By Abdul Kalonga:
In recent years the government, through the Ministry of Health, has intensified its nationwide drive to achieve universal health coverage and significantly reduce maternal mortality.
Anchored by the rollout of the Presidential Initiative for Maternal Health and an expanded Emergency Obstetric and Neonatal Care network, capital investments and clinical mentorship programmes are targeting the root causes of preventable maternal deaths.
Yet while national policies present a picture of progress, recent checks in Ntchisi, Kasungu, Mzimba and Zomba reveal a far harsher reality in some health facilities.
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In Ntchisi District, the vision of safe motherhood is being undermined by a severe shortage of basic medical supplies, particularly surgical and examination gloves.
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The shortage has reached a critical point, with under-resourced health centres routinely turning heavily pregnant women away from labour wards and forcing them to return home or seek care at distant hospitals.
Although Malawi has reduced its maternal mortality rate from 439 to 224 deaths per 100,000 live births over the past decade, those gains mean little when health workers lack the basic supplies needed to assist women safely during childbirth.
At Malomo Health Centre, the shortage of essential medical supplies has compromised infection prevention measures and disrupted standard delivery procedures.
Healthcare workers, bound by infection control protocols, say they cannot safely conduct deliveries without sterile gloves.
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As a result, women arriving in active labour are told to travel to Ntchisi District Hospital or Kasungu District Hospital, while some are turned away altogether.
“When I arrived at the health centre, the nurse told me plainly that there were no gloves,” one mother from Traditional Authority Msauka said.
“I was told to go to the district hospital, which is over 25 kilometres away, or travel more than 45 kilometres to Kasungu. I had no money and I felt completely abandoned.”
For many rural women, such referrals are far from straightforward.
With limited public transport and poor road infrastructure, asking a woman in labour to travel long distances on foot or by motorcycle taxi increases the “second delay”, the time it takes to reach an appropriate health facility.
The district’s Director of Health and Sanitation Services, Alexander Chijuwa, rejects claims that women were turned away, insisting that gloves are routinely distributed to all health centres.
However, Chijuwa acknowledges a shortage, attributing it to reduced supplies from the Central Medical Stores Trust (CMST).
“As a district health office, we ration the few gloves we have across all facilities so that services are not interrupted.
“All our hospitals are operating normally, except that supplies of gloves from the CMST have recently declined, affecting facilities across the country,” Chijuwa says.
While CMST has maintained that national stocks of maternal health commodities are adequate, local distribution bottlenecks and supply chain inefficiencies continue to leave many rural health facilities without essential items.
Maternal health expert and former presidential adviser on safe motherhood Dorothy Ngoma warns that sending pregnant women home or delaying their care through “unnecessary referrals” risks reversing Malawi’s progress in maternal health.
“As a country, we have been fighting to end home deliveries and reduce reliance on traditional birth attendants. Unfortunately, our healthcare system is still failing to provide adequate services,” Ngoma says.
She adds that shortages of essential medical supplies force some women to give birth at home or while travelling without skilled birth attendants, increasing the risk of postpartum haemorrhage and neonatal sepsis.
“Such situations increase the risk of infections, ultimately endangering the lives of mothers, nurses and midwives. The government needs to step up and mobilise every available resource to address this problem,” Ngoma says.
In the meantime, advocates insist that if the Ministry of Health is to achieve its target of reducing maternal mortality to fewer than 70 deaths per 100,000 live births by 2030, it must close the gap between national policy and frontline service delivery.
They add that safe motherhood cannot be achieved simply by building health facilities and training healthcare workers but that it also depends on ensuring that the most basic tools, such as sterile gloves, are always available.
