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Suffering amid plenty

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UNFINISHED—Village Head Dickson points at a crack at Kanyenga
Health Centre

Pregnant mothers deliver in the bush. People cover long distances to access public health facilities. They have health centres a stone-throw from their homes but the facilities have never been opened since being constructed. Contractors abandoned some of the facilities years ago. YOHANE SYMON exposes this national malaise in this Friday Shaker.

It was raining heavily that night of February.

But when labour pains started, 42-year-old Phoebe Kapitawo of Dickson Village, Traditional Authority (T/A) Nankumba, in Mangochi District just had to brave the rains.

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Accompanied by her sister, Kapitawo started off for Nkope Health Centre, hoping to deliver for the fourth time.

But an hour into her journey, the labour pains became intense. The inevitable happened as Kapitawo stopped at a nearby bush. With the help of her sister, Kapitawo delivered a baby girl.

Nevertheless, they proceeded to Nkope Health Centre.

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Recalling her ordeal, Kapitawo says she nearly died while giving birth.

“It was not easy to deliver. When I started delivering, I was weak because I had walked for a long time. Pushing for a baby was so hard that I almost gave up on myself. But I am grateful to my sister, who helped me deliver the baby. At some point, she used water from a two-litre bottle to pour on my head so that I could regain some energy and push on,” she says.

Kapitawo’s story is familiar to the communities of Village Head Kanyenga.

Some estimated 20,000 people of Kanyenga depend on Nkope Health Centre, which is located 30 kilometres away.

Under-five children from Kanyenga do not receive immunisation services. Kapitawo’s child has since that time never been immunised. Post-natal services are inaccessible in this village. Their constitutional right to health is but wishful thinking.

SORRY SIGHT—Another abandoned facility at Kanyenga

People of Kanyenga are struggling to access healthcare services when they have a health facility right in their vicinity.

However, the government is failing to finalise construction works at the health facility.

Construction works stalled in 2015, two years after construction had started. Unconfirmed reports suggest that the government allocated K500 million to the project.

Five years later, two contractors have had their turns on the project and abandoned it under suspicious circumstances.

Construction of the health facility came at a cost as it occupied a piece of land for 15 houses, including those of Village Head Dickson’s subjects which were demolished. And there was no full compensation to the displaced families.

“In 2012, our MP (Member of Parliament) told us that the government had approved the construction of a community hospital at Kanyenga. We were told to identify a place and elect a committee to monitor the works,” Village Head Dickson, who was appointed chairperson of the construction committee, says.

Construction works were abandoned early 2013 due to what sources at the Ministry of Health say was due to dried funding from the government after the donors had stopped funding Malawi due to plunder of public resources commonly called Cashgate.

During the first stint, the contractor erected hospital office blocks and wards up to window level.

“In 2015, the contractor came again to introduce another contractor who was expected to finish the works. But instead of this contractor finishing the existing structures, he started constructing staff houses. We were surprised as to why there would be need for staff houses in the absence of a hospital structure first,” Dickson says.

Efforts by the communities to follow up on the project hit a snag.

The sight of the abandoned structure hurts the people who pass through it while in transit to Nkope Health Centre.

The situation for people of Kanyenga is not different from that of Mbalama, T/A Bwananyambi, who have been waiting for the government to open a health facility whose construction was completed in 1997 when the government introduced Malawi Social Action fund phase one.

In total, eight health facilities remain unopened in hard-to-reach Mangochi areas such as Maganga in Makanjira, Chiponde Health Centre, Maleta and Chimwala.

At Mangochi Boma, there is a maternity wing that, after being constructed by non-governmental organisation Iceida, remains unopened. This is the case despite that Iceida offered to employ and pay nurses deployed to the facility for five years.

For the past 21 years, people of Mbalama have, in vain, been pressing the government to open the facility.

But all the people get are excuses that there is no readily available clinical officer to manage the facility.

WASTAGE—Uncompleted structures at Kanyenga.

Despite that some stakeholders have, of late, expanded Mbalama Health Centre by constructing a maternity wing and staff houses, the structure remains unopened.

Mangochi District Council Chairperson, Twaha Salanje, says the council, under the devolution process, is putting in place modalities to open four of the eight structures.

He says the other health facilities will not be opened because they did not pass the infrastructure audit officials conducted recently.

“We cannot open three health centres because the structures have developed cracks after staying a long time without being opened. The other one at T/A Chimwala cannot open because we are failing to get [access to] electricity,” Salanje says.

The issue of abandoned and unopened health structures is slowly becoming a national problem.

The government estimates that 80 health facilities, that consumed billions of kwacha, remain unopened across the country due to various reasons.

Affected districts include Ntcheu, Mangochi, Lilongwe, Ntchisi and Nkhata Bay.

Ministry of Health Principal Secretary, Dan Namarika, says he cannot remember the number of hospitals that were abandoned before completion.

“I cannot have the totals by heart because, apart from hospitals, we also have staff houses which we are constructing across the country,” Namarika says.

He blames politicians for forcing councils to start constructing hospitals without consulting the ministry. Namarika says district councils initiate most of the abandoned projects.

Unlike other sectors, Namarika says construction of health facilities needs to correspond to finances for running such facilities.

“On top of that, we need to populate the facilities with human resources, which we do not have at the moment,” he says.

Namarika says the ministry has a vacancy rate of about 52 percent in all departments.

The vacancy rate for nurses is 63 percent while that of health surveyors’ assistants is at 50 percent.

“We can end these challenges and others facing the Ministry of Health if the ministry is not considered a consuming ministry as is the case now. We need to take the Health Ministry as a productive sector that can improve productivity of the country,” Namarika says.

He bemoans that the ministry is not getting enough funds to meet requirements such as recruiting staff.

But he says expects things to improve because the government has allocated the ministry K38 billion under the Health Sector Joint budget to cater for the completion of health facilities that are under construction.

The projects would be completed in phases.

Namarika says his ministry wants to reduce the distance between health facilities from the current eight to five kilometres in line with the Sustainable Development Goals.

He says the government has a capital investment plan to guide construction of public facilities so as to avoid wasting public funds through projects that do not serve the interests of the people.

“Most importantly, we will be able to fill all the vacancies by 2022. Which means that there would be no health facility which would not be opened due to lack of medical personnel,” he says.

Dickens Mahwayo, Civil Society Network for Mangochi Deputy Chairperson, has been pressing the government to explain why construction works at some health facilities stalled.

“We have visited some of these structures in Mangochi. Most of them are in a dilapidated state such that they need to be completely demolished and construct new ones. This means that Malawians will pay for the government’s failure to utilise the structures that were constructed,” Mahwayo says.

He says it is disheartening that most of these incomplete structures are in areas where people cover over 20 kilometres to access healthcare.

By the year 2030, the government wants to achieve Universal Health Coverage.

However, such a target might be unrealistic in view of the multiple challenges facing the health sector.

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