Mary Mulligan, Churches Development Officer, has recently returned from a visit to our Scottish Government funded maternal health project in Malawi. Mary shares her experiences.
After a long eight hour drive from Lilongwe to Karonga in the north of Malawi, it was dark and very quiet when we arrived. Our first morning dawned warm and sunny - though our Malawian colleagues kept telling us it was cold, as it was winter!
First of all we got to meet our partners FOCUS and MASHAP, and we were also joined by Ngonya from the Malawian health service, who has responsibility for ensuring the programme is sustainable after the three year church partnership comes to an end.
Early challenges for maternal health programme
The partners explained how the programme was established and the early challenges they faced - such as how to reach some of the outlying areas, how to engage the different groups, and practical concerns like how to fund motorbike ambulances once they were purchased, and how to fund monitoring and evaluation of the programme.
They told us how they set targets to reduce maternal deaths, increase attendance at ante-natal clinics, and increase the delivery of health services to under-fives.
Progress towards saving lives
We found that there has already been a considerable amount of progress since the project began a year ago.
This has included the training of 63 Health Surveillance Assistants, as well as work with men through the Men as Partners programme, and young people through various youth groups.
One very positive development has been the use of a community scorecard, which has meant the people who should benefit from the work of the programme will be able to score it and offer comment on its effectiveness.
Meeting the mothers
On the second day we visited a clinic in Fulirwa where many women were queuing for their ante-natal appointments and some of them joined in a song for us!
We got to visit the post-natal ward, where there were four new babies, the youngest of which was born at 2am that morning. We spoke with the midwife who delivered the baby - she was bright and enthusiastic about the service she was providing despite having been at the clinic for the birth at 2am and now running the ante-natal clinic.
We met some of the 63 newly trained HSAs whose role it is to encourage women to attend the ante-natal service in the first trimester and at least three other times.
They visit the women in their homes and give them a contact number, a counselling card, and advice on nutrition and healthy living.
Healthcare in remote areas
In the afternoon I met two women in their homes, which were in hard to reach areas.
‘I realised how hard it must be for a woman to get to the clinic when she goes into labour, especially in the dark or bad weather.'
The first woman was almost nine months pregnant so her HSA was gently encouraging her to make arrangements to go to the clinic before her labour began.
The woman already had three young daughters and her husband was present and was very supportive. The second woman I met had already delivered her sixth child and the HSA was offering contraceptive advice but the conversation was difficult as the woman was deaf, and without her husband present she had difficulty communicating.
Later we met with one of the men's groups FOCUS is working with. The village chief was also in attendance and was clearly very supportive of the programme. The men discussed many sensitive issues such as maternal deaths, child marriage and diagnosis of HIV.
They said the most important thing for them was to see this knowledge and awareness rolled out to other men in other areas.
The next day we went to meet a Traditional Birth Attendant in her home. This woman had been a TBA since 1982, and she said she understood how her role had to change. However, she did say she would still help any woman who came to her, and there was some evidence in her room that a birth had taken place fairly recently.
We were encouraged by her honesty and the partners will be doing more work with the TBAs to help them create sustainable livelihoods now that they are encouraging women to attend the clinic for their births.
Our next stop was to speak to two womens’ groups, who treated us to more singing and dancing, then we talked for a long time about the issues that were important to them. They were lively and articulate, and were very obviously benefitting from the opportunity to discuss these issues together and with the partners.
SMS text alerts
We made a short visit to Chilumba hospital to speak with the HSA responsible for the SMS text messaging. The idea behind the texting is to remind women of their ANC appointments and to offer general advice.
This was a pilot project but is already showing signs of benefitting women in hard to reach areas.
Our final visit of the day was to a young people’s project. The young people treated us to a performance of a young woman’s experience of pregnancy and her husband’s control over what happens, with friends of both offering advice.
The performance was loud and funny but also very insightful and a great way for young people to explore the issues concerned. Afterwards they spoke of their enthusiasm to share this way of communicating with others through youth groups.
As we drove back to Lilongwe we all reflected on what we had seen and heard, the progress of the programme, and the challenges that the community still face. We were encouraged by the work that has been undertaken so far and the ownership by the community and local partners, particularly the district health officer.
It is only with full community partnership that projects like this can be a success.
Find out more about our work in Malawi.