For 23-year-old Madalitso Mbewe, pregnancy in 2024 was not a journey taken lightly. She faithfully attended every antenatal clinic session, never missing a single visit when health workers came to her village in Elunyeni.
She knew her expected delivery date—November 5, 2024—and prepared for it.
But life rarely follows dates on paper.
“On October 17, I started feeling labour pains,” she recalled.
Living on the foot of Zuwe Hills, Madalitso and her family scrambled in the night to find transport to Mpherembe Community Hospital, about 30 kilometres away. By the time they found a way out, it was too late.
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“We stopped by the roadside. That is where I delivered… painfully,” she said.
At dawn, bruised and exhausted, she continued her journey to Mpherembe.
“Luckily, doctors told me the baby had come out fine but it should not have happened that way,” she said.
Her story is far from isolated.
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Twenty-year-old Hope Ngulube also followed every instruction given during her antenatal checkups, held once every month in a small shelter in her area. But her labour started earlier than anticipated.
“It was in the middle of the night. Being my first pregnancy, I was terrified,” she said.
Her husband tried calling for a bicycle taxi to get her to Mpherembe, but heavy rains had left the already poor road nearly impassable.
A car was out of the question.
With no immediate help, Hope delivered at home, surrounded only by elderly women from the village.
“I delivered under very painful circumstances,” she said softly.
After the ordeal, she made it to the hospital—only to be fined K30,000 for delivering at home.
In this area, Elunyeni, in Mzimba North, a health surveillance assistant (HSA) estimates that at least seven women deliver at home or by the roadside annually.
The HSA, Edward Nyondo, said the area has over 10,000 people and that, considering the distance to the next facility, it requires a hospital.
“When a woman delivers at home or on the roadside, you cannot guarantee the survival of either the baby or the mother. It is risky because the people helping them are unskilled,” he said.
In 2015, community members celebrated when construction of an Out-Patient Department (OPD) began.
However, the celebration was short-lived as the project stalled at window level three years later.
Today, the uncompleted structure stands as a painful reminder of unmet promises, according to one resident Rhoda Mkandawire.
Mkandawire, who chairs a local women-led vaccine advocacy group, said the absence of a nearby facility affects not only expectant mothers but also children.
“Imagine a child suffering from malaria or cough. We have to travel all the way to Mpherembe. A bicycle taxi costs K15,000 one way. Many cannot afford that, so they walk four hours to get there and this four-hour travelling time is one way,” she said
She added that Thunduwike, the other nearest health facility, is even farther.
Mkandawire said women are willing to mould more bricks and contribute labour if resources are provided to complete works on the stalled hospital.
Another resident, Lexina Ngwira, said the area has six HSAs—a clear indicator of the large population requiring support.
“Communication during emergencies is also a struggle,” she said, attributing the problem to poor mobile network coverage.
Inkosana Zebedia, a local leader, said several attempts to lobby for support have yielded no results.
“The OPD was started by the late Goodall Gondwe when he was MP for the area. We feel isolated in many ways and, on this issue, we ask the new administration to help us finish the hospital,” he said.
Elunyeni is surrounded by two hills, Kalama and Zuwe, and two rivers, Gonela and Tchesamo, which cut off roads in times of floods, worsening access to healthcare.
Beyond the hospital issue, access to clean water remains a critical challenge.
In 2007, a Solar-Wind Hybrid System provided electricity to 150 households and 12 communal water points. But the project failed, and the solar equipment was eventually removed.
A study by Christopher Hara, titled ‘An Overview of Community Energy Systems in Malawi’, attributes the collapse to poor maintenance, minimal community participation and a tariff system replete with gaps.
Today, most households draw water from shallow wells.
When The Daily Times visited the area, we came across one of the wells. Three women were waiting in line to draw water which they use for drinking, cooking and washing.
Nearby, cattle grazed—and sometimes drink from the same source, according to Monica Nkhoma, one of the women we found at the well.
“We have one borehole but it’s not enough. The population is too big. In 2008, we had clean piped water, but that is gone. Only the structures remain,” she said.
All these challenges compounded are affecting the health status of the people in Elunyeni.
Back to the hospital issue, Mzimba North Health Promotions Officer Lovemore Kawaye acknowledged that hospitals in Mzimba North are not enough to cater for the growing population.
Kawaye said the standard requirement for establishing a health facility is a population of 10,000 and a distance of at least 5 kilometres from the nearest facility.
“In most of our facilities, the population is big and, also, the distance between a facility and another is usually more than 10 kilometres. So, what we are doing is to ensure that we provide outreach clinics in hard-to-reach areas, more so because we are aware that we cannot manage to construct health facilities everywhere they are needed,” he said.
Commenting on the health-related challenges people in Elunyeni are facing, Malawi Health Network (Mehn) Projects Officer Kumbesi Gomile said the area’s situation reflects a broader national crisis where health facilities are too few, too distant and severely under-resourced.
Gomile said Malawi cannot be talking about meeting Universal Health Coverage goals while entire communities remain cut off from basic care.
“We call on the Ministry of Health, local authorities and elected representatives to act with urgency. There is a need for collaboration because people of Elunyeni have waited for too long,” he said.
Speaking in Parliament recently, Health Minister Madalitso Baloyi said the government is committed to ensuring that people easily access health facilities across the country.
Baloyi noted that the country’s population continues to rise while health facilities remain limited.
She said the government will continue mobilising resources to upgrade existing facilities and construct new ones, adding that the ministry is assessing areas where people walk over 7 kilometres to access health services.
However, for countless women in remote communities like Elunyeni, childbirth remains a life-threatening encounter.
The story of Elunyeni also challenges Malawi’s commitment to Sustainable Development Goal (SDG) 3, which focuses on ensuring healthy lives and promoting wellbeing for all, as 2030 inches closer.
