In January, Malawian civil rights activist Paul Msoma raised the alarm over a lack of COVID-19 supplies while in a bed at Kamuzu Central Hospital, one of the biggest referral hospitals in the country.
At the time, the hospital did not have any oxygen flowmeters — devices used to regulate the flow of oxygen.
“Yes they have oxygen cylinders but in my case they cant connect me to the much needed Oxygen because the whole KCH has no Oxygen flowmeter,” Msoma wrote on Facebook. “My situation is getting bad and l desperately need oxygen. Anyone who can urgently help out there please please help by donating this very gadget.”
Msoma died a few days after making the appeal. His death sparked a debate about how COVID-19 funds were being used, with health and human rights activists calling for more accountability.
In August, the government released 6.2 billion Malawian kwacha in funding to respond to the pandemic. Last month, President Lazarus Chakwera issued a directive demanding that controlling officers and department heads submit details of how their clusters spent the funds after previous failures to submit expenditure reports.
Last year, a report by Malawi’s ombudsman investigating how the country’s COVID-19 “Coordination Cluster” utilized its budget of over 320 million Malawian kwacha between March and July 2020 indicated that there had been some maladministration.
The report found that 79.8% of the total funding allocated to the cluster was spent on staff allowances or benefits. It highlighted that this spending was “a reflection of misplaced priorities,” and recommended that government allowances be made “more realistic, considerate to the country’s economy and clearer to avoid abuses.”
“It felt sad seeing people die of the disease just because the hospitals did not have enough equipment. It was like the country had been taken unaware.”— A nurse at Kamuzu Central Hospital in Malawi
The report also found irregularities in staff assignments. Presenting the report last year, Ombudsman Martha Chizuma said investigations uncovered that some departments were assigning a large number of officers for tasks that could have been done by fewer individuals.
“Our investigations established that some people were getting daily subsistence allowances while they were eating in hotels on bills paid by the COVID-19 response fund; some officers were getting allowances for days they never worked for,” she said.
Chizuma told Devex that in April or May, her office would be releasing another report on the utilization of COVID-19 funds.
Though health care workers have been reluctant to talk about how their work was affected by the alleged mismanagement of COVID-19 funds, a nurse at Kamuzu Central Hospital — who spoke on condition of anonymity out of fear of reprisal — said working in COVID-19 isolation wards was equivalent to working in a war zone.
“It felt sad seeing people die of the disease just because the hospitals did not have enough equipment. It was like the country had been taken unaware,” he said.
The Human Rights Defenders Coalition in Malawi, a group of civil society organizations, has demanded that the government publicly release all COVID-19 expenditure reports.
Gift Trapence, chairperson of HRDC, said the organization had received several queries, concerns, tipoffs, and demands for accountability from the public.
“The allegations show that corruption is still rampant in the country. The government should be vigilant to make those responsible to be accountable,” Trapence said. “This is high time the country reviews its procurement procedures and its policy on subsistence allowances because these are areas where the country is losing a lot of money.”
Health rights activist Maziko Matemba added that COVID-19 fund mismanagement should be a bitter lesson on how public money must be handled to avoid such mistakes in the future.
“The most important thing to put into consideration is how the money was programmed for the response. If most of the funds were used as allowances, then that was gross mismanagement of public funds,” Matemba said.
In response to the public outcry, Chakwera last month established a public service systems review task force.
David Beer, British high commissioner to Malawi, welcomed the move.
Malawi is the second country in sub-Saharan Africa to eliminate elephantiasis through strong leadership, donated drugs, and adequate funding for implementation.
“We fully support the task force's mission to review allowances, procurement, contracts, conditions of service, and structure, with a view to ensuring a system that is fit for purpose and uses public resources as well as possible for the benefit of Malawians,” he said.
The United Kingdom provided £9.2 million through UNICEF and the Health Services Joint Fund to help Malawi prepare for and respond to COVID-19. The funds were used to purchase personal protective equipment and to establish emergency treatment and testing centers.
This year, the Malawian government released an additional 17.5 billion Malawian kwacha to all clusters dealing with the COVID-19. The funds are earmarked to go toward four urgent needs: tracking the spread and severity of the pandemic through testing and tracing, recruiting additional medical personnel, procuring medical equipment, and increasing admission space and infrastructure.
However, Sylvester Namiwa, executive director at the Centre for Democracy and Economic Development Initiatives, a local nongovernmental organization that has been advocating for accountability around COVID-19 funds, questioned the move and the government resolution to fight corruption.
“If people failed to account for 6.2 billion kwacha, what is the justification of releasing a colossal 17.5 billion kwacha?” he said. “This is a sad story. We are only moving in circles.”