A neglected urban community

It is seven degrees Celsius in Mzuzu City. On this Thursday night, the atmosphere is cold and cloudy with rain drizzles. Apparently, the weather has been chilly and unfriendly with very cold nights and mornings for a number of weeks now.

Experts attribute the harsh weather conditions to Chiperoni winds which are associated with rains and coldness. They have since advised people to stay warm to avoid opportunistic diseases such as asthma, sore throat and flu.

But some patients and guardians at Mzuzu Health Centre do not have that privilege of staying warm as they sleep on the veranda due to shortage of space. We arrived at the facility around 5pm and found over 20 women seated on the veranda, waiting for nightfall to sleep in the open.

Mick Msukwa from Mchengautuba Township was one of them. She had escorted her expectant second-born daughter Maggie Mwiba, 17. They had been at the facility for four days.

“She was feeling body pains. So, we came here on Monday for checkup. And the health personnel told us to wait here until she delivers,” explained Msukwa, who expects to be at the facility for another week.

The centre does not have a maternal waiting home. This forces guardians to sleep on the veranda. Msukwa said even expectant mothers sleep at the veranda due to lack of space in the maternity ward.

“It is very cold at night here and we are exposed to mosquitoes,” she laments. “This puts us at risk of malaria, flu and asthma attacks.”

Modester Phiri, from Malivenji on the outskirt of Mzuzu City says the facility has no kitchen.

She also expressed fear of contracting sanitation-related infections due to lack of enough toilets and bathrooms.

“The few toilets available are broken and very unhygienic,” she says.

Maternity ward chairperson Rose Soko, who is also a guardian says the ward is congested to unprecedented levels.

She said the ward has 12 beds and priority is given to newborn babies and their mothers.

“One bed is shared by three people. Some women sleep on the floor,” she says.

Soko says the hospital needs to be expanded to accommodate the rising demand for health services in the city.

“We also need a maternal waiting shelter to spare us the cold weather,” she says.

Mzuzu with a growth rate of 4.4 percent, is the fastest growing city in the country. Rapid population growth and urbanisation are some of the reasons according to Mzuzu City Council plan 2014-2019.

However, the city has failed to match up the population rise with provision of health services as evidenced by long queues for treatment and patients sleeping on the floor in hospitals which is a violation of patients’ rights to safe health environment.

For example, the chilly northern city like Blantyre, Lilongwe and Zomba, has no district hospital.

Its population pegged at around 250 000, relies on Mzuzu Health Centre, also known as Mapale Health Centre, which is supposed to cater for a population  of no more than 20 000 people. This is apart from the newly opened Zolozolo Clinic, private hospitals and Christian Health Association of Malawi (Cham) facilities.

In these four cities, patients are forced to rush to central hospitals, which are supposed to cater for referral cases only.

However, at the referral hospital, patients are forced to pay a by-pass fee of K1 500 which the poor like Msukwa can hardly afford. World Bank report says majority of Malawians live on less than $2 (about K1460).

Mzuzu City mayor William Mkandawire says Mzuzu’s population is expected to increase to 306 000 by 2020. He says the health facilities available cannot cater for such a rapid population growth.

“Inadequate health facilities in the city are putting pressure on Mzuzu Central Hospital, which is supposed to be a referral hospital for the Northern Region and not as a primary health care unit,” he says.

Mkandawire says the city needs at least two more facilities and a district hospital for Mzimba North if they are to contain the pressure of population growth.

Mzimba North district health officer (DHO) Emily Gondwe-Gama says Mzuzu Health Centre was built to cater for a small population then.

“But now with increased population, the structure is too small to accommodate all the patients,” she explains.

She agrees with Mkandawire that the city needs two or three more health facilities if residents are to have access to quality health care.

“Government’s policy demands that a health centre should be able to serve at least 20 000 people, but in Mzuzu, the population is way over that, meaning that we need more health facilities to be able to provide quality services to patients,” she says.

Malawi Health Equity Network (Mhen) executive director George Jobe said the issue in Mzuzu is also of concern in other cities.

According to levels of health care, the country is supposed to have primary health care represented by health centres and health posts, secondary  level health care represented by district hospitals and then tertiary level health care represented by the four referral hospitals.

“In our cities, it means there is no secondary level of health care. Much as sometimes there is creativity, for example in Lilongwe where Bwaila serves that purpose. But in essence, secondary level health care is lacking in our cities,” he said.

Jobe says, consequently, people are forced to move from health centres to central hospitals leading to congestion.

“Our central hospitals are congested because they are addressing both secondary and tertiary level problems. So, when people are told to pay the by-pass fee, it is very unfair to them. They are paying for something which is not their problem,” he argues.

Jobe says it is very urgent for the country to consider having district hospitals in districts with tertiary hospitals to decongest central hospitals and at the same time provide the necessary secondary level services to residents of such districts.

In the current budget, there is a provision to start construction of Blantyre District Hospital as well as an allocation to complete construction of Domasi Community Hospital in Zomba to serve the purpose of providing secondary health care.

In Mzuzu, plans are underway to construct the Mzimba North District Hospital at Dunduzu the boundary with Mzimba.

“We know government will say there is commitment because of such provisions, but to us, whether there is commitment or not, our interest is that people should not suffer. This is the reason why we say since there are no such district hospitals, there is no need to charge a by-pass fee,” he says.

Ministry of health spokesperson Joshua Malango says plans are in place for Blantyre and Lilongwe to have district hospitals and decongest central hospitals.