As our country is going through public sector reforms, we need to ensure that reforms in our institutions and sectors translate into changes in people’s lives.
According to World Health Organisation (WHO) statistics, Malawi has one of the highest maternal and infant mortality rates in the world. On average, every year in our country, one in every 36 pregnant women dies rather than become a proud mother. And in 2014 more than 66 babies out of 1 000 live births died before reaching their first birthday.
Surprisingly, more than half of these early child deaths are due to conditions that could be prevented or treated with access to simple, affordable interventions.
Leading causes of death in under-five children are preterm birth complications, pneumonia, asphyxia, diarrhoea and malaria. About 45 percent of all child deaths are linked to malnutrition. And children in sub-Saharan Africa are 15 times more likely to die before the age of five than children in developed regions.
Proper analysis of these infections and diseases shows that they are either caused or exacerbated by using unsafe water, poor sanitation and hygiene. Although water, sanitation and hygiene (Wash) are recognised as important for health, health systems in low-income countries like Malawi are rarely tasked with ensuring adequate Wash access and practices. Sometimes due to the perception that Wash services are too costly to be attainable over the short-term, this in turn creates a cycle of neglect.
Nearly three million babies die every year in their first month of life and a similar number are stillborn. Up to half of all deaths occur within the first 24 hours of life. The 48 hours immediately following birth is the most crucial period for newborn survival. This is when the mother and child should receive follow-up care to prevent and treat illness.
Shockingly, diarrhoeal diseases caused by poor sanitation and unsafe water kill around 600 children a year, more than Aids, malaria and measles combined. At present, there are more than seven million people are living without safe sanitation, which means countless communities where people are exposed to their own and others’ faeces. Excreta are then transmitted between people by flies or fingers and also find its way into water sources, resulting in a public health crisis.
All too often the positive impact of health interventions for children and newborns in one area are undermined by lack of water and sanitation interventions in another. For example, children may be de-wormed, but are quickly re-infected through poor sanitation and hygiene in schools and at home. Improving children nutrition often focus on food and nutrient intake and neglect factors that hinder nutrient absorption such as recurrent Wash-related diarrhoea. And efforts to reduce maternal and newborn mortality often focus on increasing health facility-based births while newborns and mothers may be exposed to infections via unhygienic birth conditions in facilities that lack basic requirements such as toilets and running water.
As a poor country, we must consider investing in strategies and interventions that require less money but have a higher impact on people’s lives. Our health programmes need to have a complete cost and benefit analysis. While the vaccines are a vital part of prevention for pneumonia and diarrhoea they need to be combined with breastfeeding and nutritious food, and a clean environment. Ensuring that families have access to health services and the right medicines are also essential.
Therefore, do changes in the public sector improve people’s lives? Is our money being spent where the majority of people in Malawi will benefit? Are our health sectors investing in programmes that will reduce preventable deaths of pregnant mothers?
Let us save the lives of mothers and children by ensuring that every birthing centre has sufficient toilets and bathrooms for both patients and guardians. And that all public places ensure basic hygiene and sterile conditions, such as hand washing with soap, repeated cleaning and disinfection of facilities. A simple act of washing hands can save lives.
They say prevention is better than cure. Providing adequate Wash in homes, schools and hospitals significantly reduces preventable diseases. It can also increase student attendance and learning achievement; and helps promote dignity establishing an important foundation for ongoing development and economic growth.