For Griffin Banda, a clinical officer at Ngabu Rural Hospital, the first three months of the year were horrendous to his career. He lost five babies during birth.
“I believe they could have been saved,” he says when asked about the circumstances.
But this has been the situation for three years in which the facility has been losing at least five newborns a year.
By design, Ngabu receives referral cases from Dolo, Chipwaila, Nkumaniza and Kalemba health centres. It also serves rural populations from East Bank and Sojini in Nsanje.
It is supposed to have a multipurpose theatre for surgical procedures, including caesarian operations for at-risk women, as well as an ambulance to serve patients from the four health centres.
However, all these services only exist on paper. For three years, the facility has been operating without a functional theatre and ambulance.
Currently, patients and pregnant women in the Lower Shire Valley setting pay extra costs to travel to Ngabu or Chikwawa District Hospital.
Those who cannot afford face preventable death.
They often arrive too late for health workers to save their lives and the unborn.
“Our major challenge is maternal health. Since the theatre broke down, we refer all pregnant women requiring surgical operation to Chikwawa. However, we do not have an ambulance. We have to request from the district hospital, but it is not always available,” explains Banda.
If they call for an ambulance in the morning, it sometimes arrives late in the afternoon. At worst, it does not come.
“If this happens, we are helpless. We lose lives to treatable conditions. The worst affected are poor women who cannot hire vehicles to take them to Chikwawa. In most cases, they arrive after the unborn is dead,” he says.
Over 150 000 patients rely on Ngabu Rural Hospital.
They remain cut off from the referral hospital unless they have own transport.
Paradoxically, the problem cuts across Chikwawa District which has only one functioning ambulance.
Ministry of Health standards require an ambulance to serve no more than 50 000 people.
But Chikwawa’s serves a population of almost 583 500, according to the National Statistical Office projections.
The district needs 12 ambulances.
Chikwawa Hospital health and environment committee chairperson Mwaiwao Dowe describes the shortage as a crisis.
“The overwhelmed ambulance is not roadworthy, but a risks to the lives of patients and drivers,” he says.
Chikwawa District Hospital public relations officer Settie Piriminta says their fleet includes nine ambulances.
“Only three are running and four are at the garage while two are in irredeemable state. Of those three running, one has exceeded the recommended mileage of 300 000km. Thus, only two, including one donated by Press Cane, are on the road,” he says.
Meanwhile, patients from the four health centres spend between K2000 and K5000 to access health services at Ngabu and Chikwawa hospitals.
A 2017 World Bank report shows that poverty levels in Malawi continue to worsen, with an average Malawian living on $1.25 (around K900) a day.
Banda says he is aware that some lives are lost at home because many patients cannot afford private transport to referral hospitals.
This goes against government’s ambitious policy of universal access to quality healthcare.
Leaving no one behind is the mantra of Sustainable Development Goals (SDGs) President Peter Mutharika and other world leaders adopted in 2015.
Until the struggles that pregnant women in remote localities continue to face are eliminated, the country—which missed Millennium Development Goals to reduce maternal death rates from 750 out of every 100 000 live births to 150 by 2015—will keep missing global targets, including SDGs III, I and VIII on ending poverty and increasing access to quality healthcare services.
Chikwawa calls for urgent renewed action.
But our investigation indicates that this is just a glimpse of a national crisis which makes pregnancy a deadly risk for women without any guarantee for maternal services.
The government initiatives that encourage pregnant women to camp at health facilities days before labour seem insufficient.
Most health facilities are limited in what they can offer.
In the absence of an ambulance, pregnant women are giving birth at their own peril.
In rural areas, including Nthalire in Chitipa, they travel almost 115km to Chitipa District Hospital for critical services.
In cities such as Blantyre, to find an ambulance to Queen Elizabeth Central Hospital from a health centre is a hurdle. Over the past weeks, the referral facility has been operating with a single ambulance at night, forcing ailing pregnant women to secure own transport.
Ministry of Health spokesperson Joshua Malango says the ministry is centralised and it is the responsibility of local councils to ensure their ambulances are functional.
“Government only comes in to help in special cases, but they need to take responsibility to ensure their ambulances are operating and this includes maintenance services,” he says. n