A hospital that is supposed to save lives should never have to apologise for being too full to save them.
Yet that is, in effect, what our central hospitals are telling us. The figures coming out of the hospitals are difficult to read without wondering how much pressure the health system can take before the consequences become even more serious.
At Queen Elizabeth Central Hospital (QECH), 30 women are giving birth on an average day in a labour ward with 24 beds. The hospital performs about nine caesarean sections a day. Between April and December last year, 519 newborn babies died there. That amounted to 50 deaths for every 1 000 live births, against a facility target of 17.
There were also 50 maternal deaths during those nine months, giving the hospital a maternal mortality ratio of 484 deaths per 100 000 live births, compared with a target of 213.
The figures are alarming enough on their own, but what makes the situation more troubling is that hospital officials are not describing a temporary problem. They are describing a system that is being asked to carry more than it was designed to carry.
The same story is being told, in different ways, at the country’s other central hospitals.
Mzuzu Central Hospital serves the entire Northern Region and is handling patients at both primary and secondary levels. It has only one paediatrician, who is also its only obstetrician. Zomba Central has a neonatal unit with 26 beds despite the number of deliveries and complicated referrals it receives. Its officials say babies have at times had to share beds. Kamuzu Central Hospital too has inadequate space, staff shortages and no neonatal intensive care unit.
These revelations point to a problem with how the country’s health care is organised.
A central hospital is supposed to be a place where the most complicated cases are referred because that is where specialist skills and equipment are concentrated. The fact that central hospitals have become the destination for almost everyone shows that district hospitals are not equipped to manage even less complicated cases adequately.
There is a limit to how much additional pressure any hospital can absorb. Once the beds are full and the same small pool of specialists is expected to attend to more and more patients, the effects inevitably begin to show in waiting times, staff fatigue and the quality of care.
That is why the concerns raised by the four hospital directors during their meeting with the Parliamentary Women’s Caucus deserve to be treated as more than a plea for additional resources.
Of course, the hospitals need more specialists, equipment, medicines, blood, ambulances and adequate neonatal facilities. But putting more resources into the central hospitals without strengthening the facilities below them may simply allow the same problem to grow.
The proposal for district hospitals in Blantyre and Lilongwe should, therefore, be considered in that wider context. The objective should not be to build more structures for the sake of having more buildings, but to ensure that patients are treated at the level of the health system best equipped to handle their needs.
That requires functioning facilities, properly staffed maternity units, and reliable referral arrangements. It also requires ambulances and communication systems that allow a patient whose condition suddenly deteriorates to be moved quickly to the appropriate facility.
This is important because discussions on maternal deaths in Malawi often become about individual causes such as sepsis, eclampsia, or postpartum haemorrhage. Those causes matter, of course. But behind them are often delays in recognising complications, delays in referral and in receiving the required treatment.
Those delays become more dangerous when the receiving hospital is itself overwhelmed.
The pressure on the health system also has a human cost that does not appear in mortality statistics. Hospital officials say congestion at QECH has contributed to long waiting times, early discharges and compromised respectful maternity care. Staff are exhausted, and nurse-to-patient and doctor-to-patient ratios are far from ideal.
Yes, there will always be competing demands on government resources. But maternal and newborn care is not an area where the country can afford to accept that overcrowding, staff shortages and inadequate referral systems are simply the way things are.
The central hospitals have sounded the alarm.
The responsibility now lies with those who make decisions on health policy and public spending to ensure that this testimony does not become another report that gathers dust.
