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Accountability question on women’s health in Malawi

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Rewinding to the year 2000, world leaders agreed on Millennium Development Goals. The fifth goal on maternal health is the one the country has failed to achieve.

Although many blame the scenario on shortage of health workers, a new report from the Independent Expert Review Group (IERG) points at lack of accountability to be a major obstacle.

According to the World Bank, accountability is defined as the obligation of power holders to account for or take responsibility for their actions. Power holders refer to those who hold political, financial or other forms of power and include officials in government, private corporations, international financial institutions and civil society organisations (CSOs).

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“Health should be at the centre of sustainable development”, said Ban Kimoon in May, 2014. He continued: “Accountability will be an important part of the new development agenda.”

The UN Secretary- General was speaking during the Government of Canada’s Saving Every Woman, Every Child Summit, held in Toronto shortly after the World Health Assembly. A recent 2014 MDG endline survey conducted by National Statistical Office shows that Malawi has reduced its maternal mortality rate from 675/100,000 in 2010 to 574/100,000 in 2014, a sign of slow progress which means the country has a long way to go to reduce maternal mortality.

The IERG, in a recent visit to Malawi, observed that there was often a general lack of awareness of the Global Strategy for Women’s and Children’s health.

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Secondly, the group noted that national accountability mechanisms frequently suffered weaknesses that challenged the country’s efforts to use accountability as a mechanism to advance women’s and children’s health. Thirdly, transparency of data was a commonly discovered problem. The IERG made visits to various countries.

The experts found that Malawi shared the same problem with Peru in South America. The IERG finally discovered that health systems were often under great pressure— undergoing reform, but with limited management and health worker capacity to deliver on ambitious political goals.

“These visits showed why no single blueprint for success can simply be projected on (or parachuted into) a country. The differing political, economic, social, and environmental predicaments between countries all shape their health challenges and responses in unique ways,” reads in part the 2014.

IERG report co-edited by Richard Horton who is also the editor of the Lancet Series Journal and Joy Phumaphi As part of addressing accountability challenges in maternal and child health, the White Ribbon Alliance for Safe motherhood in Malawi (WRASM), World Vision Malawi and National Initiative for Civic Education (Nice) recently undertook citizens’ hearings in Kasungu and Blantyre.

The aim of the hearings was to engage citizens to hold leaders accountable on their promises to improve maternal health service delivery. In one of the hearings, Member of Parliament for Kasungu South East, Madalitso Kazombo blamed it on the lack of a health facility in Kapyanga in his constituency due to lack of political will and accountability within the Ministry of Finance which is responsible for budget formulation.

“My question is when is the health facility going to come to this area of Kapyanga? In parliament I made a 10-minute speech that people travel 20 kilometres to access health services at Wimbe health centre,” said Kazombo addressing the hearing. He added that the area was one of the highly neglected areas in terms of health facilities and pleaded with the citizens to be patient. He urged them to join in lobbying government and companies such as Shayona Cement to invest in health infrastructure as part of the Corporate Social Responsibility.

“In the 2014/2015 budget, Kapyanga health facility was budgeted for in the national budget. After several follow ups I found that there were no funds allocated,” he noted.

A local citizen in the hearing, Aaron Chimutu Mwale, expressed sadness and despair blaming legislators and political leaders for lacking accountability in addressing urgent women and child health needs in rural areas such as that of Kapyanga. “Just imagine at Dzaleka Refugee Camp, the refugees have a good health facility and have access to better maternal health services. Why is it that Malawians cannot access better health services in their own country? What do you want us to do?” said Mwale Amid cheering from the citizens.

Mwale also noted that husbands who act as guardians of their pregnant wives are frequently turned away at Kasungu District Hospital when they find them about to close after travelling long distances from Kapyanga area. Kasungu District Health Officer, Jerome Nkhambule admits that Kasungu South East is one of the areas highly underserved in terms of access to health services.

“This is one of the areas in the country without adequate health services, in the government policy, a person is not supposed to travel a distance of 8 kilometres to access a health centre. One health centre is supposed to serve 10,000 people yet at Wimbe, the health facility serves over 40,000 people. This places health workers under huge pressure due to heavy work load,” notes.

At an Accountability Stakeholders Meeting, held in Geneva in January, 2014, Dr Margaret Chan, Director- General of World Health Organization (WHO), noted that accountability had become “the norm in any global health discourse, debate, or discussion.”

But she pointed out that women and children’s health was the “hardest test case” for accountability. At the New York 2013 MDG Review meeting, the UK Government pledged US$1.6 billion to the Global Fund to Fight Aids, TB, and Malaria between 2014 and 2016, in addition to US$4.5 billion from the US and US$1.5 billion from France.

The World Bank Group projected $700 million in new financing to the end of 2015 in support of women’s and children’s health. And the Government of Norway contributed $75 million over 3 years to a new “Reproductive, Newborn, and Maternal Health Trust Fund.”

In total, US$1.15 billion was committed over 3 years to help save the lives of children and women.

The key question for Malawi and policy makers is that as the world leaders are about to agree on the Sustainable Development Goals in September this year, is the country ready to reduce maternal mortality by 70 percent by the year 2030? The search for answers should at least start right now.

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