In the aftermath of the devastating Covid-19 pandemic that almost paralysed Malawi’s health sector, ActionAid Malawi and partners are investing in strengthening health and community systems against current and future pandemics, FLETCHER SIMWAKA writes.
After months of battling persistent coughs and chest pains, Esther Metani of Makhonja Village in Phalombe District went for TB testing at Chiringa Health Centre.
She hoped to know her status and start receiving treatment without delay.
However, after delivering her sputum at the facility, she was made to wait for months on end to get the results. As she frantically found out, the health facility did not have a TB diagnosis machine and her specimen was referred to Phalombe District Hospital for laboratory analysis.
Still battling the nagging ailment which was almost taking its toll on her health, Metani had to pay extra costs to retake the test at Phalombe Hospital, over 30 kilometres away from her home.
Empathising with Metani, Samsom Maheya, who analyses TB samples under a microscope at Chiringa Health Centre, says the unavailability of the TB diagnosis machine rolled back the facility’s gains in the fight against TB.
“Referring the specimen to Phalombe District Hospital was both costly and time-consuming as a TB suspect had to wait for almost two months to get the results. That affected the validity of the results and treatment of patients,” he says.
Maheya adds that the gap in TB diagnosis was a huge blow for the health facility which serves a rural community of about 17 000.
“The situation led to a reduction in number of TB suspects coming forward for testing at the facility,” says Thomas Nyamula, a data collector at the facility. “Community members became reluctant to offer their sputum for TB testing, calling it useless.”
The delayed tests soured the relationship between healthcare workers and the community they serve.
“After months without getting their results, those who had submitted their sputum were suspecting us of doing something fishy. Most TB suspects became uncooperative, with others resorting to other treatment methods,” says Nyamula.
Many people in Malawi struggle to access timely TB diagnosis and treatment due to under-resourced health facilities.
According to the World Bank, Malawi had, by 2023, a tuberculosis incident of 119 people per 100 000. This is slowing the country’s progress to attain universal health coverage by 2030, the deadline for the Sustainable Development Goals.
Moved by the lessons from the devastating Covid-19 pandemic that left the country’s health sector on its knees, ActionAid Malawi and partners in 2024 rolled out a Health and Community Systems Strengthening project targeting 1.15 million people in 12 districts, including Phalombe and Rumphi.
Funded by The Global Fund through the Ministry of Health, the project empowers communities to take charge during health emergencies using a community-led monitoring (CLM) approach. The new initiative challenges people who use health services to take the lead in identifying and routinely monitoring healthcare issues that matter to them. This facilitates evidence generation, health education and capacity building, engagement and advocacy.
Chilinga CLM member Hanna Katemera says the community-led initiative helped engage district health authorities to provide a TB diagnosis machine for the rural health centre.
She says the exercise became possible with the support and mentorship from Creative Centre for Community Mobilisation (Creccom), who are implementing the project in the Southern Region.
She recalls: “After noting that access to TB testing and treatment was a major health issue in Chiringa, we met with district healthcare officials at Chiringa Health Centre and Phalombe District Hospital in July, 2024.
“The objective of the engagement was to highlight the impact of unavailability of the TB testing machine and demand provision of the testing machine at the facility. In October 2024 the district health office provided a Gene-Xpert, a TB diagnosis machine.”
Sister Rose Mazimbo, Chiringa Health Centre in charge, says the Gene-Xpert has improved TB treatment and cordial ties between communities and the facility’s staff.
“TB suspects now get the results within two days after submitting their sputum. This facilitates timely treatment for those who test positive. Now we have more people willing to get tested for TB here,” she says.
Fema Nankwawa, CLM officer in the district, says the successful advocacy for the provision of the Gene-Xpert at Chiringa is part of the ongoing community empowerment efforts to ensure health service users identify issues they face when accessing health services and find solutions to them.
“CLM builds the capacity of some of the community structures to monitor health issues and address those issues, thereby ultimately helping them to access quality health services,” she says.
