Invisible champions of community health
Along the northernmost tip of Chitipa District are areas such as Ipula, Kapere, Malukwa, Soperela and Chiwanga which are pretty hard to reach.
Here, access to quality healthcare services is hampered by long distances that people have to cover to reach health facilities, poor road conditions, high illiteracy levels, poverty and low mobile phone network coverage.
The nearest health facility is Kameme, which lies at a distance of about 17 kilometres on average from the mentioned areas.
“Several families have ended up having more children than they had wanted or women giving birth without proper child spacing due to lack of knowledge on contraceptives,” Alice Silomba, a resident of Ipula, says.
Apart from providing family planning products, health facilities also have the responsibility of disseminating correct information on contraception.
The United Nations Population Fund (UNFPA) describes family planning as a human right, which is also central to gender equality and women’s empowerment and a key factor in reducing poverty.
The UN population agency says in developing countries such as Malawi, millions of women who want to avoid pregnancy are not using effective methods for reasons such as lack of access to information.
“This threatens their ability to build a better future for themselves, their families and their communities,” UNFPA says.
In areas along the northern stretch of Chitipa, some women would literally fail to even take their malnourished children to the hospital due to the long distances they have to cover.
In Chiwanga, an area which shares a border with Tanzania, patients, including expectant women, have to walk to the hospital because there is no reliable mode of transport to Kameme Health Centre.
“The only option they have is to hire a motorcycle taxi which costs a minimum of K10,000 one way. That is too expensive for these people,” Health Surveillance Assistant (HSA) Edgar Nyondo says.
Charity Kaonga, who now has a two-month-old baby, says she nearly delivered on her way to the hospital.
“I went into labour earlier than I had expected. Luckily, I had shifted to the hospital earlier enough. I gave birth a day after arrival,” Kaonga says.
In an ideal situation, a pregnant woman is supposed to go to hospital several days ahead of her due time. But most of them fail to do so because of competing priorities in terms of food and other items that they are supposed to take with them.
Some end up delivering at home after labour catches them off guard. Then they also fail to take their babies to the hospital for the regular immunisation.
But they too, just like any Malawian, want quality, efficient health care which is closer to them.
Tamandani Juma, a community health nurse for Chitipa, who is also Deputy Extended Programme on Immunisation (EPI) Coordinator for the district, says in the absence of enough money for infrastructure projects at local level, community members must come in.
In the areas spanning much of Chitipa northern stretch, locals are now constructing healthcare structures using their own means.
The structures include underfive clinics and houses for HSAs and community midwife assistants. At the fulcrum of these initiatives are women in small but important teams branded mother care groups (MCGs).
Through the women-led initiative, community members built a house for an HAS at Kapere and rehabilitated another at Ipula.
They are also building an underfive clinic at Soperela. The community members have also convinced government to send HSAs to all the five areas.
They are also lobbying for the recruitment of community midwife assistants.
Mark Mtambo is an HSA at Ipula under-five clinic. Lying at the foot of Saka Hills, his house was rehabilitated through the women-led initiative.
“The floor of the house was riddled with holes and walls had a lot of cracks. It really needed to undergo serious maintenance, which was provided for by the women,” Mtambo says.
The women groups, which are typically invisible drivers of the healthcare sector in local set-ups, have also been empowered to follow up on parents and children on whether they are adhering to immunisation requirements.
This has reportedly eased the workload of HSAs in terms of tracking defaulters.
They follow all the vaccines that a child takes from birth up to the age of 16 years, which include Bacille Calmette-Guérin for tuberculosis, polio shots, malaria vaccine and measles vaccine, among others.
“Tracing vaccine adherence is not easy in rural areas because of mobility challenges. So the coming in of these women has really made my work easy. I am able to follow up on every child through them,” Mtambo says.
In the communities, households are requested to make contributions of around K3,000, depending on circumstances, to help in the construction projects.
Blessings Msomba, a member of Ipula MCG, says the group was given a piece of land by their chief on which they grow crops whose proceeds they use to reach out to struggling mothers.
“The aim is to make sure the mothers get all necessary vaccines for their children; that is why we support them in that regard,” Msomba says.
Juma says in most of these areas, full immunisation was at less than 50 percent, which is against the World Health Organisation recommended minimum of 80 percent.
She says the women, who are championing access to healthcare services in their communities, were trained by Malawi Health Equity Network (Mhen) in a five-year project on strengthening health systems and immunisation.
Supported by Gavi, a public– private global health partnership whose goal is increasing access to immunisation in poor countries, the project seeks to amplify access to immunisation, particularly in hardto-reach areas.
Mhen Project Officer Hannah Dzongo says after community members do their parts in improving access to healthcare services in their locations, duty-bearers must also come in.
“Members of Parliament and ward councillors must also do their part by lobbying for funds for constructing health-related structures in their areas to foster immunisation and general health,” Dzongo says.
She says that through the project, almost all children in the targeted locations have been reached with the required vaccines.
“The women are very passionate and we are hopeful that the systems will continue to thrive even after the project phases out in 2024,” Dzongo says.