Reaping from chiefs’ role in maternal, child health


Once in a while, Inkosi Gomani V summons his traditional leaders to his royal palace at Nzamani Village in Ntcheu to review strides the district is making in combating maternal and newborn deaths.

Ntcheu is among the districts that have been grappling with maternal and newborn deaths in the country.

These high numbers of maternal and newborn deaths have largely been attributed to resistance or mere neglect by pregnant women to access skilled delivery care at their nearest health centre.


But chiefs have now demonstrated their determination to turn the tables in the maternal and newborn health sector, thanks to Results-Based Financing for Maternal and Newborn Health Programme (RBF4MNH) Programme.

RBF4MNH Programme is working with traditional leaders in four districts to support government in addressing factors contributing to high numbers of maternal and newborn deaths using innovative approaches to health financing.

The other districts benefitting from the programme include Balaka, Dedza and Mchinji.


Government is implementing the programme with the financial assistance from Germany and Royal Kingdom of Norway through the Kreditanstalt für Wiederaufbau (KfW).

RBF4MNH Programme Country Director Matthew Nviiri says the programme has brought significant improvement in the delivery of quality service in health facilities that were targeted in the pilot phase.

Nviiri says each district has reduced by seven fewer deaths per 100,000 per month.

“As I speak now, the impact evaluation has shown that there were seven few deaths per 100,000 live births in the four districts compared to the non- RBF districts. In lay term, this means that women in non-RBF districts are dying at a faster rate when they are giving birth owing to complications compared to RBF districts,” he explains.

RBF4MNH is also closely working with Reproductive Health Directorate within the Ministry of Health (MoH) to manage and implement the programme.

And using performance-based and demand-side financing approaches, the programme is helping to improve the quality of services as well as the number of patients using them.

Women from poor rural areas are given money to pay for transport and other related costs so that they are able to stay in the facility for 48 hours after having their babies.

The programme also financially rewards good performance of healthcare workers and health facilities and has funded minor infrastructure and rehabilitation improvements, contributing to a better quality of service provided.

Health experts agree that access to skilled attendants at birth (doctors, nurses and midwives) is one way to decrease maternal deaths and such access should be available to women in rural areas as well as urban areas.

Hence, in May 2016, a group of international, regional and national delegates came together for RBF4H Strategic Workshop in Lilongwe.

MoH convened the workshop with support from the German Government, through KfW, and the Royal Norwegian Embassy to identify key RBF elements that could be integrated into the Malawi Health Sector Strategic Plan (HSSP) and scaled up as well as developing and agreeing important next steps for the integration of RBF into the HSSP II process.

Both the government and development partners present confirmed their commitment to results-based approaches more broadly.

Nviiri says discussions between his programme and government have strengthened the support to plan for the possible scale-up of RBF in the health sector.

He, however, says given the current economic climate, lack of domestic financing available for new initiatives and the need for additional external support is also an issue causing concern.

“Our team is working with our partners to further define the roadmap for the integration of RBF elements into the HSSP II, building on the commitment from government [MoH] to incorporate results-based financing into health sector policy documents,” he says.

Nviiri adds that participants at central, district, facility and community levels have been sharing their experiences in implementing the RBF Initiative and there have been calls to build ownership and embedding the project in systems and structures at the district level, in line with decentralisation policy of the Malawi Government.

RBF4MNH Advocacy Chairperson Inkosi Gomani V stresses that the involvement of traditional leaders improve patronage of health facilities for skilled delivery and antenatal care in hard-to-reach and rural setting, resulting in an increase in skilled deliveries and antenatal attendance.

He says since the programme was piloted in 2013, chiefs have remained resilient and committed to working with government to improve the health conditions of women in their areas.

“Community participation has a significant part of health service delivery in hard-to-reach and rural areas. That is why we regularly gather to renew our commitment to working with government in order to reduce the demographic growth, be part of sensitisation activities and gear towards improving reproductive and maternal and newborn health,” he explains.

Recently, Paramount Chief Kawinga of Machinga led a delegation of 18 traditional leaders from Machinga, Thyolo and Mulanje in a tour of various health facilities that benefit from RBF4MNH in Ntcheu.

The visit took them to Bilila Health Centre where chiefs, community leaders and healthcare workers have managed to reduce maternal and child deaths by a wide margin.

Kawinga observes that traditional and community leaders need to have their capacity built for them to effectively play their instrumental role in mobilising pregnant women to deliver at their respective health centres.

He challenges government to consider investing in building the capacity of traditional and community leaders in health-related issues if the country is to realise accelerated and sustained fight against maternal and child deaths.

“Equipping us with adequate information on health-related issues will help us effectively contribute towards the campaign to tackle maternal and child deaths because, unlike civil servants or healthcare workers, chiefs do not get transferred from one district to the other. This means our subjects stand to benefit from our skills for as long as we live,” he says.

Senior Chief Chikumbu of Mulanje adds that their visit to Ntcheu had revealed that traditional leaders are playing a significant role in mobilising pregnant women to access skilled delivery care in an effort to address maternal and neonatal mortality and morbidity.

Chikumbu says the programme has strengthened relationship between chiefs, community health workers and district health offices in the four districts, which has helped to provide health education on skilled delivery care.

“On the other hand, communities are being given financial and non-financial incentives for doing well in mobilising their pregnant women to deliver at health facilities while pregnant women themselves and healthcare workers are awarded for delivering at a health facility and providing quality skilled care to mothers. Communities are using these incentives to construct maternity waiting hostels among others,” she says.

MoH Principal Secretary Dan Namarika says government is exploring possibilities of extending the programme to other districts across the country.

Inkosi Gomani V assures that his advocacy team is ready to assist government to impart the skills they have learnt through the programme to other traditional leaders.

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