Malawi: Rolling Back Maternal Deaths Through Community Involvement

DEDZA, Malawi — Faustina, aged 40, lies swaddled in a thick blanket in the maternity ward of Dedza District Hospital, in Malawi. Although she has just lost a baby, delivered through Cesarean section, she considers herself lucky to be alive.

This was Faustina’s twelfth pregnancy. Although she has borne 9 children and endured two abortions, she prayed for this delivery to be normal. So, as soon as felt labour pangs, she reported to the Bembeke Catholic Health Centre. Because she was bleeding heavily, she was immediately referred to the Dedza District Hospital for expert attention. That decision saved her life.

Even though her baby died, Faustina is fortunate that she did not become another statistic in Malawi’s ongoing maternal mortality tragedy. In Chichewa, Malawi’s principle language, the words for pregnancy -- “pakati” and “matenda”-- translate into “between life and death” and “sick”, respectively.

The maternal mortality rate in Malawi currently stands at a staggering 1120 deaths per 100,000 live births, according to Dr.Chisale Mhango, Director of the Reproductive Health Unit in Malawi’s Ministry of Health. That’s almost twice as high as the rate in 1992 – 620 per 100,000. Some 6000 Malawi women are dying each year from preventable or treatable complications of pregnancy.

Dying to give life

Early and frequent childbearing leaves women vulnerable to complications. The mean age at first childbearing in Malawi is 19 years and the total fertility rate is 6.3 children. Even so, skilled care at deliveries and timely high quality emergency obstetric care could prevent most maternal deaths.

But Malawi is one of the world’s least developed countries – it ranks 164 out of 177 countries surveyed on UNDP’s Human Development Index – and its healthcare system is not functioning well. Health care workers are overstretched and underpaid. The AIDs epidemic has strained services and claimed trained personnel. Equipment, medication and other supplies are inadequate or lacking. Referrals do not work smoothly.

The Dedza District with an estimated population of 624,000 has 31 health centres and only one government referral hospital staffed by two UN Volunteers medical doctors, seven clinical officers and 48 nurse/midwives. Eleven nurse midwives struggle to provide 24-hour care in the maternity unit.

These problems are compounded by cultural practices that inform a woman’s decision to seek care. In some communities in Malawi, a woman in labour must seek a man’s authorization before going to the health centre.

Talking heath care to communities
Of crucial importance to strengthening healthcare delivery and rolling back maternal deaths in Malawi is the role of village communities. “Taking healthcare to the communities is one of the most effective ways of reducing maternal and infant mortality,” explains Juliana Lunguzi, a programme officer for UNFPA, the United Nations Population Fund, in Malawi. “The idea is to empower village communities, including men, women and young people to take care of their own healthcare. Since this is an inclusive process involving collective decision making, it ensures that appropriate and timely actions are taken when there are complications in pregnancy and childbirth.”

Transforming the role of traditional birth attendants

In Magwaza village, Dedza District, the Village Health Committee supported by UNFPA, has established various task forces – such as family planning, safe motherhood and sanitation. The community has adopted by-laws that set limits on the role that traditional birth attendants should play. For example, they prohibit birth attendants with no formal training from actually delivering babies and encourage them to adhere to government-set criteria about when to call for skilled attendance.

Some of the rules and messages are written on walls of homes in the village. The committee monitors adherence to the rules and any transgressor is fined a goat for attending a home birth.

Mawandiwe Mtchauya, is a traditional birth attendant who has been trained by UNFPA to identify pregnancy-related, complications that could threaten a woman’s life. She no longer delivers babies, but she does monitor the progress of pregnancies and refers women in labour to the nearest clinic in Chitowo village or to the District hospital. She now makes a living by counselling women on contraception, child spacing, and HIV prevention. She does not regret the change of profession and proudly points out that no pregnant woman has died during her watch. Mr. Dzoole, the village headman concurs: “Not very long ago, pregnancy and childbirth were a death sentence. That is long gone now. And we plan to keep it that way.”

Her assertion is corroborated by figures from the Chitowo Health Centre which covers 110 villages with a population of 37,000. According to nurse Elimase Kamanga no maternal deaths were registered in the catchment area in 2006 and only one in 2007. At the district level, Ms. Julie Chirwa, Deputy District Health Officer of Dedza District Hospital points to a steady decline in maternal deaths from 33 in 2005, to 18 in 2006 and 7 in 2007. She lauds the community initiative for timely referrals and the decline in maternal deaths.

Juliana Lunguzi of the UNFPA is elated by the overall results of the initiative. According to her, “in a society steeped in traditional and cultural beliefs and practices, success in health service delivery is dependent on strong community involvement. Use of existing community systems and structures enhances acceptability of new ideas and promotes unity of purpose.”

Malawi Tea Price Drops 2.4% at Sale on Lower Stocks

April 18 (Bloomberg) -- The benchmark price of tea in Malawi, Africa's second-biggest producer of the crop after Kenya, fell 2.4 percent after deliveries more than halved.

The top grade of tea, known as pekoe fannings, fell to $1.60 a kilogram (2.2 pounds) at an auction on April 8, the Blantyre Tea Auction said in an e-mailed statement from the capital, Lilongwe, today.

Deliveries of all grades and varieties fell 56 percent to 355,500 kilograms, said Emmanuel Phiri, a manager with Van Rees BV, a tea-trading unit of Netherlands-based NIBC Principal Investments.

``Deliveries slowed mainly because weather affected transport,'' said Phiri. ``It had little effect on the price.''

The U.K. is traditionally the biggest buyer of Malawian tea, followed by South Africa and Kenya. Van Rees, Unilever Plc's Lipton Tea and Stansand (Central Africa) Ltd., a unit of India's Tata Tea Ltd. are usually the biggest buyers of tea in the southern African nation.

Tea is Malawi's second-biggest export earner after tobacco.

Student asks residents to help people of Malawi

By Letter to the Editor

To the editor:

I belong to Cornerstone Free Methodist Church [in Coventry Township] and we have a project for the people of Malawi, Africa, called Clear Blue. This project is about digging wells for villages in Malawi. People in Malawi do not have any good water and cannot drink, cook or bathe. Therefore, four out of every 10 children die.

Our associate pastor, Rob Blair, who founded Clear Blue, went to Malawi and wrote back to the church: “I saw beautiful little children who already had death in their eyes. They were sick from drinking bad water and lacking medication.” I feel this is very terrible that people are dying by the hundreds each day because of bad water, which has bugs, worms, leeches and diseases in it.

What Clear Blue has done is to dig wells for some villages. This has saved many, many lives. To dig one well, you have to blast and dig until you find water, secure the well, cap it and fit it with submersible pumps (one manual and one electric), provide a tower with two large water tanks and the plumbing. All of this costs $4,000. This is a small price to pay but makes a huge difference in the lives of the Malawi people.

You can save these people’s lives by going on to the Clear Blue Web site at www.clearblueproject.com and find out what you can do to help, or you can contact our church at (330) 644-3937.

Joseph Getz, seventh-grader, Ohio Virtual Academy, Barberton

Malawi: from trade to industry

A down-ward spiral in industrial out-put over the past ten years has compelled the Malawi government to shift emphasis from trade to industry.
The administration of Bingu wa Mutharika has put industry development as a key policy goal towards propelling the economy, from one of pre-dominant imports, to an exporting nation, and renewed emphasis on industry as opposed to trade could be one of the trump cards, according to Industry and Trade Minister Henry Mussa. Previously, the ministry used to be known as trade and industry.
"We feel that there has been little emphasis on industry during the past ten years, and this has led to the almost collapse of the industry. But this government wants to change that and has initiated dialogue with the private sector on this," said Mussa in an interview.
He said the development had worsened the employment situation in the country as many people got laid off whenever key players in the manufacturing industry close shop, thus impacting negatively on Malawi's social-economic development.
Chancellor Kaferapanjira, Chief Executive Officer for the Malawi Confederation of Chambers of Commerce and Industry (MCCCI), an representative organisation of private sector players, uphailed the move. He said the development should, however, be followed by necessary incentives for the manufacturing industry to develop.
Malawi has a pre-colonial Incentives Act busines and economic commentators agitate needs to be ammended, as it has mainly worked as a disincentive to Foreign Direct Investors.
According to Kaferapanjira, most FDIs have instead resolted to setting shop in neighbouring countries, such as Zambia, Tanzania, Mozambique and Botswana.

Skipper set for 99th cap

Dunn set to return from serious injury

England netball captain Amanda Newton will reach a tantalising 99 international caps if she takes to the court on Friday evening, when England face Malawi in the third Cooperative International Test match at Wembley Arena.

Newton missed two years of her international career with injury before being recalled to the England squad in 2006 and was then awarded the captaincy. She led England to their first victory over New Zealand in 32 years last summer, as well as taking charge at the Netball World Championships in November.

Meanwhile, England and TeamBath shooter Rachel Dunn should mark a successful return from serious injury in only seven months when she is included, as expected, in the England team to face Malawi.

Selected for England's squad to contest last November's netball world championships, Dunn suffered a serious knee injury only minutes into England's last warm up match against Jamaica in September. Following surgery she has undertaken seven months of intensive rehabilitation to regain her place in the England squad for the final match of the Test series.

England lead Malawi 2-0 after wins in Sheffield and Coventry and will be looking to close out a clean sweep at Wembley. A capacity crowd is expected, including a large Malawian contingent.

The game will be shown on Sky Sports Xtra at 5pm on Saturday

Reviving the ration card

Making food cheaper is not impossible

IN RANGPUR, one of Bangladesh's poorest districts, prices of rice, wheat, cooking oil and pulses have doubled in the past year. About 40% of people there live on less than $1 a day and, in the country as a whole, more than half are landless labourers, who buy rather than grow their food. Government officials talk about “hidden hunger”.

In Malawi, on the other hand, farmers are weighing a record crop, thanks partly to government-subsidised fertilisers. Malawi has few landless poor people, though many smallholders are net food buyers.

The impact of higher food prices varies dramatically from place to place. So does countries' capacity to respond by getting cheap food to poor consumers. The simplest way is to cut taxes on imported food. Twenty-four of the 58 countries tracked by the World Bank have done it. Côte d'Ivoire, for example, halved value-added tax after its food riots. Ethiopia scrapped VAT on food. Indonesia lifted import controls on soyabeans in January after the biggest food protests there for years.

Selling subsidised bread to the poor requires more administrative competence. Pakistan recently announced that it was reviving an old system of ration cards for cheap wheat. Yemen supplies subsidised wheat at selected markets and Egypt provides it to millers to bring down bread prices. Such measures can easily become entrenched—Egypt's has been operating for years—and costs can spiral. Egypt budgeted $1.7 billion for wheat subsidies this year; the estimated cost is now $2.2 billion and rising.

Bob Zoellick, the head of the World Bank, argues that the best way to protect the poor without harming farmers is through conditional cash transfers. Mexico, for example, runs a programme called PROCAMPO which transfers cash to poor farmers. But such schemes ideally need to be up and running already (PROCAMPO was set up to compensate farmers before NAFTA came into force in 1994). And they usually work best in middle-income developing countries because they make considerable administrative demands on the bureaucracy. Countries without social-protection systems, argues Simon Maxwell of Britain's Overseas Development Institute, will depend on food aid, food-for-work and cash-for-work programmes—and it is not clear how quickly these can be scaled up. Ethiopia's various emergency programmes will probably cost well over 1% of national income this year. The World Bank is almost doubling lending to Africa, to help foot bills like this.