Maternity Worldwide began work on introducing an integrated maternal health approach project in Zomba District, Malawi at the beginning of 2010. This followed the completion of a detailed needs assessment evaluating the local situation within the ‘Three Delays’ framework which guides our work. Using this we identified those areas of maternal health provision which most urgently needed to be addressed in order to enable women in the area to give birth safely.
Zomba District is located in the south of Malawi and is one of the three poorest districts in Malawi. 70% of the population falls below the national poverty line. Our project covers two of the rural Traditional Authority (TA) areas, Mwambo and Chikowi, which together have a population of around 583,000 people. More than half of the inhabitants are aged 18 or younger.
Malawi has a maternal mortality ratio of 460 deaths per 100,000 live births. Around 3000 women die in pregnancy and childbirth each year. 29% of maternal deaths are AIDS related.
For a woman in Malawi the lifetime risk of dying in pregnancy or childbirth is 1 in 36, compared to 1 in 4600 in the UK.
Maternity Worldwide’s approach is to work closely with local partners to increase skills and build capacity thereby ensuring the sustainability of improvements to maternal health services. In Zomba we are working in partnership with the local Catholic Healthcare Commission (CHC) which operates six of the health facilities in the District. Our project will initially be working with the CHC community hospital at Pirimiti and two health centres at Magomero and Matiya.
Our work in Zomba District is also supported by MAHECAS (Malawi Healthcare Support), a UK based Malawian diaspora organisation which helps to raise funds to provide medical equipment to health centres and hospitals and which has extensive practical experience of healthcare in the country.
During this early period of our work in Zomba District one of our main objectives has been to establish links with and gain the support of key local government and other agencies as well as with the community. We have established a good working relationship with the local District Health Officer (DHO). The DHO is responsible for the Health Surveillance Assistants (HSAs) who work at village level providing community based health services and who will be key to our work in delivering maternal health promotion information.
Our project manager has been working alongside our partners to address the priority areas for development identified in our needs assessment. An additional series of focus groups have been held with both women and men in the area to ensure our work addresses the needs of the community.
Work carried out to date includes:
- Raising awareness of the work amongst staff at Pirimiti Community Hospital and Magomero and Matiya health centres.
- Carrying out an audit of clinical skills at Pirimiti.
- Meeting with the DHO and health surveillance assistant teams to learn more about their work with the villages, their skills in data collection and how we can work most effectively with them to deliver maternal health promotion programmes.
- Undertaking a training skills survey for Zomba CHC. This identified a need for improved skills in use of computers, data collection and report writing and training and a training programme is now taking place .
- Conducting scoping activities at village level and making links with microfinance organisations prior to the introduction of an income generation scheme for women.
- Involvement in management meetings and procedures at Zomba CHC and the three health facilities.
- Developing links with the Malawi Safe Motherhood programme manager and the director of CHAM (Christian Health Association of Malawi, an ecumenical body representing Christian health service providers in Malawi) to raise awareness of and support for our work at national level.
We have recently carried out an audit of equipment needed to help the three health facilities carry out their maternal health services effectively and we have now supplied the items required. These included relatively basic but essential items such as forceps and scissors to more specialized equipment such as a vacuum extraction set and an autoclave.
We are in the process of seeking further funding to enable us to consolidate and expand our work in Zomba District.