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Glaring inefficiencies in maternal, neonatal, child health

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It is 5:00am and Bernadetta Kanzuli joins a group of about 30 women who are on a queue waiting for their turn to draw water from a borehole at Bua Health Centre in Kasungu.
Kanzuli, a 33-year-old mother from Group Village Head Chitseko in Traditional Authority (T/A) Njombwa in Kasungu, has been at the health facility for close to a month now.
She is providing guardian service to her pregnant firstborn daughter Lucy Phiri who is due for delivery in a few days.
And as per the government policy and her village by-laws, Phiri is waiting at the health centre until she delivers.
Kanzuli starts her day by drawing water from the borehole, which is located at the middle of a dilapidated maternity wing and a door-less semi-detached block that serves as a guardian and waiting shelter.
The borehole is the only source of clean and safe drinking water to patients, guardians and all communities that surround the facility.
Thus, every morning, Kanzuli spends close to an hour chattering with fellow guardians and a legion of women, girls and young children from the surrounding communities as they wait for their turn to draw water.
“Life is horrible for expectant women and guardians here. Poor sanitation and hygiene in waiting homes and/or labour wards and lack of security among expectant women and guardians are posing a serious threat to our health at this facility,” she gladly opens the interview.
Kanzuli then questions government’s seriousness and sincerity on tackling maternal and neonatal deaths and morbidity when it is failing to provide structures to motivate expectant women to deliver at health facilities.
She argues that there are so many deterrents to the promotion of safe motherhood in Malawi atop inadequacy or total lack of skilled midwives in most health facilities.
“How does government or that Presidential Initiative on Safe Motherhood back its call for women to deliver at the health facility? Does government want us to die of waterborne diseases contracted right in the corridors of the health centre?” quizzes the guardian.
Bua Senior Health Surveillance Assistant Collings Chinyanga says he usually uses personal finances to meet the costs of other basic sanitation and hygiene items.
Chinyanga cites tablets of soap women use to wash their hands after visiting the toilet as one of the items he buys using personal cash.
“I do this not because I have more than enough but to save women from contracting sanitation and hygiene-related infections,” he explains.
Bua Health Centre is a symbol of inefficiencies and inequalities existing in the health sector, particularly in the campaign to promote safe motherhood in the country.
World Health Organisation reports that Malawi has one of the highest maternal mortality ratios globally, currently estimated at 574 maternal deaths per 100,000 live births.
And this is largely attributed to the various challenges, including lack of sanitation and hygiene and shortage of midwives in health facilities where women are encouraged to deliver.
The poor sanitation and hygiene conditions, poor infrastructure and lack of medical personnel in maternity wings are a contradiction or reversal to the commitment elected political leaders such as presidents have been making in as far as the promotion of safe motherhood is concerned.
Another guardian, Gloria Robert, says majority of the maternity wings she has visited both within and outside Kasungu operate without ideal and recommended sanitation and hygiene facilities.
Robert says this puts lives of expectant women, guardians and their expected children at risk of contracting viruses and diseases, which they sought to prevent when they chose to deliver at a clinic.
“We come to the hospital to get treated for various ailments including to deliver in a healthy environment. But could you say this is a healthy environment for preventing infections?” she asks.
The United Nations Sustainable Development Goal (SDG) 3 seeks commitment from member states, which include Malawi, to reduce maternal deaths by two thirds by 2030. This entails that every country should have less than 140 maternal deaths per 100,000 live births.
And this is not a simple task for the Malawi Government as demonstrated by the numerous challenges existing in the health system.
A midwife at Machinga District Hospital Luke Chiwala argues that there is a “bigger problem under the carpet than the smell on the table”.
Chiwala observes that although it has succeeded in mobilising women to deliver at their nearest health facilities, government is doing ‘very little’ to address the challenges that could hinder it from realising SDG 3.
Chiwala is among midwives who underwent health reporting training, which was organised by White Ribbon Alliance for Safe Motherhood in Malawi (WRASM) last year.
“Quality of care matters less provided women deliver at a health facility and go home. This is the kind of thinking that most hospital managers and policymakers have. But this is punishment and torture to midwives and patients,” he complains.
He accuses authorities for demonstrating no regard to the provision of quality of care and service in the sexual reproductive, maternal health and child health (SRMNCH) sector.
Chiwala notes that authorities tend to pile pressure on midwives and put them in dilemma by forcing them to operate in an environment that is not conducive for them to practise.
“Women are still dying due to complications of pregnancy and childbirth despite delivering at the hospital. Patients die while waiting for ambulances, an indication that despite women delivering at the hospital. This shows there is still a gap that needs to be covered,” he says.
And according to Chiwala, the situation is the same in public and Christian Health Association of Malawi (Cham) hospitals where most maternity wards are operating with only one midwife on duty, looking after dozens of clients.
The United States Aid for International Development (USAID) says maternal mortality and morbidity continue to be a serious human rights concern, justifying the increasing acceptance of application of human rights-based approaches to SRMNCH, among a diverse range of stakeholders.
And according to a USAID study, poor SRMNCH indicators are intricately linked with violence against women, poor health-seeking behaviour, marginalisation, women’s minimal participation in decision making, the under-prioritisation and under-funding of services and goods only
women require and lack of accountability mechanisms to respond to maternal deaths and grievous injuries.
USAID, therefore, urges government to prioritise the strengthening of maternal, neonatal and child health policies, standards and guidelines; mobilising communities for increased adoption of
individual, household and community behaviours that positively impact the health of mothers, newborns and under-five children; and training health workers in basic emergency obstetric and neonatal care.
WRASM National Coordinator Nancy Kamwendo says Malawi has only 3,233 bedside midwives, with only 18 percent of the number living and serving rural communities.
Kamwendo says this restricts access to suitably qualified health professionals among rural women such as Lucy Phiri in Kasungu.
She cites Mangochi where one midwife is responsible for 7,801 childbearing women.
“The majority of women of reproductive age live in rural areas where access to quality maternal health services is poor and under-resourced. Shortage of midwives and lack of sanitation and
hygiene facilities are further suffocating the gains Malawi could have made in promoting safe motherhood,” says Kamwendo.
She says there is need for strengthened local policies and standards, ensuring sufficient financing and trained staff to manage Wash in healthcare facilities, using risk-based approaches to prioritise and maintain improvements and harmonise and expand monitoring.
But Kanzuli, her pregnant daughter Lucy, Robert and millions other Malawians can only dream in colour that things will change one day.

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