“Things were bad here in Chigodi, for everyone but most especially for pregnant women. Many women gave birth at home, and some died during birth. At the time, there wasn’t much that could have been done. The clinic required money the women didn’t have and the district hospital is too far,” says Mary Sipiliano, a member of the Chigodi Youth Group in Ntcheu District in the Central Region of Malawi.
Chigodi is a village of about 13,303 inhabitants located 56 kilometres from the Ntcheu District Hospital. All Chigodi residents, as well as those of surrounding communities rely on a local health centre run by a faith-based organization (FBO) because there are no public health facilities in the vicinity. However, the residents of Chigodi faced several challenges when it came to accessing health care. Due to the size of the facility, patients were asked to wait for assistance outside especially on clinic days and when the weather was bad, the clinic was cancelled. The facility pit-latrines and bathrooms were in bad condition posing additional health risks to patients. The clinic had no water reserve and during the dry season when the bore holes had dried up the centre could not operate. In addition to these problems, the health centre required payments for services which most of the Chigodi residents could not afford to pay. As a result, many people in the community were unable to seek healthcare for treatable illnesses. Because of inability to pay, many women in the community delivered babies at home, and if there were complications that traditional birth attendants did not know how to deal with, some of them died.
CARE Malawi’s Community Score Card (CSC) team first visited Chigodi in 2016.Working with Mary’s youth group, they conducted three rounds of CSC with the community and health service providers. By the end of the third round, the relationship between the community and the health facility had been transformed. As the community members’ understanding of the constraints faced by the health centre grew with their participation in CSC, they actively engaged with Government to negotiate a service level agreement for the health centre under which Government pays the centre MWK 375,000 each month to provide free maternity and under-five child health services to the community. Now that the problem of fees was resolved, the community turned its attention to the quality of services provided by the centre.
With support from their Ward Councillor, the community spearheaded efforts to improve the health centre. Villagers provided bricks for the construction of a new shelter for the under-five clinic, and the Councillor mobilised resources for the purchase of corrugated iron sheets for the roof. The Councillor successfully lobbied to have the health centre selected for the construction of new borehole, thus resolving the water problem that has plagued the centre for years.
The need for proper bathrooms and toilets had also been raised a priority issue during the CSC process. Both the community and health centre personnel agreed that the facility did not have bathrooms and toilets fit for a health centre. As the picture (Picture 3) shows, resources were jointly mobilized by the community and government, and the facility now boasts state-of-the-art sanitary facilities. Even with the bore hole and new, improved toilets, water supply during the dry season remained a big challenge causing sanitation levels to drop and increasing the risk of infections and other problems in the health centre. So, the purchase and installation of water storage tanks was listed as a priority in the CSC action plan. The installation of the tanks is in its final stages (Picture 4) and the community can look back with satisfaction, assured of safe and sanitary health services.
The less tangible impact on community members as a result of their participation in the CSC process can be felt in the opennessof their discussions about critical issues of youth sexual and reproductive health stemming from the active involvement and leadership of young peoplein the process. Information gained about the benefits of quality healthcare is also changing health seeking behaviours in the community. More and more pregnant women are attending antenatal care in the first trimester; and sick children are rushed to the clinic at the first sign of illness.
“This is just the beginning for our community, we are feeling very positive and we will work together to bring change to the different sectors in our community.” – Chigodi Youth Group member Patrick Masula