Towards Improved Maternal, Newborn and Child Health in Malawi: Community Participation

Establishment of Maternal, Newborn and Child Health Networks (MNCHNs) to enhance community involvement in monitoring and provision of services to improve MNCH.

Introduction
The idea of establishing MNCHNs to enhance community involvement in monitoring and provision of services to improve MNCH is driven by the enormous health needs faced by people of Malawi particularly women and children. Malawi is one of the least developed countries in the world. With a population of about 13 million, the country is faced with serious health challenges - high HIV prevalence (12%), high maternal mortality rate (984/100,000), high fertility rate (6), high infant mortality rate (76/1000) and high child mortality rate (133/1000) (USAID study).

Operationalisation
MNCH services in Malawi are largely provided by the Government followed by faith based organizations under the umbrella of the Christian Health Association of Malawi (CHAM), non-governmental organizations (NGOs) and the private sector. Due to high levels of poverty, budgetary constraints and poor infrastructure such as roads, MNCH services are not widely available and accessible particularly in rural areas. The USAID report also singles out the lack of manpower such as doctors, nurses and other health staff as one of the major constraints to the effective delivery of health services, including MNCH in Malawi. How can this human resource related capacity gap be filled to ensure increased access of MNCH services?

Training of adequately qualified health personnel is very costly and a poor country such as Malawi is likely to lose such personnel as they are attracted to seek better opportunities in industrialized countries. The MNCH services can still be provided with the limited number of health personnel currently working in Malawi only if they are supported by a local robust and functional network of trained traditional leaders and local volunteers. The establishment of MNCHNs is one of the key strategies that can help to address the capacity constraints being currently experienced by the health system in Malawi. Community involvement through MNCHNs would entail the participation of communities, through their community leaders and volunteers in the collection of data and information regarding MNCH. Simple notebooks can be provided to trained community leaders and volunteers to register pregnant mothers, births, sickness and deaths. This information alone, if kept up to date, would go a long way in creating awareness about the enormity of the MNCH needs and therefore direct scarce resources appropriately. The registers can be kept by traditional leaders and be regularly checked and collected by health personnel such as Health Surveillance Assistants (HSAs). In turn HSAs would lodge the data at district level which would then be collated and sent to the national tallying centre.

Similarly, traditional leaders and volunteers can be trained to provide basic immediate MNCH related support to women and children. This way, simple, inexpensive and community owned MNCH support networks would be created in all communities. These networks which would be built on the existing strengths of the extended family networks that already exist in Malawian communities.

Benefits
Through monitoring the MNCHNs would help planners from the Government, donor community, NGOs, private sector and others to have up-to-date statistics that are not only inexpensive to generate but also useful in allocating and prioritizing the scarce resources.

The MNCHNs would help to address the basic health needs of women and children such as provision of basic immediate support in form of advice to pregnant mothers on the need to attend ante-natal and post-natal clinics; support for arranging transportation (ambulance services) as and when needed; provision of health and nutrition advice, family planning, among others.

The MNCHNs would act as easy community entry points for any MNCH interventions that may be planned by the Government and its partners such as donors, NGOs, the private sector and others.

Apart from being cost-effective in the sense that they are easier and cheaper to establish and maintain than building a new hospital for example, the MNCHNs would also be sustainable in that they would be in a position to own the MNCH projects or programmes and ensure their functionality even long after specific NGO interventions or projects have phased out.

Conclusion
The enormity of MNCH challenges in Malawi calls for concerted effort – collaborative effort is required involving the Government, faith based organizations, NGOs, the donor community, the private sector and the community members themselves. By putting resources together to create MNCHNs, these stakeholders will not only create synergy but will also initiate a process that is community generated, driven and owned. At the end of the day, when the lives of mothers and children are saved, the communities will not only say to the various development partners and stakeholders, “thank you for your support” but they will also proudly say, “we did it ourselves” (Lao Tzu).

Kennedy Lweya, PhD
Goma – Eastern Democratic Republic of Congo