By Chancy Namadzunda, Contributor:
In the Central Region district of Ntchisi, about 61 percent of women within the age group of 15-49 are using a modern method of family planning, according to the 2015- 16 Malawi Demographic and Health Survey.
Yet, inspite of this reasonable number of women seeking modern methods of family planning in the district, there are challenges which prevent most women from accessing the methods.
Malomo Health Centre, which lies on the northern stretch of the district, serves about 46,000 people with some coming from the neighbouring district of Kasungu.
According to Noel Ngwata, who is charge of the centre, its catchment area has about 25,000 people of reproductive age, of whom 1,000 women and 100 youths access family planning services per month.
Ngwata says although a lot of women and youths are eager to access family planning services, challenges such as unavailability of family planning products, shortage of qualified health personnel and funding problems remain stumbling blocks.
“In 2017, the centre had four nurse-midwife technicians, but we now have only two who are assisted by two community midwives and two medical assistants,” Ngwata says.
To compound the problem, each Health Surveillance Assistant (HSA) serves over 2,000 people against the recommended ratio of one HSA per 1,000 people.
Ngwata adds that the health centre sometimes runs out of family planning methods such as Depo-Provera and IUDs (loop), which had been unavailable for three months and six months respectively as of mid-November.
“These are the mo s t preferred methods by women and girls. Mostly, we are left with condoms which are rarely preferred because, according to the women, they bring about differences in the family as they are mostly accused of cheating by their husbands,” he explains.
As a result, Ngwata said, the hospital registers not less than five teenage pregnancies per month.
On the other side of Ntchisi Boma, about 45 kilometres away, lies Kangolwa Health Centre, which serves about 18,730 people. Of these, 8,990 are youths of whom 4,308 are of reproductive age. The facility registers about 937 pregnancies per year.
According to Sestino Kamkulukutu Arkangel, who is in charge of the facility, their main challenge is shortage of health personnel.
“We only have one medical assistant, three nurses and 10 HSAs who are not enough to serve the whole population because, sometimes, we also have people from the neighbouring district of Nkhotakota who come here to seek medical assistance,” Arkangel says.
Par t of the personnel shortage is covered, even though inadequately, by 18 community health workers who are employed by some non-governmental organisations.
Unlike at Malomo Health Centre, Arkangel says almost all the required family planning methods are available at Kangolwa Health Centre.
However, due to long distances, the health centre makes the initiative of reaching out to the communities, which is costly because of the little funding they get from the government.
The government is the largest provider of health services in Malawi, covering around 60 percent of the health services, but the private sector also directly acts as a provider of healthcare services.
About 40 percent of health services are provided by private actors such as the Christian Health Association of Malawi, commercial providers and some non-profit actors.
Malawi has only 0.52 professional health workers per 1,000 inhabitants, whereas the World Health Organisation has calculated that a country needs at least 4.45 professional health workers per 1,000 inhabitants to realise Universal Health Coverage and the Sustainable Development Goals.
According to the World Bank Workload Indicators of Staffing Need study completed in 2017, there is an overall vacancy rate of 51 percent for all cadres in Malawi.
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