Village clinic eases access to nutrition care
Bringing nutrition services closer to children
In June 2022, Gladys Ojezi walked longer than 15 km to seek medical assistance at Mkumba health centre when her third child suffered acute diarhoea and breathing difficulties at night.
The mother woke up at 5 am to make the three-hour trip from Chokola village to Mkumba health centre in Mangochi, Southern Malawi.
"The baby was sickly and underweight, having lost appetite a month earlier. Due to the long distance to the nearest health facility, I only made the trip when the situation got out of hand," explains Gladys.
After being diagnosed with severe acute malnutrition, the two-year-old baby received ready-to-use therapeutic food (RUTF). Health workers prescribe the peanut butter supplement for treating severe wasting in malnourished children under five years old.
"I wasn't surprised that my only daughter had severe malnutrition. She loves food, but it had been weeks since she had eaten," she states.
Two times, Dija received 14 packets of RUTF per week at Mkumba.
Gladys rues the long travel with a baby on her back though policymakers in Malawi envisaged everyone covering no more than five kilometres to get quality health services.
She says replenishing the weekly dose proved repelling and costly for her family, which thrives on hand-to-mouth piecework.
"I used to leave home by 6 am only to return around 3 pm. I had to walk for over 15 km because I couldn't afford to hitch a bicycle or motorcycle, which costs up to K10 000 for a return trip," she explains.
The mother felt relieved on the third trip. She replenished the RUTF dose at a village clinic nearly a 30-minute walk from her home.
"Through the half-hour walk, I remembered the tiresome trip to Mkumba with a two-year-old child on my back. The time and energy wasted would have been used to do piecework so that my children can afford a nutritious meal," she says.
Gladys says the long travels over hills and valleys in the thick of Liwonde National Park discourage parents from presenting children with malnutrition for screening and treatment.
She reckons families with sickly children were getting poorer while spending valuable time and money on the rocky road that splits the protected forest.
"Crossing the thick natural forest early in the morning or late in the evening is scary. The roaming wild animals or rapists can waylay you with no rescue in sight," she explains.
However, she is happy that her child is steadily shaking off malnutrition.
"Dija is getting better. Her weight has increased from 11 to 12 kilograms in three weeks, and she is no longer frequently bedridden. She loves eating, especially RUTF," Gladys brags.
Janet John, secretary of the village clinic committee of 10 that monitors service delivery and supports a community health worker, says the three-hour walk to Mkumba “takes longer when you are sick or carrying a child”.
"Since the village clinic is right in our community, no one has to leave home before sunrise or shun health services if they cannot afford to hitch a bike. This gives me peace of mind as our clients now save time for activities that can lift their families out of hunger and poverty,” she says.
Concurring, committee member Dina Wilson says gone are the days when long travels left children dying from treatable malnutrition and deprived of routine immunisation by their fifth birthday.
"Most children in the area were not fully vaccinated and those with malnutrition were dying before knowing their status. Now they seek medical assistance on time" she says.
UNICEF, with support from the UK’s Foreign, Commonwealth, and Development Office, is supporting the Ministry of Health to strengthen community management of acute malnutrition. This includes training of front health workers and provisions of essential supplies such as RUTF, therapeutic milk, and tool kits for nutrition screening.
Every Thursday, health surveillance assistant Adbester Banda, from Mkumba, dispenses RUTF to children with severe acute malnutrition. Each goes home with 14 sachets for seven days, a dose of two per day.
The community health worker also provides nutrition screening, immunisation and modern family methods alongside treatment for common killers of children such as malaria, pneumonia, coughs, eye problems, and diarhoea.
"I have been coming here since 2016. Every week, I travel 13.5km from Mkumba on my personal motorbike. However, I pity the rural dwellers who used to travel longer, often on foot, to get to the health centre. To them, the health clinic under Mgawo health post is a huge relief," he says.
A village clinic is supposed to see less than 10 people, but Banda sees more every Thursday.
Gladys states: "I'm satisfied because the HSA and volunteers at our village clinic assist me and my child with a smile. They also explain ways to prevent malnutrition, including the importance of eating six food groups and practicing sanitation and hygiene."