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Horrors of inadequate funding: case of Simlemba Health Centre

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At 37, Jessie Shawa is heavy with pregnancy, expecting her fourth child. She travelled from Mnjondo Village to Simlemba Health Centre—a 50-kilometre distance—for a safe delivery, bypassing the ubiquitous traditional birth attendants (TBAs) in her Traditional Authority Simlemba, Kasungu District. She had to take heed of the advice by safe motherhood campaigners on the need to deliver under the care of specialist midwives in hospitals.   Sitting on a veranda of a waiting shelter, she broods over the many problems she faces at the hospital as the clock slowly ticks towards her due date.  “There are so many challenges at this clinic. This could be the reason some women opt to deliver in their homes with the assistance of TBAs. “To begin with, there is no water here. Our guardians travel long distances to fetch water. It sometimes takes them the whole day just to make a single trip because there is always a long queue and the water trickles very slowly. You cannot like it. And the tradition is that the ‘owners’ draw the water first. That is why we can be waiting the whole day just to draw a single bucket,” she said. The hospital and the surrounding communities use a single borehole located half-a-kilometre away from the clinic. In its poor state, the borehole serves over 1,000 people; thus, there are always snaking queues. “Then we have to queue again to take a bath. The bathrooms are not enough for the ever-growing number of people visiting this hospital. Now you can imagine that a woman who has just delivered has to queue to get a bath. The labour ward has no bathrooms because there is no running water. So, we all have to scramble for the few bathrooms that are available. This is not supposed to be the case,” Shawa said. Another woman, Lucitia Banda, 41, of Mnyanja Village is mad about the unavailability of toilets at the health centre. She said the absence of adequate pitlatrines compromises sanitation and hygiene, hence posing a threat, especially to pregnant mothers and newly born babies. Of the four pit-latrines which Unicef constructed at the facility long time ago, only one is usable as the rest are full. Patients, guardians and members of staff share the single toilet. Speaking during a media clinic organised by National Initiative for Civic Education (Nice) Trust, the hospital management conceded that they were facing many challenges which compromises infection prevention efforts. “It is true that we have a big water problem in this area. The single borehole that is shared by the entire surrounding community has proved to be insufficient to meet the demand for water at this health centre. If members of staff go to fetch water, it means patients will remain unattended to. “The labour ward, for example, is one of the critical areas that need water to be readily available but that is not the case here. Infection prevention cannot be achieved in such situations. Sometimes, we agree with guardians to fetch water for use in the wards. This happens on humanitarian grounds but it is not supposed to be the case. The situation is dire,” Edward Mtontholi, a medical assistant at the health centre, explained. He said infection prevention efforts are also challenged by the absence of a proper incinerator and a placenta pit. “We have a rubbish pit for incinerator and the placenta pit is full and not covered such that it stinks. This is a serious infection prevention issue. And again, the toilets are full. There is only one which is in usable state. The maternity has no bathrooms and toilets, meaning that even after delivering, women share the general washrooms which are also used by guardians; likewise the toilet,” said

Mtontholi, franked by the hospital’s lone nurse midwife Vincent Jere and other officials. “Apart from compromising infection prevention efforts, we fear that these challenges can discourage women from delivering in hospitals, which will be another maternal challenge. Nevertheless, we implore women to deliver under specialist attention in hospitals despite the challenges that are there. Home deliveries are not safe,” he added. Being near a boundary between Mzimba and Kasungu, Simlemba Health Centre serves a population of 33,790 from its primary catchment area, an additional 15,000 from Mzimba and 5,000 from Wimbe area in Kasungu East.  Statistically, the facility is expected to handle 270 child deliveries in a month but it handles between 80 and 100 births per month. According to Mtontholi, this is a big number considering the unavailability of resources at the clinic. “We don’t have delivery packs in the labour ward. We just improvise them and that is even more challenging due to lack of water. We don’t have sterilisers. The gas-powered steriliser has been idle since 2014 due to lack of gas. The labour ward is very small and has only two beds, which are very close to each other thus compromising privacy as well. Some women deliver on the floor. “Additionally, there is need for more members of staff. Against the given population, there is only one

medical assistant, one nurse-midwife and at least 17 HSAs. There is also need for a vehicle and electricity. Solar panels are there but the batteries are dead. We have been using torches for the past five months,” he said. “On a positive note, we are trying our best to provide standard services with the little resources we have.” Making his contribution, Group Village Headman Kathewera said there was a big water problem in the area. “There are about 60 boreholes in this area against 141 chiefs [village heads]. We have heard that the government has given 12 boreholes to each constituency but still that is too little to reverse the situation here,” Kathewera said. Simlemba is in Kasungu North North East Constituency. “We are planning to have an audience with the Member of Parliament (MP), Roger Sithole, as an ADC [Area Development Committee) to see how best we can solve the problems. About electricity, we understand that Marep [Malawi Rural Electrification Programme] was already approved, so we are keenly waiting for the implementation,” Kathewera said. Ward Councilor for the area, Alfred Chiwayula, attributed the challenges to unequal distribution of Constituency Development Fund (CDF) resources by the MP.  He alleged that his Mthabua Ward has not benefited much from CDF projects as was allegedly the case with

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Mpeni Ward where the MP comes from. However, Sithole said the allegation was false, describing it as mere politics. “We cannot develop the whole constituency at once. Mthabua Ward has 11 polling centres whereas Mpeni has 17. Mpeni is bigger than Mthabua, hence you do not expect funds to be shared equally. The other thing is that some chiefs in Mthabua Ward are crooked and not supportive. They are bent on abusing resources for selfish reasons. It is difficult to work with such people. “For example, we procured materials for a teacher’s house at Msezaumoza School in 2014. I told the communities to hire builders who were to be paid by CDF. But up to now, construction works have not started. Would you take such people seriously? But the underlying factor is that we cannot do everything at once; by-and-by we will reach more areas,” Sithole said. Vincent Kalawa is Nice’s Northern Region Civic Education Officer. He pointed out that access to quality health services is a constitutional right under Section 30 of the country’s Constitution. He, therefore, said the situation at Simlemba is a blatant slap on fundamental human rights.  “One wonders why after 53 years of independence, the standards of living are still poor like this. It is sad that we still have such problems not because we lack resources, but due to greed and corruption. This is why we must condemn corruption at all levels of governance because it is the most vulnerable that suffer the most

due to such malpractices. “The communities at Simlemba deserve better services. They are very participative as demonstrated by the fact that they have moulded thousands of bricks. They only lack technical and financial assistance. What we see there is pathetic,” said Kalawa whose institution is sensitising people in the area to demand better services from duty bearers. At least, K129 billion (9.9 percent of the total budget) has been allocated to the Ministry of Health— the third highest after Education and Agriculture. On the other hand, CDF’s allocation was hiked from K18 million to K23 million. However, limited access to information and critical policy documents by citizens due to a culture of secrecy by duty bearers, coupled with low literacy levels among the citizenry remains a challenge for many communities to demand quality services. In other instances, the inability of political leaders to effectively play their representative roles due to narrow partisan interests and lack of capacity results in frustrating the citizenry, hence their communities remain undeveloped. As public resources continue to be plundered, Shawa—like everyone else at Simlemba— is still hopeful that one day, a better world will dawn upon them. “We just have to cry louder until our voices are heard,” she summed up the frustrations at Simlemba

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