Giving birth the safer way in Malawi
July 10 2007
Giving birth in a developing country is a perilous business. With around one in
every hundred live births resulting in death for the mother or child, Malawi has
some of the worst maternal mortality figures in the world. Pregnancy is lined
with risks, particularly in rural areas where physical access to public
health facilities is difficult. Services provided by Malawi's public health system are
free of charge. However, where the nearest hospital is privately owned and fee
charging, many of the poorest are forced to give birth at home, which can be
unsafe.
DFID is currently providing funding, over a six year period, to get more
expectant mothers into Malawi’s hospitals, and ensure that care in the hospitals meets
their needs and the needs of their newborns. This funding is provided through the Sector Wide Approach (SWAp) and the Emergency Human Resources
Programme, which are targeted at improving health services in the country. Through these
initiatives, more women in Malawi are now receiving vital antenatal care
and safe hospital deliveries.
A hospital delivering results
One place where improvements have been seen is Mtengowanthenga Hospital in
Dowa district. This hospital is owned by the
Christian
Health Association of Malawi (CHAM), and unlike public health
facilities, it charges fees for most services. A year after receiving SWAp money, which allowed it to offer free
maternity care, upgrade facilities and solve staffing problems, the hospital reported a 30% increase in antenatal visits,
and a 44% increase in deliveries.
A central factor in these results has been the
close work with Traditional Birth Attendants (TBAs). TBAs, who have long
provided hands-on help to pregnant villagers, are now rewarded with 200MK (70p)
for every patient they refer to hospital. Each week, nurses from Mtengowanthenga
visit TBAs in their villages, to discuss the health of patients, detect any
risks,
and arrange treatment or referrals.
As Sister Jovita, the hospital’s senior nurse, explains: "The nurses are able to
visit TBAs in the village because of the extra funding available. The visits to
the TBAs are proving to be very important, as we are avoiding a lot of
complications. If the TBAs detect the risk factors on their own, they then refer
the patients to a hospital. We have seen an increase in the number of patients
referred to hospital by the TBAs. Most of these women are the ones who in the
past could not afford to come here, as we used to charge for the services."
Quality care comes for free
Kaso Kamwendo is just one of the women that Sister Jovita could be talking
about. Kaso recently gave birth to a healthy 2.9 kilograms girl: her fourth
child, but the first to be delivered at Mtengowanthenga hospital. She is grateful
for the care she received: "Thanks to the free services that the hospital is now
providing, I was able to attend an antenatal clinic to make sure my baby was
alright."
"All my other three children were delivered through a TBA at home as I could not
afford to pay for hospital delivery and the only non-paying hospital, a
government hospital in Lilongwe district, is too far away. Now that the hospital
provides these services for free, I came to deliver my baby in hospital."
"Throughout my pregnancy…I received good advice on my health. I will encourage
other mothers to come and deliver at the hospital."
There have been many other women at Mtengowanthenga who would echo Kaso’s
words. At the end of June 2005, before SWAp funding was in place, a total of
5,035 women paid antenatal visits to the hospital. By the end of June 2006,
following funding, 7,171 women had received antenatal care. By increasing access
to free maternity services, Malawi could go a long way towards reducing its
shockingly high maternal mortality rates. DFID, Malawi's Government and its
hospitals must now ensure that the lessons learnt in Dowa are applied throughout
the country, so that the lives of thousands more mothers and children are saved.
Key facts
- DFID is providing £100 million over six years (2005 - 2011) to deliver an Essential Health Package (EHP) in Malawi (£45 million), through the SWAp, and an Emergency Human Resources Programme (£55 million).
- An EHP is a prioritised set of services that focuses on the major causes of death and disease in a country, and in Malawi this includes support to maternal health.
- A SWAp is defined by the
- Districts are able to provide free maternal healthcare by signing Service Level Agreements (SLAs) with the
- To date, 49 SLAs have been agreed between the MoH and the CHAM, which provides 37% of healthcare in Malawi.
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