Building a path for improved health results in Malawi Stories

7 April, 2021

Malawi is a low-income country with a critical shortage of health workers, and a high disease burden. The country has registered important advances in newborn and child health but has one of the highest maternal mortality ratios in the world, with 439 maternal deaths per 100,000 live births. Access to quality emergency obstetric care services remains limited, despite a high number of institutional deliveries, which near 90 percent. People in rural areas and those at risk of poverty are particularly vulnerable in the face of these health challenges.

Accelerating progress through the scale-up of proven maternal, newborn and child health (MNCH) MNCH interventions is essential to saving the lives of women and children, particularly the most disadvantaged.

The Integrated Pathways for Improving Maternal, Newborn and Child Health Project (InPATH), funded by Global Affairs Canada, One Drop Foundation and JCM Power, and implemented by Cowater International, was a partnership with Plan International and The Society of Obstetricians and Gynaecologists of Canada, which focused on addressing the unique MNCH challenges facing Malawi.

In collaboration with the Government of Malawi, InPATH worked to reduce maternal, newborn and child mortality in three Malawian districts – Kasungu, Chitipa and Salima – covering a population of 1.5 million, through strengthening local health systems, improving governance and accountability, and tackling gender inequality. The project worked with local and central health authorities to improve the gender-responsiveness of emergency obstetric and newborn care service delivery. It also targeted investments in health facilities, including improved access to water, sanitation, hygiene and medical waste management systems. In addition, InPATH engaged at the community level to strengthen the capacity of the Health Centre Management Committees and community-based health workers to enhance accountability and capacity in the delivery of gender-responsive maternal, newborn and child health services.

InPATH was successful in addressing three major sets of health challenges affecting Malawi.

First, it contributed to a reduction in maternal mortality rates. In Kasungu, the project was successful in reducing maternal mortality from 184 deaths per 100,000 live births at project inception to 85 deaths per 100,000 live births at end of project. In Chitipa district, the figures dropped from 114 to 73 deaths per 100,000 live births. Across all three districts, the project contributed to a reduction in neonatal mortality rates from 25 deaths per 1,000 live births at project inception to 10 deaths per 1,000 live births at end of project.

Second, InPATH modernized a substantial number of healthcare facilities in the three districts. The project supported the renovation, expansion and construction of 25 healthcare facilities, including three district hospitals and two health centres in extremely hard to reach areas. The renovated hospitals and health centres were equipped to provide adequate maternal and newborn care, including emergency services, for pregnant women, mothers and newborns, particularly marginalized women and children.

Third, the project was successful in upgrading the institutional capacity and skills of health service providers to support improved MNCH services. Over 540 people were trained in basic emergency obstetric and newborn care to provide services in 37 healthcare facilities. Over 570 people were trained as health surveillance assistance to provide maternal and newborn care for disadvantaged and hard to reach communities. Gender equality interventions and awareness raising activities resulted in the establishment of 40 Health Centre Management Committees that aims to advance the rights and interests of women and girls in MNCH service provision.

Bua Health Centre is a government health facility in Kasungu district, Malawi. It serves a catchment population of more than 47,000 people, with almost 11,000 women of childbearing age. With limited resources for facilities maintenance and equipment, Bua Health Centre struggles to meet the needs of the clients. With the aim of improving maternal newborn health outcomes and reducing maternal and neonatal mortality, InPATH invested in the health centre, undertaking the rehabilitation of the facility, constructing a new maternity wing and providing essential emergency obstetric and newborn care equipment.

Chinsinsi Banda, a 23-year-old mother of two noted the remarkable difference in the centre’s service provision quality because of InPATH’s investment:

“As far as my memory serves me, the time that we were coming for labor before the InPATH Project, I was told to bring candles and matches, the situation was bad because the candles were producing insufficient light and the room only had two delivery beds. Some of the expectant women delivered on the floor. This was unhygienic and undignified care, similar to delivering at home. [This time] I also delivered at night, but we had electricity throughout the night because the building has solar powered backup which provides adequate light. What is more, even the treatment from health workers was friendly. The beds were enough, a big space and an exciting environment with running water in every room including bathrooms and toilets.”

Chinsinsi Banda holding her newborn child

Francisco Ngwenya, who is in charge of Bua Health Centre highlighted: “From the day this wing was officially opened on 27 November 2019 we have recorded an increase in the number of deliveries. In December 2018 we had 58 deliveries compared to 151 in December 2019. In January 2019 we had 63 deliveries compared to 159 in January 2020 and in February 2019 we had 32 deliveries compared to 130 in February 2020. This shows that the new maternity wing is attracting more expectant women to come and deliver here.”

Bua Health Centre – before and after the InPATH renovation

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