The Local Government Act (1998) provides for the decentralisation of vital services, including healthcare delivery, to district and city councils.

The law empowers communities to be responsible for their own healthcare services as required by the National Health Policy of 2017 to 2022.

The Act works in line with the National Decentralisation Policy, which gives district commissioners the power to take control of every sector in districts.

The policy facilitates grassroots participation in decision-making and supports the district health systems from the community to secondary service delivery levels.

This is crucial to accelerate efforts to achieve the health sector goals such as improving the health status of Malawians, providing adequate financial risk protection and improving client satisfaction.

I strongly support decentralisation because the idea promotes sustainability of developmental programmes and projects in districts.

However, it also has negative effects on the health status of some Malawians.

Currently, most civil servants are denied transfers when they need to follow their spouses.

This compromises their physical and mental health, breaches their human rights and denies them peace of mind. These affect service delivery much to the peril of Malawians public servants who ought to serve with a smile and to the best of their abilities. 

Social determinants of health show that the conditions in which people are born, grow up, work and socialise have an impact on their health and health outcomes.

How can individuals and communities adequately address, understand and manage social determinants of health with limited respect for the rights of individuals and communities?

Denying civil servants a right to follow their spouses increases their cost of living as their families spend on two homes. Just like that, their expenditures become higher than income.

The National Health Policy stipulates that workers must be motivated and occupational health must be respected.

For example, when a man is transferred from Mulanje to Karonga, his wife, who works in the civil service, finds it tough to follow him.

For her to go to Karonga, she is supposed to find someone to swap with. If not, she will remain in Mulanje until a space is available.

Did the lawmakers consider the impacts of such scenarios on individuals’ health and service delivery?

There are roles, responsibilities and circumstances that demand the presence of a woman at home. These include illnesses, taking care of children who are supposed to go to school from Monday to Friday and taking care of the husband in all aspects of life.

However, most families lack this support and live in agony because of laws that make it hard for civil servants to follow their spouses.

The split makes it tough and expensive for both parents to take care of their family since they are supposed to pay rentals, buy groceries and pay utility bills for two houses. They also have to meet transport expenses and school fees.

The costs worsened by the insensitive policy do not tally with the financial standing of most civil servants’ families.

Besides, there are a lot of stories of marriage breakups, polygamy and even loss of jobs as some women desperate to protect their marriage either suffer in silence or quit employment to follow their husbands.

Yet we say educating a girl is educating the nation.  How are we going to motivate girls to remain in school and achieve their dreams if educated women are forced to resign from work just to preserve marriages?

Women have a role to play in both government affairs and their families, including supporting their parents who invested a lot of resources in their education.

The State-sponsored breakups or separations also fuel multiple sexual partnerships, which expose unfaithful spouses to HIV infections.

The spread of HIV does not only affect the spouses living far apart, but also their families and the country’s workforce.

I do not think the government is proud of the iconic role it is playing in breaking civil servants’ marriages and failure to address social determinants of health. I plead with members of Parliament to revise the law for the good of couples in the civil service.

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