Malawi has vast health problems ranging from its high unmet need for family planning services (26 percent), with acute needs among young people. Even with the gains in child health, 37 percent of Malawian children suffer from chronic malnutrition. Malawi is also high-burden malaria country with an incidence rate of 332 cases annually per every 1,000 people and approximately 4.8 million episodes of malaria per year. Over a third of established positions in the health sector are vacant and there is a perpetual shortage of qualified health workers in facilities across the country. Such tremendous health challenges combined with constrained economic resources, and marginalized women and youth place a significant burden on the health system.
One entity of the community based health care workers are Malawian Health surveillance Assistants (HSA) who are expected to serve at least 1000 each but they are faced with more people than they could manage efficiently. Due to this, many rural people lack access to information on different health issues which is resulting in a continued circle of unhealthy behaviors resulting from uninformed choices.
Through the USAID funded Health Communication for Life (HC4L) project, community structures such as Community Theatre Groups (CTGs) and Radio Listening Clubs (RLCs) were established to complement the work of such government structures in the promotion of positive Health behaviors
These CTGs and RLCs work with the government through the HSAs and other stakeholders to supplement their efforts towards ensuring that Malawians are living healthy lives by demanding and accessing priority health services within their reach. The HSAs act as their patron and point of reference whenever they are carrying out community sensitizations and household visits using the wheel of lifesaving practices.
The fruits of such synergy between HSAs and Community structures disseminating health messages is manifesting through the increase in number of people coming forward to adopt positive health behaviors such as prompt health care seeking, uptake of Family Planning methods, Construction of pit latrines, hand washing facilities as well as maintenance of such.
In Lilongwe’s T/A Masumbankhunda, the collaboration between Chitsulo CTG and their HSA and patron Luzayo Jere is bearing fruits as there has been a tremendous change in adoption of positive behaviors. Jere and Chitsulo CTG go together in conducting awareness meetings on vast health issues in their communities and their combined effort has yielded positive results.
Jere explains that between 2018 which the club got actively involved in community mobilization to date, there has been remarkable progress in reaching many women and men with health messages including those of family planning. Currently number of people coming forth to take a Family planning method from the club’s catchment area keeps rising and currently has risen from 40 people in January in 2020to over 67 clients in January 2021 with about 34 people among the 67 adopting long term Family planning methods.
“I have seen the power of collaborated communication manifesting itself over the years of the project, We now have women in their first parenthood starting Family planning which was not the case as people waited to have multiple un spaced pregnancies first then choosing FP at a later stage. Long term FP methods as provided by PSI have also made the numbers to increase and currently almost 80% of women are on FP in Ndumila.
In GVH Tanga where Chitsulo CTG and Kamboyoka RLC also mobilizes communities on different health areas, there has also been an increase in women taking up Family planning methods and an eradication of home birth deliveries as people are constantly sensitized on the dangers of home delivery .
Lufina Elias, A 24 year old mother of 2 from Chintanga village said she chose to space her children following frequent sensitization by community structures as Chitsulo CTG and Kamboyoka RLC which operate in her area. She added that she sees the importance of messages that are being repeated even on radio and decided to take part after being enlightened.
Elias said “I decided to take family planning so that I should have time to take care of my children and also get my body back in place after giving birth. As such my oldest is 3 years and I have a 5 months old baby.”
Saini Lankeni from Kathyokamwendo village, who has newly embraced family planning, said she expects that it will help her to have ample time to take care of her new born baby before having another child.
Many women like her who come for outreach clinic at Tanga, one of chitsulo CTG’s catchment areas agree that frequent dosing of healthy messages by different stakeholders result into their adoption of positive behaviors such as taking family planning and sleeping in mosquito nets as they deem such repeated messages important
To ensure sustainability of initiatives by HC4Lstructures in the communities, the clubs are encouraged to work well with local authorities such as Traditional Authorities and chiefs who set bylaws that act as binding forces for some behaviors to be followed. Chitsulo CTG has also benefitted from the support by local leaders which led to support by their subjects as well.
Chitsulo CTG chair Ulemu Kapasuka attests that the good working relationship the club has with the patron, coupled by an enabling and welcoming environment set by chiefs of villages they work in, has contributed to the change in their communities such that there are visible strides in people’s ways of living.
Kapasuka said “the chiefs here such as Kumalindi, Ndumila where we mainly work in are guided by the by laws set by the Traditional Authority Masumbankhunda who declared that each village head should ensure that their subjects have pit latrines or risk being penalized, this made chiefs see our sensitizations as ideal to deliver such health messages.”
She added that in their sensitizations, the GVH Chitsulo accompanies them to villages such as Chanika, Ndumira, Chapundima and Ntata and help in delivery of the health messages thereby boosting the morale and credibility of the club among the communities they serve.