Feature

Delayed projects choke health coverage

People of Traditional Author i ty (T/A) Chilooko in Ntchisi District walk more than 20 kilometres to Malomo Health Centre. Elsewhere, people from 15 villages in T/A Phambala in Ntcheu District walk at least 50 kilometres to the nearest hospital.

This contradicts the Malawi government’s goal, as outlined in the Health Sector Strategic Plan II (HSSP II) which prescribes that every Malawian should live within eight kilometres of a health facility.

To ease the burden, Malawi Red Cross Society (MRCS) pledged to help remote communities build health centres to bring healthcare closer to them.

In 2006 Red Cross mobilised the people of Chilooko to provide bricks for the construction of a health centre in their area. By the end of the year, the community delivered over 250 000 bricks.

The structure was completed in 2014.

But the project chairperson village head Chipolokazi said the community could not open the facility because the office of the district commissioner felt the project was incomplete.

People wait for service at Malomo Health Centre

Several visits to the office of the district commissioner and the district health officer did not yield anything.

“We were told that the project was not ready for opening. We were told to mould extra bricks to construct a maternity wing and a nurse’s house,” says Chipolokazi.

The community went back to work and produced more bricks. Work on the maternity wing began in 2014 and ended in 2016. The community handed over the newly constructed facility to the district health office in the same year.

The effort to bring a health facility closer home that started 16 years is yet to bear fruit. People from scores of villages in Ntchisi still cover more than 20 kilometres to get to Malomo Health Centre, the nearest facility.

The long wait has seen some members of the community dying while waiting for the facility to open.

One such soul is Gogo Nanjinga, an elderly woman who took part in the project, died in 2018 while waiting for the DHO to open the healthcentre.

The wait could go on as the government wants the community to mould more bricks.

“This is confusing now. However, I have mobilised our village heads to mould bricks. Now we have about 300 000 bricks,” says Chipolokazi.

As the wait continues, Malomo Health Centre remains overwhelmed.

The health facility caters for 55 000 people, about five times higher than the 1:10 000 hospital to patient ratio recommended by the World Health Organisation.

The situation in Ntcheu is similar to that of Ntchisi communities.

Meanwhile, people from 15 villages in T/A Phambala are still waiting for government to open Bayani Health Centre, about 11 years after construction work ended in 2010. People still walk long distances to access healthcare.

The people in the two districts represent many others who travel long distances to access medical care.

The developments highlight the Ministry of Health’s struggles to provide quality and accessible health service in accordance with the United Nations Sustainable Development Goa l s (SDGs).

Malawi is expected to achieve universal health coverage, including access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all by 2030 in line with SDG 3.

The delays in opening local health facilities in Ntcheu and Ntchisi threaten to derail the dreams spelt out in the UN SDGs and several other international conventions on health, including the 2005 Abuja Declaration; the 2008 Ouagadougou Declaration on Primary Health Care; and the Paris Declaration on Aid Effectiveness.

Village head Mlombwa of Mtsekaphata in Ntchisi says women in his community cannot afford K9 000 for transport to the nearest health facilities, Mzandu or Kongola heath centres, located about 16 kilometres away.

“We have been forcing women to go to the hospital, but it is difficult [to convince them] because they cannot afford the transport costs. I have been to government offices asking for help, but nothing worked,” he said, referring to Chafumba Health Centre.

Ntchisi district health officer Lumbani Munthali a cknow l e d g e d that Red Cross constructed three health centres— Mndimba, Chinkhande and Sambakusi—but the government is yet to open the facilities because they did not meet the specifications prescribed by the Ministry of Health.

“These [the health centres] are integrated community health service delivery structures which are physical buildings staffed by health surveillance assistants (HSAs) in hard-to-reach areas in order to increase access to healthcare services for the population that do not live within eight kilometres of a health facility,” he says.

As are sult , the government cannot allow the facilities to offer health services.

But Munthali stressed that the government is committed to renovating the structures to ensure that they meet the standards set by the Ministry of Health.

“ Through the Governance to Enable Service Delivery Project, a maternity unit will be built at Chinkhande Health Post. For Mndimba, resources are yet to be identified to renovate the maternity structure,” he said.

On his part, Ministry of Health head of health infrastructure development Sanderson Kuyeli said some health centres will not be completed soon.

“Some projects may slightly go beyond in the case of Chafumbwa in Ntchisi [and other districts] as the contract was terminated and the process of reworking on the resources and reengaging new contractors is ongoing,” he said.

Completing the projects would be in line with goals outlined in the 2017-2022 HSSP such as building and providing more equipment to local health facilities.

It reads in part: “Priority will be given to completion of unfinished projects and rehabilitation of upgrading of existing facilities.” Malawi Health Equity Network executive director George Jobe says this dream is far-fetched considering that most Malawians still travel long distances to access medical care.

Malawi Human Rights Resource Centre (MHRRC) has been working in Ntchisi and Dowa districts where they are tracking Constituency Development Fund (CDF) School Improvement Grant and simplifying and popularising district budgets with support from Norwegian Church Aid and DanChurchAid Malawi Joint country program. 

Limbani Phiri is capacity development officer at MHRRC and said under the enhancing citizens participation in local governance and development process work plan, his office is trying to contribute towards fighting inequality through enhanced pro-poor budget allocation and expenditure in sectors of health, education and social protection programs.

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