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Saturday, February 4, 2023
LILONGWE, Sep 24 2010 (IPS) - In Ntcheu, a rural district in central Malawi, villagers have taken the fight against the country’s high maternal mortality rate into their own hands. They have almost eradicated maternal deaths in the area by urging pregnant women to give birth in hospitals, under medical supervision.
Chief Kwataine, who has 89 villages in Ntcheu under his traditional authority, launched a maternal health campaign that first addressed common cultural beliefs associated with pregnancy, for example that a woman’s first child should be born at home or that the men of the family decide when women need medical attention. Kwataine also banned all traditional birth attendants in his villages, compelling women to give birth in hospital.
These measures have gone hand in hand with a widespread maternal health education campaign. In each of the 89 villages, between two and five skilled maternal counsellors register every pregnancy and advise mothers on best practices for achieving maternal health. Bright messages sprayed on the walls of villagers’ houses are bold reminders of important health messages.
“We also monitor their hospital visits. Every time they go for an antenatal check-up, they bring their medical passports to us so that we can record what’s been entered by the hospital,” explains Pilirani Nkhoma, who is one of the maternal counsellors.
The results have been tangible. Between 2000 and 2005, before the chief started the maternal health initiative, the area recorded 52 maternal deaths. But not a single woman in the 89 villages under Chief Kwataine’s authority has died during childbirth in the past three years.
To meet MDG 5, the country would have to bring the number down to 155 maternal deaths per 100,000 live births by 2015, which the country’s government admits will be impossible to achieve.
Kwataine’s maternal health initiative faces a number of hurdles, however, since the measures can only be successful in the long-term if they are accompanied by sufficient human and financial resources in the public health sector. The hospital closest to Kwataine’s area of traditional authority, for example, now receives almost twice as many pregnant women than the maternity ward has capacity to admit and struggles to assist all women in need.
“By all accounts, the campaign in Kwataine’s area is a brilliant approach. But we are almost buckling here now because we do not have corresponding resources,” a health official who preferred to remain anonymous told IPS.
Lack of capacity
Experts fear that gains made in reducing maternal mortality could be reversed because of lack of skilled health workers and hospital capacity.
The national health department hasn’t been able to get a grip on the problem. In 2005, it promised to recruit more midwives and upgrade health facilities, with a view to boosting maternal health, but five years down the line, skilled health workers are still too few and health facilities remain poorly equipped.
The Malawi Health Equity Network (MHEN), a Lilongwe-based independent alliance of organisations and individuals promoting equity and quality in health, faults government specifically on budget distribution. A report in which it analyses the national health budget shows that in the past four years, the health department has allocated between 50 and 60 percent of its annual budget towards activities at the health ministry headquarters, instead of using those funds for the improvement of health facilities throughout the country.
“This is money spent on allowances and four-wheel drive vehicles that race in the streets of the capital, yet 80 percent of Malawians are in the rural areas where health problems are forever acute,” complains MHEN executive director Martha Kwataine.
Well aware of the questionable spending priorities of the national health department, chief Kwataine and his people decided not to wait for government to provide all services.
Malawi’s rural population, even though largely poor, has the power to find its own solutions to the country’s maternal health woes, the chief believes. On the back of a successful community-driven safe motherhood initiative, he managed to mobilise his people to donate money to construct their own clinic, which will be offering basic emergency obstetric services.
“We believe that the clinic will ease pressure at the main hospital, therefore allowing more women to access better services there and also ensuring faster attention here,” he explains.
Kwataine also hopes that government will become aware of the successes he achieved in his villages and will make funds available for other communities to replicate the approach: “If communities around the country committed themselves into doing programmes of this nature, and if government came in to support such initiatives, Malawi would have a better story to tell in 2015.”
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