The journey to Kangamowa area begins at Kalewa Bus Depot along the M5 Lakeshore Road in Traditional Authority (T/A) Mwadzama, Nkhotakota District. As you branch off from the tarmac road, heading for Kangamowa, a natural forest dominates one’s sight.
However, the 18-kilometre journey to Kangamowa is not enjoyable. The bumpy and dusty road robs off the pleasure of travelling in a comfort vehicle. On arrival, Kangamowa Primary School classrooms catch your sight. The presence of a motor vehicle in the area is not something ordinary to learners at the school; hence, they take curious looks at the Nissan 4X4 vehicle that has ferried us to the area.
Anyway, we proceeded to our destination after parking the car at the school.
Minutes later, we set our feet at Kangamowa Under-Five Clinic. Bordering three districts of Dowa, Ntchisi and Salima, Kangamowa is an area in T/A Mwadzama, with about 1,254 households. A cast of eyes around the area shows that it is dominated by grass-thatched houses, with Kangamowa Primary School emerging as the notable government-built structure.
“This is the only health care facility in this area and it serves under-five children only,” Village HeadBesera says.
Community leaders, women groups and other stakeholders have converged at the place to appreciate the challenges that Kangamowa women face due to lack of a health facility that serves all in the vicinity.
Their nearest hospital, Mtosa Health Centre, lies at a distance of 18 kilometres. Others cover 25 kilometres to access health services at Benga Health Centre. Those privileged with financial resources travel 35 kilometres to Alinafe Mission Hospital.
During the day, the journey to Mtosa— where the facility is located— costs about K5,000 if one uses a hired motorbike, the only available means of transport in the area. At night, the motorcycle fare almost doubles. Sadly, as women say, antenatal clinics are rarely conducted.
“Life is really hard. In fear of complications during delivery, a pregnant woman is advised to leave early and wait at the hospital. The waiting period demands that one should have money. So, a pregnant woman has to have about K25,000 for transport and food at the hospital, which is not easy for a villager,” says Veronica Jossam, one of the concerned women in the area.
Lack of health facilities in the vicinity is one of the challenges facing most pregnant women in Nkhotakota District.
In the northern part of the district, the story is the same. Our next destination is Kasitu in T/A Kafuzira. The nearest health establishments available to communities around Kasitu are Ngala Health Centre and Dwambazi Rural Hospital, situated at a distance of about 20 kilometres, respectively.
In line with the government’s call for pregnant women to deliver in hospitals, one has to save at least K15,000 to hire a car to either of the hospitals. All referral cases go to Nkhotakota District Hospital.
However, due to lack of ambulances at health centres, one has to look for own means of transport in case of a referral.
It becomes a challenge, according to one Sophia Banda, for a woman who is due for labour but has to wait for an ambulance to cover a distance of 100 kilometresto the main hospital— especially when the time of arrival is not guaranteed.
However, it is not by design that these women deliberately choose to report late to hospitals. Due to long distances covered to access antenatal services, some pregnant women miss the services.
For instance, a woman who has to cough K1,000 to travel from Kasitu to either Dwambazi or Ngala for antenatal services may convince herself that it is logical to stay home. So.due to financial constraints, most choose to go to hospitals when they are due for delivery.
In a country where hospital deliveries are being encouraged so as to promote safe motherhood, the battle seems far from being won as long distances to hospitals form a major stumbling block.
Faced with uncountable challenges to deliver at hospitals, pregnant women have been opting for Traditional Birth Attendants (TBAs). In 2007, former president, the late Bingu wa Mutharika, imposed a ban on TBAs who were associated with higher rates of obstetric complications and maternal deaths.
But villagers still regard the ban as ill-timed.
Maikhanda, a local non-governmental organisation promoting safe motherhood, has since 2014 been implementing a four-year project premised on improving maternal and new-born care. Appreciating financial challenges as a major culprit thwarting safe motherhood efforts, Maikhanda spearheadedformation of women group forums aimed at killing two birds with one stone.
“We wanted to encourage the women to engage in income generating activities so that distance should not be a barrier to accessing professional medical help when they are pregnant. Through the groups, they are able to discuss challenges affecting them, especially those related to safemotherhood.
“They also brainstorm on how they can deal with those problems,” says Maikhanda’s Project Officer, Princes Begue.
She said they have, so far, trained facilitators in T/As Kafuzira, Mwadzama and Mphonde, who are engaged in door-to-door visits, through which they disseminate messages on safe motherhood.
The initiative has given a glimmer of hope to most communities in the district. One of them is Chitawotawo women’s group task force, which is spearheading the construction of an under-five clinic. Fed up with travelling long distances to access antenatal and under-five services, community members used their man-power and resources to mouldbricks and burn them to at least construct an under-five clinic.
“Soon, construction works will begin,” says Estere Kapana, one of the group facilitators in Group Village Head Chiwoza, T/A Mwadzama.
“We should not wait for government to do everything for us. After Maikhanda helped us in forming task force groups which have seen the birth of village banking groups, we can now save something with which to assist pregnant women to visit health care facilities in time,” Kapana says.
About 35 members form Bangwe Club in Kasitu area where, apart from raising awareness on issues of safe motherhood, the women also indulge in agri-businesses.
“The challenge of travelling long distances to the hospital is still there but no woman now goes to TBAs because we are aware of the risks. Instead we are into income generating activities where we are growing rice. We also do village banking where we financially support each other on maternal issues. Besides that, we reach out to other women by lending them money to travel to hospitals,” says Mary Zimba, Bangwe Club Chairperson.
Maikhanda’s team leader,Mackson Mtambo, said challenges related to long distances covered to get to hospitals cannot be addressed overnight; hence, their approach in coming up with short term solutions.
“It has, so far, been a success story because there has been a significant increase in the number of pregnant women who seek help from professional health workers. The biggest challenge remains that of long distances to hospitals and the only way we thought of addressing this was by ensuring that the women should be able to empower themselves economically. We are happy that it is working as some communities are even thinking of constructing a clinic,” Mtambo says.
On his part, Nkhotakota District Health Office (DHO) spokesperson, Samson Mfuyeni, commends Maikhanda for the initiative.
But Mfuyeni is quick to say the issue of covering long distances to get to health facilities should not be a challenge as pregnant women are advised to be waiting at the hospital before their delivery time.
He adds that the DHO conducts monthly antenatal outreach clinics in hard-to-reach areas to scale down the problem.
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