At Chitekesa health centre in Phalombe, struggles for universal access to quality healthcare got harder due to lack of safe water and sanitation facilities.
Pregnant women and guardians used to draw water from unprotected, shallow wells almost a 30-minute walk from the facility. The wells get contaminated by run-offs when it rains and runs dry during the dry season.
“In the absence of running water, bathrooms and toilets here, pregnant women used to give birth at home. Others, especially the well-off, would go to Matiya Health Centre, almost 50km away. For the majority of women from surrounding villages, Matiya is faroff,” explains senior nurse Lydia Katsonga.
Eliza Maxwell, 28, gave birth at Chitekesa in 2010. Her daughter, Halima, died of suspected sepsis—a bacterial infection—17 days after birth.
Ever since, she has vowed never to give birth at the health centre.
“After giving birth, a woman needs water to take care of herself and the baby. However, there was no running water, no bathrooms and no toilets. I feared I was going to lose another baby,” she narrates.
According to Chitekesa clinician-in-charge Emmanuel Njirazafa, the health centre has been operating without running water and proper sanitation facilities since 2004.
Last year, the breakdown in water and sanitation services was a burning issues when Development Communications Trust (DCT) supported by Oxfam rolled out a transparency and accountability initiative to improve health governance in the district.
The project, funded by Irish Aid, focuses on inclusive citizen participation in demanding universal health coverage (UHC) through transparent and accountable processes.
Studies show that without access to safe drinking water and basic sanitation, women face numerous health risks in pregnancy, during childbearing and after giving birth. Contaminated water and unsanitary conditions expose them to diarrhoea and other infections that account for over half of the patients in the country’s clinics. Women and girls also encounter violence as they endure long walks in search of water.
To address water and sanitation problems, DCT facilitated meetings with duty-bearers at community, facility and district levels.
“The trainings, dialogues and engagement meetings we conducted increased the urgency of communities we are working with to demand quality healthcare by holding duty-bearers to account,” says DCT project coordinator Zione Mayaya.
Through this interaction, affected communities voiced their concerns with age-old water and sanitation challenges at the health centre.
In fact, community members, district council officials and district health office (DHO) met and resolved to install running water and construct toilets at the health facility.
Last September, Chitekesa Health Centre had piped water and modern toilets.
According to village head Tsikulamowa, the training in universal health coverage offered by DCT and Oxfam equipped village development committees and the rural community with knowledge on healthcare issues, especially how they can demand quality healthcare services from their duty-bearers and hold them accountable for negligence.
“Chitekesa Health Centre run without water for a very long time not because we were happy, but we did not know where to take our problems,” he says.
With poor sanitation at home, pregnant women and those who have just given birth are three times more likely to die than those with basic sanitation.
This health risk is not confined to their homes as some health facilities, which are supposed to have safe water, sanitation and hygiene all the time, lack these facilities.
This puts women at risk of contracting preventable infections in clinics where they give birth.
“Due to the running water and sanitation facilities now available at the health centre, cases of infection affecting pregnant mothers and newborns have gone down drastically here. The number of clients, especially pregnant women, the poor and other marginalised groups seeking healthcare services here has also increased significantly,” says the in-charge.
Oxfam governance programme manager Lusungu Dzinkambani calls for interventions that recognise and treat water, sanitation and hygiene as complex factors that affect a woman’s health—not a separate problem from maternal health.
The 2015/16 Malawi Demographic Health Survey indicates a steady decline in pregnancy-related deaths from 675 deaths per 100 000 live births in 2010 to 497 deaths.
Dzinkambani says there is need to build on this “considerable achievement” to further bring down that number of maternal deaths.
“Without clean water and basic sanitation, a woman’s ability to fight infection is compromised. Imagine how difficult it would be to prevent infection during a Caesarean -section, cord-cutting and the healing process after birth if there was no clean water or toilets at a health facility?” she asks.
At last Eliza Maxwell is happy that Chitekesa Health Centre has safe water and decent toilets. She hopes this is the beginning of a new chapter.
Last October, the woman went back to the facility and delivered a bouncy baby boy.
“As you can see, my son and I are in good health,” she brags. “To celebrate his survival, I named him Chimwemwe because he brings joy in my life as I try to forget the loss of my first child who succumbed to a bacterial infectionshe might have acquired from this clinic.” na