No water, no treatment


Access to safe drinking water remains a huge challenge in Malawi, especially in rural areas. But when the problem becomes more pronounced in health facilities, questions linger about where patients will seek solace. SAM KALIMIRA writes.

Chisomo Nkhata, a nurse at Chintheche Community Rural Hospital in the lakeshore district of Nkhata Bay, had to think twice before stepping into the maternity ward which had not been cleaned for a week.

However, as a nurse in charge of the ward, she had no option but to proceed into the dirty and stinking room where her fellow nurse Ruth Ziba was delivering the baby of a woman who had arrived at the facility after she had already started experiencing labour pains.


“We had to assist her. Sending her to Nkhata Bay District Hospital would be doing a terrible injustice to her. As medical workers, we are supposed to use all necessary and safe means of assisting patients caught up in such situations,” Nkhata said.

After successful delivery, which was conducted without clean water, the new mother’s guardians rushed three kilometres down Lake Malawi to fetch water for the mother to bathe and for cleaning the labour ward.

This was the case early last month when the rural health facility’s taps ran dry for 12 days.


The referral facility that caters for seven health centres in the southern part of Nkhata Bay and serves a population of 28,071 faces regular water challenges.

The hospital accumulated water bills amounting to K48 million which it is struggling to settle with Northern Region Water Board (NRWB).

The board in June this year removed a post-paid meter from the facility and replaced it with a prepaid one.

Chintheche Community Rural Hospital in-Charge, Greyson Kumwenda, said since the board changed the meter, the facility had been struggling to buy the required units for water, a development which sometimes leads to dry taps.

Kumwenda said the facility is normally allocated K1.4 million for water bills, of which 16.5 percent of the amount is deducted for withholding tax.

“When we buy units, the water board gets 50 percent of our payment for part settlement of the debt. Thus, we get less units which fail to supply water consistently to the facility,” he said.

He also revealed that, during the 12 days that the facility had no water, patients were being referred to Nkhata Bay District Hospital, which is 45 kilometres away.

Lea Banda, 62, from Mgodi area under Village Head Ntepera, said she felt bad when she failed to access health services at the rural hospital due to water challenges.

“My son was sick but hospital personnel told me that he could not be assisted because there was no water. We simply had to return home because I had no money for travelling to Nkhata Bay District Hospital,” Banda said.

Health Advisory Committee (Hac) member, Olive Banda, said the situation becomes dire when guardians decide not to go to the lake to fetch water, but keep on asking for it from nearby homes.

He said patients who cannot afford to buy bottled water take their medication using untreated water

“We have been receiving complaints from surrounding households that they are at risk of contracting waterborne diseases from guardians and some patients who often rush there to search for water,” Banda said.

The hospital’s matron Juliet Phiri said, during the 12 days of dry taps, the facility became a death trap for health workers, patients, guardians and people from surrounding areas.

“If there is no water, there is no hygiene. This means people can be at risk of contracting waterborne diseases, among others. Now, all of us are at risk of contracting Covid-19,” Phiri said.

The situation at Chintheche Community Rural Hospital is just a tip of the iceberg in term of health facilities that are failing to sustain buying water from NRWB on prepaid basis.

Karonga and Rumphi district hospitals owe the board over K100 million each for water bills.

Karonga District Hospital Director of Health and Social Services David Sibale said the bills have been accumulating due to leaking of water within the facility’s system as it is old and most of its structures are in dilapidated states.

Apparently, if NRWB could decide to install a prepaid meter at the facility, a similar challenge is likely to surfacce.

On the other hand, NRWB Chairperson James Munthali said the K4 billion that government institutions owe the board was crippling its operations.

Munthali revealed that Malawi Defence Force and Malawi Police Service are among those that owe NRWB millions of kwacha in unpaid bills.

“These accumulated bills affect the board’s operations. We use the same money for procuring materials, chemicals and other resources for treating water. Therefore, the money is supposed to be collected,” Munthali said.

Minister of Forestry and Natural Resources Nancy Tembo gave a go-ahead to NRWB to disconnect government institutions that have accumulated bills, saying water is not for free.

“If State House pays water bills, others should not resist paying,” Tembo said.

However, Universal Health Coverage Coalition Chairperson George Jobe said NRWB should have understood that hospitals deal with lives of people and therefore consider other means of collecting the due bills without compromising healthcare service delivery.

On the other hand, health activist Maziko Matemba said Malawi could be reported to the United Nations if the Medical Council of Malawi closes hospitals that have no running water.

“Obviously hospitals cannot operate without safe water; so this means there is a probability that some facilities can be closed and this is dangerous to the country.

“However, let us also look at the cause of such huge debts. There must be mismanagement or failure to properly weigh priorities,” Matemba said.

On his part, Principal Secretary in the Ministry of Health Charles Mwansambo said that discussions were underway with the boards to find proper ways of repaying the debts while not deducting units from current payments for water.

“We have talked to the boards that we are paying the current bills. But for the arrears, let us find other means of how we can pay back because deducting from units which hospitals buy is resulting in the facilities failing to sustain the flow of water,” Mwansambo said.

According to Unicef, Malawi’s poor sanitation, unsafe water and unhygienic practices contribute to 3,000 of under-five child deaths every year with 5.6 million people not having access to safe water sources.

Yet, by 2030, Malawi and the rest of United Nations member states are supposed to ensure all their citizens have safe and affordable drinking water. This is supposed to be achieved through investment in adequate infrastructure, provision of sanitation facilities and encouraging hygiene.

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