Heavy-laden with pregnancy, regardless of whether it is closer to term, some women in Mzimba District are left with no choice but to cover up to 13 kilometres (km) on foot to get to the nearest hospital.
This is despite that the Ministry of Health’s policy advances the agenda that every Malawian should reside within an 8km radius of a health facility.
Nonetheless, a significant proportion of the population, notably people who stay in Luvwere area in Mzimba District, consider the prospect of having a health facility within 8km as a luxury.
This is because they have become used to covering a distance of a dozen-plus km or so to access health care. To make matters worse, for them to cover the tedious distance of 13km from Luvwere, they have to cough between K2,500 and K3, 500 on transport fares one-way to reach their destination— Kafukule Health Centre.
According to a World Health Organisation (WHO) fact sheet on Universal Health Coverage, an estimated 150 million people suffer financially-crippling health payments while 100 million people are pushed below the poverty line simply because they need to use healthcare services but must pay out of their pocket.
Luvwere Health Centre, which was established in 1958, is situated in Traditional Authority Mtwalo, Mzimba district. This is a health facility which does not provide maternal healthcare services.
But, then, one has to travel through a rough and dusty earth road to get to the facility.
In 2013, the then president of Malawi Joyce Banda laid a foundation stone for the construction of a health centre but, for whatever reason, the project was abandoned at foundation level for reasons not known to people who were earmarked to benefit from the services.
However, due to unavailability of a maternity wing, pregnant women are forced to cover long distances on foot to go to other facilities, like Kafukule Health Centre, to access the services.
Forty-nine-year-old Daina Chaula of Chilamaonga Zgambo Village said people are suffering because, in 2013, the contractor who was supposed to construct the health centre—which was to include a mortuary, maternity and Out-Patient Department (OPD) wings— abandoned the work at foundation level.
Chaula said they could not trace the contractor and eventually gave up.
“Due to the long distance we cover to Kafukule Health Centre, some pregnant women have been delivering along the way,” she said.
The concerned community member added that it is very painful that women are suffering in such a way, a problem compounded by poor road network.
“It is costly to use public transport, which leaves us with no chance but to walk to the hospital on foot.
“People here are poor and fares on public transport are expensive. Unfortunately, some patients die on the way to the health facility and it becomes very difficult to carry the dead on this dusty and rough earth road, which sometimes becomes impassable during the rainy season,” she said.
Flyton Tembo, 75, from Chim’dima Village, said, apart from lacking a maternity wing, the road can best be described as a death trap.
“We do not have tarred roads. As such, when pregnant women travel to the hospital, they sometimes deliver prematurely due to the bumpy nature of roads. We are very worried with the situation, which paints the picture that we are not Malawian and, yet, during political campaign time, we were tricked to vote for candidates who promised to offer solutions to our problems,” he said.
Chairperson for Luvwere Health Centre Health Advisory Committee (Hac), Anthony Chiumya, said, when they noted that the designated contractor had abandoned the project, they tried to make some follow-ups, to no avail.
“We, as Hac, were not briefed about the amount of money that was pumped into the project despite being told that we were going to have a fully-fledged health centre. From 2013, the contractor has not showed up again. We believe that the government is aware of the issue,” he said.
Chiumya said, when the project commenced back then, they were happy that they would have a structure that would have facilities such as mortuary, OPD and staff houses, among other things.
One of the traditional leaders in the area, Howard Mhango, expressed worry that people, let alone pregnant women, are being forced to cover long distances on foot in search of healthcare services.
Mhango said, had it been that the health centre was constructed, some deaths would have been prevented.
“I am pretty sure that, had the structure been constructed, it would have lessened the burden of preventable deaths we are registering here,” he said.
Oxfam Health Governance Programme Officer, Rejoice Kankhande, said, while it is good to commend the government for ensuring that the health budget has, over time, been among top three sectors that have been getting a good chunk of the budget, the health sector remains in dire straits.
“Of course, the government has great ambitions, as evidenced through the introduction of Universal Health Coverage, but, then, Malawi’s health sector still faces constraints, in terms of financial and material resources.
“The problem of resource constraints means that we, as a country, are unable to totally achieve Universal Health Coverage goals in a manner that is sustainable and equitable. Investing in the healthcare system not only saves lives; it is also a crucial investment in the wider economy,” Kankhande said.
She said this is because ill-health impairs productivity, slows development and adversely affects human capital development.
“The government must invest in primary healthcare since it forms the foundation of all health systems, ensuring that all people stay healthy and get medical care at the most convenient accessible point when they need it,” Kankhande said.
Ministry of Health spokesperson Adrian Chikumbe said, in line with Health Sector Strategic Plan 2, which promotes universal access to healthcare, the government is putting much effort in improving the healthcare service delivery system by reducing the walking distance to the nearest health facility.
“In this current [2022- 23] National Budget, we have already funded 55 health posts that will be able to manage complicated illnesses. We are also increasing the capacity of health centres to make sure that we recruit technicians and nurses [and we are also] upgrading some health centres to community hospitals so that people can be accessing care wherever they are,” Chikumbe said.
The ministry spokesperson added that they are providing appropriate equipment to healthcare facilities.
In 2017, the maternal mortality rate was at 2.51 percent, a decline from 2016, when it was at 3.24 percent.
Universal Health Coverage means that all people have access to health services they need, when and where they need them without any hardship— a tall order for some people in Mzimba District.