, and of course we all do what we can to work in that direction, what you mentioned, but I would suggest a little "but" for the analysis and for thinking it over again, when we talk about these situations. Since quite some years there are more and more poor people in Germany,  most of them "ordinary Germans", some are immigrants from all over the world, and what happened to them is, they became poor, in a so-called rich country. They cannot afford all these marvellous things, you describe; the times, when everybody in Germany had access to it, are over, the neoliberal system made it more and more difficult, and it depends how much money you got, when you want to be healed, cured or having your teeth being repaired in a nice way. First time since the 2nd world war there are thousands of Germans without health insurance, something which was not imaginable before. And the actual crisis makes it worse of course. Which means: it is not poor country has poor people, rich country has all rich people, but in both countries are few rich and many poor people; and the poor ones should not allow to be used against each other by our beloved politicians ....

Hugs, suerte, cordialmente Gerd

really good things

You do a really good things, the world needs more people like you


First time since the 2nd

First time since the 2nd world war there are thousands of Germans without health insurance, something which was not imaginable before. And the actual crisis makes it worse of course.

The condition is similar.

Even in my country the condition is similar. The health services mostly private one charge high and in the government hospitals we don't get good service. Poor people die with simple deseases.

thank you! I hope others do

thank you! I hope others do see it...clearly. I can't recall the last time I saw such shining hypocrisy on display. 

Dawn - 'socialized health

Dawn - 'socialized health care' does not mean a Stalinist grind and people dying in the hallways. I live in the UK and, in general, my health is good (he worked for the NHS for 5 years and have seen it at its best and worst). I have no way of filling, no co-payment (very important when you have two small children), and no bills at the end of it, except for some perscription charges (and if you are on benefits or the script is for children, then they are free). As for the computerization of records, despite the relatively slow here in the UK, having worked in the medical record of the number of times, certainly not want to rely on paper or personal recollections of patients only.

BoBQ - all EU countries have lower per capita health care costs, and they all have 'socialized' health systems, but a high level of attention - this is not a mystery. If anyone here in the UK has a brain tumor, the system starts up very quickly (no problems with insurance companies), and their fate seen by a specialist within the week (cancer have time goals -- the strange and NHS managers in charge have to answer for it). The fact that the patient may be a grandfather aged '75 years' makes no difference.

The irony is that the U.S. spend roughly the same proportion of public funds such as the UK (and yes, the NHS has historically operated on the cheap), but because private health costs, lobbying by pharmaceutical companies and a piecemeal approach of the type that did not do justice in the United Kingdom in the 1930s, is completed without better results, less coverage and higher staff costs. Put it this way Dawn, do you like having to deal with insurance companies? If you do, stay with your current system. Please ....


Congress is beyond the point

Congress is beyond the point of discussing health reform in the abstract.

Now the bills before Congress that are the subject of discussion now.

Bills and describe the health care "reforms" that do not control costs, which in fact will do nothing, besides launching over 1 trillion U.S. dollars currently uninsured. The Congressional Budget Office found that almost nothing in ObamaCare control costs. It's all about spending $ 1 trillion in health wellness for the uninsured. Costs be damned.

Beyond that:

Obama and his supporters told us that the current health care system is "broken" (their words), costs are rising, the situation is intolerable - I just got a major reform!

Then he promised to all Americans who already have private insurance (which is 78% of the population) who can keep what you have???

So tell me: How to control the rising costs of a system, if 78% of retaining exactly the same, while over 1 trillion U.S. dollars spent in 22% of it???

And more:

Obama assured his Liberal supporters called "public choice" was merely a step towards a single payer system, which is what we have been asking for years. By offering premiums low enough to attract employers to require their employees to public choice.

Then he turns around and "reassured" the rest of us who ObamaCare not going to bring a single payer. How to square this circle?

Too afraid of a reaction to state clearly what they are really after (single payer), Obama and his supporters have been reduced to hemming and hawing. While his Republican opponents are very focused - they do not want to know anything about any of that. And that's why Obama is losing the fight. Are reduced to "reassuring" the American people are not getting what Obama supporters hope they will get expensive!

It is now clear that "Obama hope and change" is built on a pile of evasions, lies, and duplicity.


great work

Thanks for your work. Truly you are involved in something that is changing lives in Malawi for the better. In countries like the US it is difficult for us to imagine a place where everyone doesn't have Individual Health Insurance and access to needed treatments. I have seen the health facilities in rural Africa and I can attest to the fact that many people have no idea what health care means in the rest of the world.

International Blogs

I think in first time since the 2nd world war there are thousands of Germans
without health insurance, something which was not imaginable before. The actual crisis makes it worse of course. 

The paperwork is not fear or

The paperwork is not fear or hard. I have to fill out forms when I see
a new doctor. Or I fill out forms or give him a verbal history of my
life and health. Socialized health care can not take this step, as
doctors need demographics, histories, and lists of Medicine. When the
office is computerized, is saving time, but there has not been recorded
somewhere. In fact, serves a purpose. Demographic more paperwork
invovled, you are actually the number 35. You want the registration
number 45 health care? He has a brain tumor.
As for the insurance
and payment, stop being so cheap. My personal experience with the
military doctor (USA) shows that government health should never be an
option. I should have paid for the civilian health care that would
cost, but could have avoided a nightmare. How to Beat Depression
I'm more concerned
about the quality of health care. I'll stick with the speed of oil
change only. Quality means time and money. The reform of health care
happens all the time. Some CEOs have a brilliant idea to computerize
the records and health care reform. Oh, that's what happened. We must
find ways to fill the gaps in coverage does not assume responsibility
for the government. How Hawaii and Illinois are doing with their health
care for all systems?

Great Idea

Excellent post. Not just conceptual but useful on the ground.  urban connection