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A letter from Barbara Nagy in Malawi

Fall 2013

Anatomy of a Mission Hospital Budget 101

Greetings, friends and supporters of Nkhoma Hospital,
Imagine that the tax refund check you received from Uncle Sam last spring bounced when you deposited it… This is essentially what has happened to Nkhoma Hospital recently. Eight years ago we entered into a historic agreement with the government of Malawi (Service Level Agreement) to offer free care to all pregnant women and children under the age of 5. This removed an important barrier to people coming to the hospital for care and has been part of the drastic reduction in maternal and child deaths we have seen in our area. Although fees had been minimal—for example, $1.35 for a normal delivery—they were enough to keep mothers from delivering their babies in hospitals or health clinics and sacrificing their lives when emergencies happened in remote villages without access to blood or emergency surgery. They were also part of a delay in taking a sick child to the hospital, hoping it would recover, to save money needed to feed the family, until that child was critically ill and often beyond the point of being saved.

Due to the many economic challenges in Malawi, government has had difficulty paying its part of the agreement, which still does not fund all of the costs of care. They had kept their commitment for many months, but lately have fallen behind. For the past several months hospital staff repeatedly requested payment for services already provided. When a check was finally written and deposited a few weeks ago, it was returned for insufficient funds. After months of managing without a crucial part of our finances, as of today the hospital could no longer accommodate and faced not being able to pay staff or buy medicines. We were blessed when the Presbytery of Western North Carolina was able to wire funds that had been collected by churches in our presbytery to support our ministry, but this was a stopgap measure. Nkhoma Hospital operates at a bare bones minimum with a significant deficit annually, for which we depend on donors. The budget is geared to provide World Health Organization–recommended minimum levels of care to the hundreds of thousands of people seeking health services annually through our health care system, with people sleeping on the floors in every ward due to demand. The only way to truly balance the hospital’s budget without donors would be to stop offering services to vulnerable people living in our hospital’s catchment area who live in extreme poverty and are estimated to spend less than $1.00 per year on health services.

Would you prayerfully consider becoming a supporter of the work of Nkhoma Hospital? In the critical financial environment in which we constantly live we want to continue to offer services to seriously ill people who ask for help, but move beyond that goal to dramatically increase preventive services for people living far from the hospital. Both of these things must be done well in order for the communities surrounding the hospital to climb out of chronic poverty and begin to thrive. We believe this is part of the vital work of the Kingdom of God coming to the people we serve. We are grateful for everyone who partners with us in this ministry. Online donations may be made at for Nkhoma Hospital (click on “change it here” and type in E051772). Gifts for my position as Physician, Nkhoma Hospital, Malawi, can also be made at online to E074708 for Barbara Nagy’s sending and support. To mail a check see box below. Designate the check for one or both: Nkhoma Hospital E051772 or Physician, Nkhoma Hospital, Malawi E074708.

As for the Nagy family, we are watching our time of training in Public Health and living in the U.S. rapidly draw to a close. Next year at this time we hope to be back at Nkhoma rebuilding a community health program whose goal is to keep people from getting sick and transforming communities into places of health and development, experiencing the abundant life God desires for all.

Sincere thanks to all who have supported us in prayer, projects and financial gifts. We would invite any new readers to join in support of our ministry in Malawi.

Peace be with you,
Barbara, Melia, Anna and Happy for all of the Nkhoma community

The 2013 Presbyterian Mission Yearbook for Prayer & Study, p. 117
Read more about Barbara Nagy's ministry

Write to Barbara Nagy
Individuals: Give online to E074708 for Barbara Nagy's sending and support
Congregations: Give to D507546 for Barbara Nagy's sending and support



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