FOURTH EDITION

MASM MEDICAL AID SOCIETY OF MALAWI FREE COPY CHRISTMAS EDITION 2022 GTHIVAINNKGS



4 A LESSON IN MANAGEMENT CONTENTS TALENT MANAGEMENT 8 GENERIC VERSUS BRANDED DRUGS IS THERE A DIFFERENCE 12 EATINGANDLIVINGHEALTHY HEALTHY LIFESTYLE & DISEASE PREVENTION 14 THEINTERVIEW FROM CHIEF TO CHIEF 20 MEDICALINFLATION AND THE IMPACT ON CLAIMS PREMIUMS 22 SHORTSTORY THE COST OF FRAUD 24 POETCOLUMN THANKFULL 25 ACCIDENTSAREPLANNED



Christmas Edition | 2022 WHAT AYEAR DR T. DZINGOMVERA - EDITOR Hello Readers, The closing of an old chapter and the beginning of the new one gives us a chance to take stock and start anew. New resolutions will be made by many focusing on health, finances, and relationships. Looking in the rear-view mirror we see agreed, and covered in full. (Refer to an the time when the Society had its budgets article in this edition on ‘Branded versus approved by the board only to be slapped Generic medicines’). by the 25% devaluation a few weeks later. The scarcity of forex has negatively This was at a time when the assumed affected foreign medical treatment average inflation rate was at 12.5%. The services with our partners especially in Society could not go back and ask for South Africa where due to our central more contributions without affecting the tightening of the forex we cannot pay membership that was still recovering our service providers within reasonable from the economic effects of the time limits. However, the Society is trying pandemic. As such, the Society is walking its best to negotiate with its bankers a tight rope between claims‘ costs and on timely payment of foreign service membership retention. Hopefully the providers’ bills. assumptions and control measures the All in all, your Society has plans but at Society has instituted, will hold to the end the same time it is being realistic with of the financial year. the parameters at play on the ground As reiterated during the breakfast until such a time as a country we are out meetings in all the three regions, the of the woods, economically speaking. Society’s financial year ending June 2022 We are grateful for what we have and finished with a deficit of K1.2 billion. The the assurances that the Society is still dynamics at play on the ground meant around. that the projected contributions could On behalf of the board, management, staff not match with soaring claims’ costs and the editorial team, let me wish you unleashed by the lifting of foreign travel all a merry Christmas and a prosperous restrictions and the pandemic-related 2023. medical inflation. As one way of managing the claims’ costs, the Society has campaigned to encourage its membership to scrutinize the medical bills before signing for the same at the point of treatment. The members are also encouraged to familiarize themselves with the digital platforms at their disposal to monitor various benefit sub-limits. The Society is also appealing to its members to use more of their trusted primary care practitioners where familiarity means tests are rationally streamlined, prices are negotiated, MASM Health | 3

Christmas Edition | 2022 A LESSON IN MANAGEMENT TALENT MANAGEMENT LINDA MAPEMBA 4 | MASM Health

Christmas Edition | 2022 Reading through her promotion letter, Sautso’ s smile lightened the room. She could not restrain herself from smiling. Whispering silently, she thought Whew! 20 years of toiling has finally paid off. Then her parents’ words rang through her mind “You have been offered a job at a service company, know that you are the architect of your own destiny, the managers are only there to help you grow. Listen and learn.” Sautso was born in a family of two girls. Their family was middle class. As the two girls grew up, the parents noted that the girls had a rivalry on proving who was better. Mostly, the parents would note that Sautso wanted to be noticed as the more intelligent, while Chrissy was calm and tactical. Sautso was good at expressing herself, whilst Chrissy was good at mathematics. As they progressed in school, the parents realised that they had not been wrong in their assessment, as Sautso was admitted to study business administration, whilst Chrissy was to study Finance in College. After college, both got jobs in different organisations. Within 5 years, Chrissy was promoted to a position of an Assistant Manager while Sautso remained in the Account Executive position. This did not go well with Sautso as each day she would point out the areas she was good at, how she felt her manager was afraid of her because the manager had not “Walked the corridors of the University of Malawi” but was a product of the so-called generic universities. Sautso would often complain, “Mum I know my boss is afraid I may snatch his job that is why he has never recommended me for a promotion”. The parents would always advise her to wait for her time. “Look our daughter, have you heard of this proverb? It is only those who steal things that are afraid of being robbed”. “From what I am hearing, you are the one who wants to steal this position. This proves that you are not professionally mature enough to be considered for the position you are aspiring for.” Then her mother Elsie said, “let me tell you a story. When I started work, fresh from college, I thought I knew everything. What I had not figured out was that college and office are totally different environments. I would go to work, argue, and tell all the experienced members of staff at the office that since they had never been to the University of Malawi, they would not understand what I was explaining. This behaviour stagnated my rising up the corporate ladder for years until when a certain manager took me under her wing and patiently listened to all I had to pour out in anger. She then said I noted some talent in you, so I have decided to train you. From now on, I have volunteered myself to be your mentor. The manager continued, when I start training you, always remember that a great leader doesn’t have to see hierarchy, she has to see human beings.” “You see Sautso, what each manager in an organisation needs to do is analyse each employee and find which areas each would add value and realign those values to the goals of the organization. There are some who may be talented in public speaking, others in customer service, others in finance, Human Resources management etc. “ Adding value means contributing more to the company than the position which the employee is filling. The added value is key to having a competitive advantage in this knowledge era. MASM Health | 5

Christmas Edition | 2022 NKJV Matthews 25: 24. Then he who had received the one talent came and said, “Lord, I knew you to be a hard man, reaping where you have not sown, and gathering where you have not scattered seed. 25 And I was afraid, and went and hid your talent in the ground. Look, there you have what is yours.” 26 But his lord answered and said to him, “You wicked and lazy servant, you knew that I reap where I have not sown, and gather where I have not scattered seed. 27 So you ought to have deposited my money with the bankers, and at my coming I would have received back my own with interest. 28 So take the talent from him, and give it to him who has ten talents. 29 For to everyone who has, more will be given, and he will have abundance; but from him who does not have, even what he has will be taken away. 30 And cast the unprofitable servant into the outer darkness. There will be weeping and gnashing of teeth.” Adding value means contributing more to the phone. Always meet your manager at hundred which includes the philosophy of the company than the position which the employee percent on this journey.” business and systems for increasing is filling. The added value is key to having a organizational capabilities to achieve its competitive advantage in this knowledge Her mother continued further, ”there are goals. era. The added value might be intangible but several important points I learned from my 5. Talent Development Managers require appreciates with purposeful use. An example manager on talent management, and these of adding value is when two talents produce were: to maintain a strong talent pipeline. synergy. Synergy can be defined as an effect They should recognize knowledge which is more than the sum of its parts such The obvious thing you need first is of flow patterns within the organization that 1+1 is equal to 3 or more and not 2. Such course the talent or talented people and accelerate the learning patterns talents are best managed with realignment within the organization and not control, with abundance mentality and 1. When the companies are hiring, they 6. Managers should oversee and often not scarcity mentality as in the Bible parable need to undergo an effective hiring be involved in the performance of the talents. process that will enable them to evaluation process, identify, and recruit top talent. acknowledge special talents. “Organisations”, she continued, “ are there 7. Talent Development Managers should to grow an employee, however, understand 2. When hiring, managers need to coach all managers to foster a culture that not each employee is going to become a conduct an organisational skills gap that promotes continuous learning and manager, others will add value while sitting analysis. retaining high performing employees. at a bottom position. Walking through the Having said all that my dear daughter, note corridors of the University of Malawi does not 3. Before hiring from outside try to that the bottom line is to prove yourself. guarantee a leadership position. What each build professional development Organisations always provide the route to employee needs to do is sit and reflect, what opportunities for current employees. a destination each employee may aspire is it that am I contributing to this organisation through training. Managers would never that my manager would notice and then nurture 4. Qualities to look at are the employee’s promote an employee they are aware shall me to the position I am aspiring for. competence, relationship ability and only manage to bring the organisation to its In HR they say, leaders are born while values. For example, one talented in knees. Managers who are worth their salt managers are made. Managers are made customer service is the one who will would easily note those employees who through the nurturing of talents. Look at how have the ability to form effective are trying to get on their best side for the your sister has made it. Now go to the office relationships with customers, sake of promotions only. and then treat each day as your first day, start suppliers, the industry, and the with reporting early for work, then listen and markets. He or she will easily elicit Arrivederci learn. Do not sit in the office and stare at the aspects of trust, understanding, clock the whole day or spend the office days strength and loyalty in customer checking social media platforms on your cell relations. The next important step needed is the infrastructure for talent development 6 | MASM Health

Christmas Edition | 2022 The Boss in the Bible parable had well mentored his team and could afford the long-deserved holiday abroad knowing these folks would deliver. He was not a micro-management control freak. The lazy servant had a scarcity mentality, just filling a post. MASM Health | 7

Christmas Edition | 2022 GENERIC VERSUS BRANDED MEDICINES, IS THERE A DIFFERENCE? NIXON KALIATI 8 | MASM Health

Christmas Edition | 2022 Medicines we take exist in two mild discomfort, or worse. Medicines Medicines Regulatory Authority in forms, they may either be are given on the assumption that the Malawi. It takes years of research for Branded or Generic. We may have benefits realized outweigh the side the innovator company to bring the new wondered why we keep coming across effects and that the side effects can be drug to market. To recoup these costs, different colors and shapes of tablets tolerable. in USA the FDA gives the company and capsules, yet we are told it’s the patent rights usually 20 years, after same drug. This should not confuse us Inactive ingredients, which are also which other companies are permitted because whilst the pills we receive at called excipients, are the components to replicate the molecule exactly. This the pharmacy counter may look slightly that do not have a healing effect on you, is the reason why branded medicines different but they have the same effect. but then they are included in medication have higher prices than their generic They have the same active ingredients, as binders, fillers, flavourings, coatings, equivalent because the generic although some are termed generic while dyes, preservatives etc.. Some drugs manufacturers did not sweat it out others branded. We need to emphasize would have been too tiny to take in intellectually or entrepreneurially. But that both branded and generic medicines the recommended doses for example the FDA rules are very strict that the have the same quality, strength, safety, 1 microgram of the drug digoxin or generic should be exactly the same as dosage and route of administration thyroxine. The commercial sachet of the original drug in terms of the active (termed pharmaceutical equivalence). salt at the restaurants is usually 1g and ingredient properties, effectiveness one microgram would be one millionth (termed bioequivalence), bio-availability In essence, the difference between of that weight, so to make the drug and safety profile otherwise they would branded and generic drugs is in the touchable the manufacturers have to not approve. circumstances of producing the drugs. bulk it up to a bigger size by using fillers. Brand named drug refers to the name The difference between generic and There is a third category in India where given by the producing (innovator) branded medicines therefore lies in the patent rules are loose, and the drugs company, while generic drug refers to a composition of its inactive ingredients are termed branded generics. This drug named after the active ingredient hence can have different colors, only means that these are copies of or the molecule. shapes, etc. Like brand named drugs the original but modified differently in they have their own unique names and excipients according to manufacturer. An example is the brand name Fansidar compositions. Due to trademark laws, But they are not owners of the produced by Roche pharmaceuticals generic and brand-name medications intellectual property. has an active ingredient Sulphadoxine are not supposed to look the same. In Pyrimethamine (SP) being also its many cases, the name of the generic Unlike brand companies, generic generic name. drug will be the same as the active manufacturers compete directly on ingredient. price, resulting in lower prices for An active ingredient e.g. SP is the consumers. As such the information component of a medication that This is done to protect the brand image on brands and generics is crucial to all is responsible for its medical or ( trademark) which has some cost patients to know. therapeutic effects. In addition to implications and is properly guarded providing a healing effect, an active by medicine control bodies such as Below are examples of drugs existing in ingredient can also cause adverse or the Food and Drug Association (FDA) generic and branded forms. unintended effects that could cause in America and the Pharmacy and • Diclofenac = Voltaren • Salbutamol Inhaler = Ventolin Inhaler • Metformin = Glucophage • Amlodipine = Norvasc • Prazquantel = Biltricide MASM Health | 9

Christmas Edition | 2022 In some countries, health insurance companies do not cover branded medicines especially in chronic conditions while others cover them only up to the equivalent of the generic price and patients pay the difference out of pocket. The differences between generic and branded prices are noticed more when people are taking chronic drugs. For pure reasons of continuity, generics for chronic conditions have proven to be more effective than branded because the branded chronic drugs are more likely to be skipped due to costs to patients. Chronic conditions are ongoing conditions whereby people must take medicines continuously for over three months and many are for lifetime. Suffice to say generics have saved Americans a lot o f money through awareness done to the public on both generics and brands. 90% of prescribed medicines in America are generics while that figure for MASM is around 70%. We observe that in the developing countries the difference in price is so remarkable as much as 10 times between branded and generics. MASM just like other medical aid funders, encourages its service providers and members to prescribe and use generics and only switch to branded where circumstances do not permit. There are however some cases where you should stay on a brand- name medication or use it over a generic one and they include: • When there is no generic version available. E.g., Premarin. • When you take a narrow therapeutic index drug. These are drugs where small differences in the dose or blood concentration of the medication can lead to serious reactions. e.g., Digoxin. Dosing slightly lower would result in the drug not being effective and slight overdose will result is serious side effects. • When you are not responding to the generic drug. Very rarely, people respond poorly when they switch to a generic. • When you experience allergic reactions or intolerance to the Inactive ingredients used in the formulation of generic drugs. When such is the case in the above scenarios, the prescribing doctor usually adds: “Do not Substitute” or “dispense as written”. In a survey, it was found that 11% of doctors had a negative view of generic drugs (thought less effective) while the figure was 2.3% for pharmacists. This can be explained by the fact that pharmacists have more experience with the drug intricacies than doctors who are usually approached during marketing. There were also placebo studies whereby a generic was packaged in a branded label and the recipients felt better than when the same drug was packaged in its generic packaging. Such is the power of marketing. In summary, branded drug in the strict sense of the word refers to the version of the drug by the inventor which underwent different trials but is expensive until the company recoups its expenses afterwhich the same drug becomes cheaper or is permitted to other companies to copy manufacturer in its scientific name (generic -USA) or various generic flavours (branded generic – India). Strict and rigorous laws means that generics are manufactured 100% specific to the active ingredient of the branded and as such only differ in choice of fillers and price. Only in very rare occasions branded medicines cannot be substituted. This piece of advice is very important in terms of affordability of treatment to patients that access treatment in hospitals and pharmacies. Many people are thrown into health-related poverty because of failure to make decisions related to general healthcare and medications. This presentation will help our members to look again on usual medicines that they take and start making decisions in consultation with their doctors on which brands and combinations can be changed to realize savings on various limits of allocation or benefits while not compromising quality of care. 10 | MASM Health



Christmas Edition | 2022 EATING AND LIVING HEALTHY DR. YANKHO KAIMILA, PHD. Like everything else in life, success does not come while REGISTERED CLINICAL NUTRITIONIST idle. It requires intentional and focused plans to help you achieve whatever your goals are. This principle applies to \"eToatoinpgtimhiizgehlyyouprrobcaelasnsecde dfioeotd, savofoidr living a healthy lifestyle. You may be asking, what is considered nreudturiceentssaarletlosinttdaukrein, g preroducecessinogr, healthy living? A healthy lifestyle is the type of living that fosters esuligmairnaetseptehceiaclloynssuumgaprtyiodnrionfkasddanedd good health and well-being both physically and mentally. It also aanvodidtrcaonns-sfuamtsp.tion of saturated fats includes ones spiritual and emotional well-being. Healthy living prevents diseases, prolongs life, and improves mental clarity. LIVING A HEALTHY LIFE While the list is large, here are some things you can do to live a healthier lifestyle: 1. Get at least 6-8 hours of sleep per night. 2. Intentionally increase your water intake to at least 2 litres a day. 3. Avoid stressors where it is under your control and find healthy ways of dealing with stress. 4. Do not smoke. 5. Drink alcohol in moderation, that’s 1 drink for women and 2 for men per day. 6. Maintain a healthy weight. 7. Exercise regularly, walk for 150 minutes per week (30 minutes per day five days a week). 8. Eat healthy. 12 | MASM Health

Christmas Edition | 2022 WHY YOU SHOULD INCORPORATE HEALTHY I am sure you are now thinking “that’s a lot To optimize your balance diet, avoid eating HABITS INTO YOUR LIFESTYLE of nutrients to eat in one day, how much food highly processed foods for nutrients are Research has shown that people that do I need to eat to meet my requirements?”. lost during processing, reduce salt intake, include all of these five practices into Don’t worry, it doesn’t mean grazing all reduce or eliminate the consumption of their lifestyle; eating a healthy diet, day, some foods are nutrient dense, that added sugar especially sugary drinks and exercising frequently, keeping a healthy means they contain a high number of avoid consumption of saturated fats and body weight, not smoking and drinking different nutrients. This is true for many trans-fats. alcohol in moderation; live 14 years longer fruits and vegetables, especially dark green for women and 12 years longer for men. And vegetables. I am sure you have heard fruits YOUR MOTIVATION incorporating just one of these lifestyle and vegetables being advocated for since Just by adding any one of these changes to adjustments extended life by 2 years. The you were a child and have probably been your life, you will be adding 2 years to your more healthy habits one had, the longer force fed vegetables at some point in your life. So, make better food decisions and their life was prolonged. This is absolutely life. That is because by eating fruits and enjoy your week. staggering [1–4]. vegetables at every meal, you increase your HEALTHY EATING HABITS chances of meeting your daily micronutrient Interact with us Let’s talk about one habit, healthy eating. requirements. In the world of nutrition, we define eating Protein is found in foods like meat, fish, We would love to hear your thoughts and experiences healthy as consuming foods that provide legumes, nuts, milk and eggs; fat is found with incorporating healthy habits into your life with all the necessary nutrients that your body in foods like cooking oils, oily fish, avocado regard to nutrition, wellness, health and fitness. requires per day, also known as a balanced and nuts while carbohydrate is found in We are also able to help you incorporate healthy diet. Every day, our bodies require protein, rice, grains (maize, sorghum, millet, wheat) food choices to support your condition, whether carbohydrates, fats, several micronutrients and their by-products and starchy tubers ill or otherwise healthy. You can reach us on such as iron, zinc, calcium, magnesium, (potatoes, cassava and yam). The eat well +265887524417/+265992695507. iodine, potassium, phosphorus, B vitamins guide, which serves as the global guideline and vitamins A, D, E and K. Therefore, a for eating healthy provides a visual of the balanced diet consists of foods that contain type of foods to incorporate in your daily these nutrients and many others. meals. MASM Health | 13

Christmas Edition | 2022 THE INTERVIEW FROM CHIEF TO CHIEF DR ULEMU KATUNGA (PHD, FCCA, CA(M)) MASM CFO 14 | MASM Health

Christmas Edition | 2022 Tell us about yourself and where do you hail So, the Zambians stole our boys and made from? them part of their own history? Originally from TA Katunga in Chikwawa, then In broad day light. But the boys took over the grandparents moved to Ntcheu. expeditions with Dr Livingstone from where Is there a connection with T/A Chief Katunga the Makololo left off. of Chikwawa? Who are the present-day descendants of Yes, there is a direct connection to Chief the Makololo? Katunga of the Makololo tribe. The well-known chiefdoms today are Who are the Makololo people, for many have traditional authority chiefs Kasisi, Katunga, never heard of them? Maseya and Makhuwira in Chikwawa The Makololo are descendants of an altruistic In one of the photos, staff from African band of warriors who accompanied Dr David Lakes Company are depicted at Mbame as Livingstone from Botswana during his many resting from their journey from Katunga's, expeditions to Angola, up the Zambezi and what was there at Katunga's? the Shire. It was a group of daring men who As a place, Katunga historically was where wanted adventure and establishing trade Sir Harry Johnston signed treaties with the routes for their King while protecting Dr David key chiefs of Nyasaland to commit them to Livingstone from hostile natives wherever be under the British protectorate. The Africa they went. They were also used as interpreters Lakes Company were too afraid to venture (for local tribes and preachers) and guides. into war torn Mozambique to trade so they When Livingstone hit the Murchison falls resorted to trading with the Makololo for (now Kapichira), a navigation obstacle on ivory at Katunga. the Shire, some decided to settle in Lower Shire marrying among the Mangánja people. The UMCA missionaries in Magomero used many of them as porters and as armed guards deployed in the freeing of slaves. Their payment was in guns, ammunition, and cloths. In 1864 the UMCA missionaries relocated to Lower Shire where four years down the line, when the London Missionary Society ceased funding of the mission work, the foreign missionaries withdrew to Britain leaving their supplies, guns, munitions, and trade goods with the Makololo people. The guns were the sole reason the Makololo were never taken into slavery by the Portuguese or their proxy the Afro-Portuguese Chikundas. Given their proven ability to wade off the blood thirsty slave traders, many Mangánjas sought solace among the Makololo. Their fortresses could not be breached by the marauding Ngoni of Middle Shire or the warring Yao from Mozambique. So, they were altruistic in leaving their homeland to help Livingstone evangelize other natives and in protecting the neighbours from the scourge of slavery. Were Chuma and Susi, the last two porters of Dr Livingstone, from the stock of Makololo people? No, Susi was Mozambican riverman working Chief Katunga - Makololo tribe (January 5 1889) with boats along the Zambezi while Chuma was a freed Nyasa Yao slave from a band intercepted by Livingstone around Mbame, Blantyre. MASM Health | 15

Christmas Edition | 2022 So, can we say that commerce Tell us more about your career voluntary exposure at QECH and hard work (hunting) were path was not in vain as it gave me a well displayed by the Katungas During my accountancy studies head start in knowing the basic as early as 130 years ago? at MCA, I secured a vocational processes and medical jargon Probably employment with David which I come across in my daily Tell us your academic background Whitehead and Sons Limited work. So, the finance training led I did my primary school at Misesa, where I was attached to the me to MASM, the closest I can be secondary school at St Patricks subsidiary company, Blantyre to my original passion of medicine. and then opted for “A” level studies Netting, working as an Accountant Last year MASM did not finish at Chichiri High School majoring Trainee. Soon after qualifying well financially. How did it differ in science subjects. From there I as an Accountant, I was lucky to from 2016 when MASM struggled had a stint with National Bank of secure employment with NICO to pay claims yet in 2021 MASM Malawi as a bank teller. as Head Office Accountant. I paid claims in the face of covid With the grades I had in secondary was further transferred to MASM pandemic? and High School, the discipline (then being managed by NICO) as The COVID-19 pandemic had I aspired to do was medicine. I an Accountant. NICO and MASM presented challenges across voluntarily attached myself for delinked early 2000, and the story several industries in the last over a year at Queen Elizabeth of the Society continues. financial year 2020-2021. Central Hospital (QECH) for pre- I further advanced my studies to Nonetheless the Society had professional training in medicine. Ph. D. I am currently working as remained financially stable on the However, the long-awaited the Chief Financial Officer and backdrop of significant reserves. Government Scholarship could Company Secretary. The pandemic period had not be secured. I had started So, when you were denied the however resulted in a significant some self-studying in the Malawi opportunity to be a surgeon you drop in the claim loss ratio due College of Accountancy (MCA) chose to be a surgeon of money to lockdown regulations and Library as I was preparing for that figures? the postponement of elective scholarship. A professor from I guess you can characterize procedures in most healthcare the MCA stumbled upon me and it like that, I have learnt that facilities to make provision for in- advised that if I ever changed surgery does not address the root hospital treatment of pandemic’s my mind from studying medicine cause of diseases, neither does it related illnesses. In line with to finance, he had scholarships prevent future occurrence of the this trend, the Society June 2021 available. I was forced to change same or similar disease in another with an improved claims loss my mind. This professor was location. So, the focus should be ratio of 81% (79% in June 2020). Godsent proving “where there is a on the overall picture or system. As late 2021, the easing of strict will there is a way.” Nevertheless, the one-year lockdown regulations saw the steady resumption of postponed Captives and black slave-drivers, nearing Mbame’s village By David Livingstone - David Livingstone: Narrative of an Expedition to the Zambesi and Its Tributaries, and of the Discovery of the Lakes Shirwa and Nyassa, 1858-1864. London: John Murray, 1865. 16 | MASM Health

Christmas Edition | 2022 elective hospital visitations and took in late 2017 resulted in tangible assets. In my view the incremental increase in utilization instant improvement on the major investments that MASM of other healthcare services as a claims loss ratio performance, has achieved are the brand natural consequence of increased that immediately translated to name MASM and investment in freedom of movement. This as improvement of the Society’s its people, the employees. To a consequence, increased the reserve position. me these are number one as claims loss ratio to 85%. In those two crises why did you the other investments such as The challenge in 2016-17 was not leave MASM? What did you the MASM House investment in emanating from change of the see that nayseyers did not? Blantyre, MASM EMS and the Society’s business model that Running away from any problem chain of medical clinics under the had been introduced in 2016 (that only increases the distance from 100% subsidiary company MASM of not collecting any shortfalls the solution. The easiest way to MEDI-Clinics are off-shoots of the from members). Key was to escape the problem is to solve MASM Brand and the employee’s immediately arrest the alarming it. All of us have those weak ability to craft such strategies. depletion of the reserves, realising moments in life, when we feel that if this were not contained, that despite working hard and to It has been said that you don't the Society would not continue to the best of our ability, somehow smile unless figures make exist. the universe gangs up against us sense? In 2017 in the history of the and makes the going very difficult I also smile to show someone that Society, contribution rates were for us. Be it in relations, work, the figures are not adding up. I unprecedentedly increased twice finances, health or practically always believe that figures speak in one financial year to arrest anything and everything in life. for themselves. the haemorrhaging of reserves. As Albert Einstein said: “We can’t This however did not address solve the problems by using the What are the key attributes or the problem. It was realised same kind of thinking that we skills of an effective CFO? that the issue of poor financial used when we created them.” performance was to do with When the going gets tough, its MANAGEMENT THINKER PETER DRUCKER members’ behaviours resulting hard to stick it out. Running away IS OFTEN QUOTED AS SAYING THAT from the “no shortfall policy.” is often an easier way to cope. “YOU CAN’T MANAGE WHAT YOU CAN’T Reversal of the model policy, It’s when we stay and persevere, MEASURE.” DRUCKER MEANS THAT YOU that the Board and Management even when it’s difficult, that we CAN’T KNOW WHETHER OR NOT YOU prevail. Go on fight and don’t ARE SUCCESSFUL UNLESS SUCCESS IS ever give up! So, irrespective of DEFINED AND TRACKED. WITH A CLEARLY who you are, what your problems ESTABLISHED METRIC FOR SUCCESS, YOU are, and what your fears are, CAN QUANTIFY PROGRESS AND ADJUST rather than looking outside, start YOUR PROCESS TO PRODUCE THE DESIRED looking inward and identifying OUTCOME. WITHOUT CLEAR OBJECTIVES, how you can battle it out with YOU’RE STUCK IN A CONSTANT STATE OF your problems. When in trouble, GUESSING. make sure your dreams drive you, not your problems! In undergraduate and What are some of the major postgraduate, what are your investments MASM has recommendations to someone achieved? aspiring to be CFO? People tend to think of investments as only being the ALWAYS THINK STRATEGIC. ALWAYS THINK OF THE NEXT MOVE. As an analogy, in a game of chess, one needs to be strategic by sacrificing a piece in order to checkmate an opponent. Believe in working in a coordinated team focusing on clearly defined objectives. The sum time of a team competing in a relay race is quicker than same individuals running individual sprints. “If you want to go fast go alone, if you want to go far, go as a team”. The African Lakes Company's halting station in Limbe, on the route from Katunga to Mandala MASM Health | 17

Christmas Edition | 2022 business models, and a changing The Society’s strategic plan spans consensus on globalization over the period 2020 to 2025. The Being in the leadership position and trade have for decades Society’s Strategic Pillars are that you are, would you say challenged the very notion of identified as: Strategic Pillar 1: leaders are born? executive decision-making. The Membership Growth & Financial Leaders are both born and COVID-19 pandemic, however, has Sustainability, Strategic Pillar nurtured. The latter is the more changed–all collective calculus 2: Members & Service Providers reason we have management of uncertainty because there is no Satisfaction, Strategic Pillar 3: and leadership schools because reference case for the COVID-19 Process Efficiency & Improved leadership can be learned, and crisis in living memory. Governance and Strategic Pillar 4: leaders can be shaped. Not all Talking about the outlook/ Organization Capacity & Culture descendants of famous leaders forecast of 2023 for the Society, it Development. Annual strategic make leaders though. Being is pleasing to note that the major planning process is undertaken born merely implies closer or assumptions we had employed in whereby the Society’s strategic earlier exposure mostly. After coming up with our budgets for plan is reviewed and updated. all there is no better leadership the 2022-2023 are still holding and The Trustees will exhibit to style, just effective and non- we trust that our KPIs of revenue the members that the Society effective leaders. growth, the claims loss ratios and continues conceiving new As CFO, What is your outlook or the non-health expenditure ratios innovations as an avenue of forecast for MASM in 2023? will not vary materialy. You would maintaining its strategic goals Business uncertainty refers to agree with me that the country’s of financial stability, providing situations in which businesses main economic fundamentals competitive and value-based face risks that can't be foreseen have changed substantially in services in the process reinforcing or measured. During these times, 2022 and inescapably. In simpler its leadership in healthcare it may be hard for businesses to language all things being equal funding position in the country. predict their performance due we expect the Society at the end All in all, the Trustees expound to unprecedented or constantly of the 2022-2023 financial year in that whatever the future brings, changing events. June 2023 to report a net surplus. in the minds of the Trustees they The world has been operating What should members look have the sturdiest conviction in and living through what forward to in the upcoming AGM? and certainty that the Society’s we believed were uncertain Members should expect an members will continue to times. Continual upheavals, exciting meeting as we are experience the peace of mind of disruptions and global shifts like coming from a pandemic. The knowing that their Society will Society’s Trustees will need to persevere in caring. digitization, technology demonstrate to the membership EDITOR: DOC, THANK YOU FOR transformation, that working strategies have YOUR TIME AND INSIGHTS changing been put in place positioning the Thank you. geopolitics, Society to be ready for the future. evolving 18 | MASM Health

JOANA MALUNGA

Christmas Edition | 2022 MEDICAL INFLATION AND THEIMPACTON CLAIMS AND PREMIUMSNIXONKALIATI Inflation is a measure of the rate of rising prices time. This includes the price of new treatments, of goods and services in an economy. Inflation drugs and procedures and their widespread can occur when prices rise due to increases availability and services. In developed countries in production costs, such as raw materials the medical inflation average figure is provided and wages. A surge in demand for products and separate and is used in making decision on services can cause inflation as consumers are pricing of services and this also determines willing to pay more for the product. premiums for health insurance schemes. In In Malawi the National Statistics Office comes Malawi, the medical inflation is expected to be up with average monthly and yearly inflation even higher because almost all medical supplies figures. The inflation figure is an average of both are imported from other countries. food and non-food items. The annual inflation The level of the general and medical inflation rate in Malawi accelerated to 26.7% in October are very important factors having a significant 2022, from 25.9% in the previous month. It was influence on the functioning of the medical the highest inflation rate since June of 2013. aid scheme industry. The general inflation The figure below shows the average inflation directly influences the expected price inflation in Malawi for the year 2022. Is shows average (healthcare tariffs movement from one year inflation figures from the month of November to the next) of healthcare providers. Medical 2021 to October 2022. inflation consists of price inflation, ageing of scheme members and utilization of medical services. The following are the factors that have led to high medical inflation in the past years. The term Medical Inflation describes average • Treatment is getting more expensive healthcare services' per-unit costs increase over Worldwide, there are new drugs, new treatments, new technology - these lifesaving innovations are great news and help to make healthcare more effective. It means that we’ve never had a better chance of surviving serious illness, such as heart disease and cancer; however, it all comes at a cost. 20 | MASM Health

Christmas Edition | 2022 We are living longer medical schemes. Actualists are guided by the The global population is ageing. With age, often inflationary values to advise on premiums and comes illnesses. With such a large proportion average adjustments on prices of services. of the global population over the age of 65, we When the devaluation took place, MASM had expect to see more people with chronic medical already made its budgets such that it could conditions taking on more recurring medicines not go back to its membership to ask for more and also going for newer forms of treatment. contributions in the face of the devaluation We are getting busier without affecting the membership retention. Life is busier than ever and even though we know We belong to the same ecosystem. Raising what is and isn’t good for us we are forced by contribution rates has its limits and is not the circumstances, as a result people are taking a lot only way of mitigating against medical inflation. of junk foods. This in turn is increasing incidences There are tips and roles described in this article of obesity, diabetes, hypertension, and cancer. on how to contain the problem. Another tip is on These conditions are very expensive to manage. the choice of drugs whether branded or generic Sedentary life and lack of physical activity is addressed in a separate article. Lack of physical activity is commonplace in many What is MASM doing about the current medical countries around the world, but it also adds extra inflation? pressure to healthcare systems, costing them The rising cost of new medicines, treatments and more and more each year. technology is unavoidable and MASM must take The increased cases of the pandemic which are these changes into account to make sure we expensive to treat can always offer our esteemed members access As has been the case with Covid 19 which cost a to quality services. However, the following are lot of money to treat the emerging cases. being done by MASM: The factors above are the ones that have been 1. Encouraging members to access treatment responsible for gradual rises in prices over the years. from reasonable providers e.g., accessing primary care from their Panel doctors and The Current Situation only go to specialists when referred. Make The impact of the Covid 19 and the war in Ukraine sure to be discharged from the specialist have caused a situation of high inflation in many back to the primary care practitioner when African countries including Malawi. Medical the condition had been stabilized inflation in particular went up during the Covid 2. Monitor the cost of treatment from various 19 peak period because all our medical supplies providers to ensure it falls within acceptable are imported. In addition there was a time when limits. there was a surge in prices when as a result of 3. Negotiatting on costs with some service the lock down there was scarcity of medical providers to the benefit of our patients., which supplies. Unfortunately the prices were not is good news. revised downwards after the situation returned 4. Limiting the impact of these increasing to normal. (typical of prices once they go up, they costs by having a global network of medical are gone). providers which helps patients to have The situation is worse in the case of countries cheaper options at same quality. This like Malawi where all drugs, medical supplies promotes price competition to the benefit of and equipment are ordered from other countries. the members. Majority of our drugs, equipment and medical 5. Putting members in charge of their benefits consumables are ordered from India, South and sub limits on various services. Africa, UK, German and other countries. The 6. Monitor invoices to make sure that we are 25% devaluation that took place in May 2022 and only paying for treatment that is medically the scarcity of the forex is another factor that necessary and correct. impacted negatively on the prices of medical What should members do to safeguard their supplies. Another problem that pushed the benefits and prevent frequent adjustment of prices up was lack of raw materials for drugs and contributions? consumables during the Covid peak periods. On their part members have got a responsibility The situation above have led to adjustment to ensure that all claims paid on their behalf are of prices for various drugs and services by genuine by reporting any suspicious activities healthcare providers putting pressure on the observed as they receive treatment. Members should also take interest to look at their bills after they have been settled to ensure that they correspond with the treatment that was rendered. MASM Health | 21

Christmas Edition | 2022 Short Story THE COST OF FRAUD DELLOPETER GWADANI MATAKA It was a hot summer afternoon, and a scent of fear, diseases and mortality filled the corridors of the Chiphazi district hospital. Murmurs and confusion lingered through the halls as the doctors and nurses raced to their assigned wards with nothing but faith in their hearts and stethoscopes in their pockets. The hospital rooms were flooded and with each turn they took, they were violently attacked by desperate guardians pleading for the lives of their loved ones. The hospital was low on supplies and the pharmacy was empty. There was not much that any of them could do. It was crystal clear that saving lives seemed impossible. It was all in God’s hands. Amidst the chaos, Binau was awoken by a At that moment, his late father’s words hit scream that pierced through the halls. He him “regret is a wasted emotion” his father jumped from his seat and raced to the room, would always say when he advised him. his fingers shaking and his sight vivid. He Binau felt responsible for his daughter’s knew who it was. It was Duwa his little girl. condition. Now he resented his existence and He felt his fatherly instinct alert him and fear the choices he had made that destroyed his shook his core. career. As Binau contemplated and battled “She won’t make it through the night” Binau’s with his thoughts, a tall thin individual in the wife whispered, her voice breaking and barely blink of death appeared and stood beside audible. Binau stood dazed and confused as him. He could not believe who it was. His her words caught him off guard. He struggled rage grew by the minute and with his whole with all his might to keep his stance. He felt a being, he tried not to strangle this individual. shiv piercing through his ribs to his heart and It was his younger brother Dalitso. He had the discomfort lowered to the abdomen. His single-handedly ruined his career and had little girl was dying and there was nothing become the bane of Binau’s existence. Binau that he could do to save her. The doctors had stared at the malnourished millennial whom said she needed surgery. Her condition was many would mistake for an octogenarian. His getting worse by the minute and the only frail trembling body was minutes away from place where she could get the treatment vanishing into literal thin air. that she needed was abroad, in India. Having lost his job because of fraud, Binau found himself on a knife’s edge as he was unable to get his daughter the treatment she needed. 22 | MASM Health

Christmas Edition | 2022 His eyes were red and his being company, Binau found himself living When they checked for his laboratory engulfed in the smell of alcohol and in luxury. Binau loved his job. He felt allocation, they discovered that it burnt cigarettes. This is ‘what’ Binau the most- happy when he was in his had been exhausted. When his wife had risked his job for, an alcoholic office closing important deals and was told of the news, she was caught who was unable to tame his lust. making his company a lot of money. off guard. Binau had previously been His eyes travelled back to his little His job also gave Binau the luxury treated for a social disease which led girl who laid motionless on the bed. of having a wonderful healthcare to the current infection of hepatitis. Her once chubby and healthy body plan. Like many progressing and The discovery confused her even disappeared in the bed as she had forward companies, his company more as he had not mentioned lost all the weight. Her radiant and had its employees under different to her about that. However, when bright skin was now pale and dark. medical schemes offered by MASM Binau awoke, he explained to her She was slowly fading away. Binau depending on their position of work. and the doctor what had depleted could feel it and it caused him great Binau had been subscribed to the his laboratory benefit limit. Binau agony. Memories of how his love for VVIP scheme which offered him the was then reported to MASM, and he his brother destroyed his life started most extensive cover for hospital and lost his medical privileges. MASM in pouring and Binau stared into the day-to-day benefits with extended turn reported him to his employer air trying to keep sane amidst the chronic medicine cover. This scheme who felt humiliated. In order for chaos. allowed Binau to receive the best his employer to save face, he was Binau once had it all. A good job, a treatment as he would be treated let go, stripped of his position. This beautiful house, and multiple cars. by the best doctors the country had was done to discourage the other HavingworkedasamanagerofMaziko to offer. He remembered how the employees from committing MASM doctor and the nurses had received fraud-related offences. him and his wife at the hospital when Binau regretted his actions and his daughter was to be born. He had wished for redemption, but it was been anxious and afraid of losing his too late. It had been a year since wife and his child during delivery as he lost his job and life was hard. the maternal mortality rate was very Many companies would not hire him high in the country. He remembered despite his flawless resume and his how the doctor himself had been once-glowing reputation. They all present during all the stages of said that he was a liability and that labour and delivery and had informed he would tarnish their company’s them calmly of everything that was reputation if they hired him. Binau going on. The doctors gave his wife wished he had not given his brother an epidural which helped her not his MASM card and things would to go through severe pain during not have fallen apart. He would still delivery. He learnt months later have his wonderful job and most that the epidural is a very expensive importantly he would be able to drug and is mostly used in rich and get his daughter the treatment she developed countries. needed. However, Binau lost his privileges His eyes stared down at his only and his job as it was discovered that daughter’s tiny face. He could tell he had committed fraud pointing to she was in great pain and that her abuse of the MASM scheme. A few fragile tiny body could not handle it years prior, Binau had noticed that anymore. He held her tiny hand as he his brother was unhealthy and was watched her slowly fade away. She always sick. Having hardly used his was not going to make it. It was only a MASM account in years and being matter of time before she descended rarely sick, Binau decided to let his to the next realm. Pain and regret brother use his MASM membership filled his heart and he wished he had card so that he could receive better not given his brother his MASM card treatment from a doctor at a private as he would have been on a plane hospital. In his mind, Binau had taking his daughter to get the best thought that the incident was a treatment that she needed and not in once-off thing. However, his brother the hospital waiting for her poor soul was constantly sick and in need of to depart. He had learnt his lesson in medical attention because of his a bitter way. reckless drinking and promiscuous activities with multiple women. Binau thought that his plan was smart and that he would never get caught. As fate would have it, things took a drastic turn when Binau suddenly fell ill and had to be rushed to the hospital. To determine the cause of his illness, the doctor suggested that Binau had to go for laboratory tests. MASM Health | 23

Christmas Edition | 2022 Poet COLUMN 24 | MASM Health

Christmas Edition | 2022 ACCIDENTS ARE PLANNED KELVIN MAIGWA ASSISTANT COMMISSIONER OF POLICE Christmas and New Year are yet New Year holidays have previously been any value to the peoples’ welfare and just around the corner. Yes, this is punctuated by rains or just drizzles. road safety, to be precise. the time of the year when every Jim and Jack would like to make merry Yes a lot of drivers attend defensive Although unconfirmed, there are in the name of celebrating the birth driving courses apart from undergoing reports that some people cut corners of Jesus Christ and welcoming the an intensive initial driving course and manage to obtain valid driving coming of a brand new year in which after which they get awarded with licenses without necessarily going no one has ever stepped his or her foot a legitimate driving license which through the normal procedure of into before. pedestrians don’t. Pedestrians are learning how to drive from relevant mostly deprived of precautionary authorities. This has also in one way Others also take advantage of the same measures to take when using roads also or the other contributed to escalating period to clear off their backloads of used by vehicles and motorcycles. The cases of accidents on our roads which year-long accumulated stress through tactics that drivers learn during their in the end pedestrians are the victims. the bottle. Due to this fact that a lot of driving courses are seldom applied people want to celebrate by excessive practically in as far as preventing road The more the accidents occur due to guzzling, road accidents during this accidents involving pedestrians is reasons that man can easily control, period also accelerate. concerned. the more we can say accidents are planned…………. Of course some accidents occur due There are some accidents that occur to reasons beyond human control but on our roads due to fatigue by drivers. Let us all join hands in ensuring that most of them are attributed to human A driver that has spent the whole this year’s Christmas and New Year error emanating from having one too previous night drinking or even driving holiday is celebrated in an accident many, under the umbrella of celebrating cannot safely drive on the road the and also crime free environment. Christmas and New Year. A driver who following day without first catching a Merry Christmas and Happy New is driving under the influence of alcohol rest in form of areasonable peaceful Year!!!! mostly gets involved in road accidents sleep. Despite his eyes being wide open due to the fact that sense of judgment and seemingly staring at the road, the by a drunkard is always inaccurate. driver may be sleeping; consequently A lot of situations including distance ramming into buildings, other vehicles and speed to vehicle driving in front is or even crashing to death innocent misjudged resulting in bashing its rear. unsuspecting pedestrians. It is therefore always advisable that There are several road safety {The author is the Officer in Charge for Mwanza Police whenever colleagues would like to go awareness programs on many radio Station. He is also the hand behind Oshema cartoon in out for a drink especially during the or television stations. However, this publication and also Nganga cartoon in the Daily festive season, the one responsible for proliferation of many forms of social Times newspaper every Friday} driving the car from point A to point B media has greatly shifted peoples’ or vice versa should be someone who is attention from grasping those not drinking beer. Driving whilst drunk lifesaving messages from radios and also at night while it is raining is to some insignificant social media very fatal, as most Christmas days and gibberish which do not in any way add MASM Health | 25

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Christmas Edition | 2022 EDITORIAL TEAM PUBLISHER Chair: Bernard Ambali MEDICAL AID SOCIETY OF MALAWI Editor: Dr. Tilera Dzingomvera 22 Lower Sclater Road Members: Dr MacFenton Shariff P.O. Box 1254 Albert Mungomo Blantyre Samantha Chimimba Malawi. Nixon Kaliati [email protected] DESIGN & LAYOUT +265 (0) 1 820 298/543 +265 (0) 1 999 169/349 Nick Liwewe www.masm.mw Blessily Liabunya Chifundo Kaufa Yamikani Kamwendo Zawadi Isyagi PHOTOGRAPHER Joseph Mbewe PRINTER Kris offset, Blantyre Pic credits: https://create.vista.coms DISCLAIMER The medical content in all MASM Magazines are for informational or educational purposes only, and does not substitute professional medical advice or consultations with healthcare professionals. MASM, editors or contributors are not liable for any harmful effects resulting from context or typos of the materials used. CHRISTMAS WORD SEARCH PUZZLE GQ C E LVESZ L I G H TS DC Z L F J SRVN U L B ZB CE L E B R A T EWM J E YF QF D C WG N R E I N D E ER PF Z E H J T GCO O K I ES GR A N CRA IR I WB I HC OM E M NO I UKS F V A ZA RI I S I NRSND O H J DN NMM S E L EAT E C O B WD AG Z D TNYCTM J C P RY MI I I U L T TW I A B T EC EVH N ZWE SSQ O S B AA NI E N AQQTF T P N J TN TNG E PQ I COP Y Z S HE DG A R J WD EQ E Y P E BS DECORATIONS CANDY CANES CHRISTMAS MISTLETOE CELEBRATE ORNAMENT REINDEER COOKIES LIGHTS PRESENTS FAMILY ELVES GIVING DINNER WREATH SANTA 28 | MASM Health

Christmas Edition | 2022 ADVERTISING RATES Middle Age is: INSIDE FRONT COVER When you and either your teeth MK305,000 (dentures) or your eyes (spectacles) don’t sleep in one bed anymore... INSIDE BACK COVER When the middle part of your body MK305,000 starts to show up than the rest... When you apply online for a OUTSIDE BACK COVER mature entry postgraduate course MK310,000 and the app does not include your birth year in the drop-down INSIDE FULL PAGE selection… MK230,000 Kelvin Maigwa INSIDE HALF PAGE MK140,000 INSIDE QUARTER PAGE MK90,000 SMALL PAGE MK70,000 Oshema MASM Health | 29

FOR MORE INFORMATION CONTACT: THE CHIEF EXECUTIVE OFFICER LILONGWE OFFICE: MZUZU OFFICE: MASM Head Office, 22 Lower Scatter Road Plot Number 11/59, Area 11 Grace Building P.O. Box 1254, Blantyre, Malawi Behind Capital Hotel P.O. Box 973, Mzuzu Tel: 01 820 298 / 543 | Fax: 01 820 217 P.O. Box 30381, Lilongwe 3 Tel: 01 311 376 Email: [email protected] Tel: 01 776 427/503 Fax: 01 311 797 BLANTYRE LILONGWE MZUZU TEL: 01 831 744/788 CELL: 0888 189 072/70 CELL: 0888 189 068/069 CELL: 0888 189 074/75 LILONGWE: 0888 731 119 / 0887 081 012 MZUZU: 0887 081 010 MASM TOLL FREE NUMBERS BLANTYRE: 0888 707 100 / 0887 081011 Tip-offs Anonymous Make a Report safely and anonymously to an independent and professional company concerning issues of theft, fraud, scams and corruption occurring within MASM. TOLL FREE LINES: 8000 0847 MTL/847 AIRTEL&TNM Fax: 01821229 Email:[email protected] Free Post: P.O.Box 1726, Blantyre.