Clinics are supposed to be easily reached sanctuaries of hope for those in pain, but patients and pregnant women in rural areas are paying an extra cost to access life-saving services because clinics are few, far apart and understaffed.
The widespread challenge stands in the way of the country’s race to achieve universal access to health, including efforts to ensure no child is born with the assistance of skilled attendants.
Imagine a rural clinic with just a single medical assistant and one nurse serving a population of almost 40 000. Such is the harsh reality at Namanolo Health Centre in Balaka where nurse Anne Mtewa endures sleepless nights to ensure nobody dies of treatable conditions.
For the two skilled health workers, every day on duty is an uphill task.
“We work day and night,” she says. “Usually, we skip lunch to help patients because we are extremely understaffed. The high workload aside, our job is made tougher by lack of necessary facilities, including a maternity wing. This is a major setback to delivery of quality maternal and child services.”
Ordinarily, the health centre would need no more than 10 medical assistants as the World Health Organisations requires one for no more than 4000 people.
In fact, Mtewa would be assisted by four more nurses if the country met the United Nations (UN) health agency’s standards which recommend one nurse for 8 000 clients.
In their constrained workplace, the overwhelmed pair sees up to 50 patients daily and 250 pregnancies every month.
Namanolo may be situated just about 10 kilometres (km)from Machinga District Hospital, but the rural Malawians say they are mostly unwelcome at the bigger health facility because of bureaucratic bottlenecks.
They decry being told to go to Balaka District Hospital, almost 26km away, because their locality is not in Machinga District.
Now they want government to intervene because they cannot continue being banished from the better equipped and staffed hospital in the neighbouring district when foreign nationals access services freely in the country’s health facilities.
To lessen the problem, the health advisory committee (HAC) and community members have moulded 500 000 bricks for construction of a maternity wing and under-five clinic.
However, government is yet to bail them out.
“It is pathetic that patients and pregnant women pay up to K1000 for kabaza bicycle taxis to take them to Liwonde where we are sometimes turned back by staff at Machinga Health Centre. Are we not Malawians?” says Dennis Dziko, the chairperson of the area development committee (ADC) in Traditional Authority (T/A) Amidu.
The situation is worse at Kwitanda Health Centre in Balaka where people access health services for only three days a week.
The medical assistant often closes the facility on Friday afternoon only to reopen the next Tuesday, says HAC chairperson Daudi Nduta.
HAcs, trained by Foundation for Community Support Services (Focus), are playing a vital role in keep an eye on how health centres work as well as ensuring that the locals take part in improving the quality of services on offer.
“We have been receiving complaints from communities that the hospital opens on Tuesdays, Wednesdays and Thursdays while on Fridays it is half-day,” Nduta says.
The committee has since reported the matter to authorities at Balaka District Health Office (DHO) where they were advised them to hold a round-table discussion with the medical assistant, he disclosed.
“Nothing has changed,” he says.
When we visited the health centre on December 29, the health worker was nowhere in sight even though government had ordered officers in critical sectors, including health, to remain on duty during the festive season.
In fact, a hospital attendant was seen examining patients and scribbling diagnosis and prescriptions in their health passports.
Asked why he was administering drugs, the unqualified man said: “I do it to help people in pain, they need assistance.”
The man refused to blame anyone for his risky and illegal intervention.
But Balaka district medical officer Dr Leonard Chafewa claimed they have no knowledge about the depressing scenario at Kwitanda.
“As Balaka DHO we haven’t received any communication that the health centre opens three days a week. What we know is that all our units, including Kwitanda, open every day and patients get assisted normally,” Chafewa says.
He reckons it is tough for the district health office to act on the alleged indiscipline because an ombudsperson, who handles complaints from patients, has not received any query from the community.
However, the health advisory committee, which benefitted from Focus’ initiative to increase citizen’s demand for accountability and transparency for maternal and child health in Balaka, say they have reported the matter many times with no change in sight.
The three-year project, funded by the Scottish Government through Christian Aid (CA), is being implemented by Focus in partnership with Malawi Health Equity Network (Mhen).
Focus executive director Kossam Munthali says: “It is very unfortunate that while we are advocating that women should deliver at hospitals some health workers are bent on frustrating the very same cause they should be on the forefront promoting.
“Malawians have a constitutional right to demand accountability and transparency from health services providers.” n