Bringing TB Testing and Treatment To Those Who Need It

by Pilirani Semu-Banda

LILONGWE, Mar 24 (IPS) - Malawi does not have accurate statistics that define the extent of tuberculosis (TB) cases within its borders, and there are fears that only half of those infected with the disease are able to access testing and treatment.

Technical advisor of the country’s National TB Control Programme (NTCP), Dr. Daniel Nyangulu, said TB is one of the top killer diseases in the country, together with malaria and HIV/AIDS. "Every year, [we estimate that] up to 30,000 people are treated for TB, and 8,000 die of the disease. TB is a huge public health problem," said Nyangulu.

In the 1980s, TB infections were much lower, with public health facilities having to treat only 5,000 TB patients per year.

Malawi’s fears that only half of those infected with the disease are accessing treatment are supported by 2008 World Health Organisation (WHO) data, which estimate that there were more than 50,000 new cases of TB in the country last year. Malawi falls short of the WHO recommended treatment success rate of 85 percent by at least 13 percent. But all existing data are estimates.

NTCP has therefore embarked on a campaign to provide universal access to TB testing and treatment. Sputum collection centres have been established in hard-to-reach rural areas that don’t have health facilities. Members of local communities are volunteering to collect sputum from people with TB symptoms. The volunteers then transport the samples to the closest health facility for testing.

According to the United Nations, up to 85 percent of Malawi’s population lives in rural areas where about 60 percent of the people live below the poverty line of $1 per day. It is difficult for them to seek medical care when they need it, especially if public health facilities are far away from their villages and they don’t have the money to pay for transportation.

"We have discovered through surveys that most people in villages are not accessing health services such as TB detection services easily. This is mainly because of the distances they have to travel to get to the nearest health centres and also because of the high poverty levels," explained Nyangulu. Residents of rural areas have to travel an average of five kilometres to reach a clinic or hospital.

Lack of knowledge about TB has also been cited as contributing to the fact that few Malawians get tested, said Nyangulu. He said most people in rural areas have little information about the disease and therefore fail to recognise its symptoms.

Mtsiriza, a rural community on the outskirts of Malawi’s capital Lilongwe, is one area that has benefited from the universal access initiatives launched by NTCP. Now that sputum collection centres have been established in the community, people have been flocking to the centre to be tested in high numbers. NTCP is also encouraging home-based care services, delivered by community volunteers who observe and follow up on treatment for TB patients.

John Chiguduli (48) is one of the patients who has been cured from TB due to the new centre in Mtsiriza. "I have been sick for about a year, and I haven’t been able to work at all. I felt very weak but I could not access testing services because the hospital is far away from here, and I didn’t have money for transport. I only got diagnosed with TB when a medical facility was set up here in my village," Chiguduli told IPS.

He believes the NTCP initiative of bringing health care to the people, instead of expecting people to make their way to health facilities, has saved his life. "I nearly died. The testing service came to my area just in time to save me," said Chiguduli, who is now able to work his fields again.

The community TB initiative also encourages all members of a household with a TB patient, especially children, to be tested.

In addition, NTCP offers ‘active screening’ at its TB testing centres, which means that HIV testing is offered in combination with TB tests. This way, government tries to identify the large number of TB/HIV co-infections, which the national health department estimates to be 77 percent.

NTCP has also established walk-in centres in the country’s main health facilities, such as referral hospitals, to enable people to access TB testing services without having to join the long queues of patients requiring other hospital services.

Hospital waiting times are usually long because Malawi is facing acute shortage of health personnel. The Department of Health indicates that up to 120 registered nurses leave the country per year for better-paying jobs in the developing world. Currently, 50 patients are looked after by only one nurse, while one doctor is responsible for 64,000 patients, according to health department figures.

In addition to bringing TB testing to rural areas as part of its universal access strategy, the NTCP makes special efforts to provide testing services in other TB hot spots, such as prisons. "Most of the prisons in the country are overcrowded and this becomes a breeding ground for TB," said Nyangulu, explaining that prison authorities are now encouraged to offer TB testing to every new prisoner and offer testing services for all prisoners on a regular basis.

Yet, health experts realise that efforts to curb TB will be less effective if Malawi does not have accurate statistics on the TB situation in the country. The health department is therefore planning to embark upon a national prevalence survey later this year. "Right now, we only have estimates, but we need specific figures to be able to treat all cases properly," said Nyangulu.

(END/2009)

Water makes the difference

by Pilirani Semu-Banda

LILONGWE, Mar 20 (IPS) - Water has become the very essence of economic development for a rural community of Ngolowindo, in Malawi’s lake district of Salima, where households are reducing poverty thanks to irrigation.

Ninety percent of Malawi's agriculture is rain-fed but government is now pushing for more diversification into irrigation farming which allows farmers to grow crops even in the dry season and allows for additional harvests.

Taking advantage of the fresh water from Lake Malawi, the people of Ngolowindo are using simple irrigation methods to grow such produce as tomatoes, cabbages, mustard, onions, okra, green pepper, green beans, lettuce and maize on 17 hectares of land.

A vibrant agricultural cooperative, the Ngolowindo Horticultural Cooperative Society, has since emerged in the area and 159 people are now members. Each individual farmer is allocated a small piece of communal land and assigned a specific crop to grow. The produce is collected into one lot and is put on the market.

Eluby Tsekwe, the cooperative’s chairperson, proudly told IPS that her community has become the largest supplier of fresh produce to the residents of the country’s capital city, Lilongwe.

"We supply all the main supermarkets and individual vendors in the capital city with fresh produce which they sell to residents of the city. We make a substantial sum of money from there and this sustains our livelihoods," she said.

Tsekwe said that members have to be 18 years and above. "We don’t want to get children into the cooperative since we believe they should be in school and not be involved in any type of child labour," said Tsekwe.

For Tsekwe, a single mother of five, the financial benefits of this collective endeavour are evident; all her children, aged between four and 19, are in school. Despite her divorce leaving her alone as head of her household, she is also able to provide three meals every day to all her children in a country where, according to the United Nations, seven out of 10 households typically run out of food before every harvesting season.

Tsekwe has also managed to build a house of bricks with an iron sheet roof and cement floors. "A typical house here is one with mud walls and floors with a grass-thatched roof but I can afford to live better and I am very proud of myself," she said.

But it has not been all rosy for the Ngolowindo project, according to Coordinator of Ngolowindo Horticultural Cooperative Society, Mercy Butao.

The cooperative coordinator explains that the agricultural initiative started at Ngolowindo in 1985 as an irrigation scheme and only became a cooperative in 2001. She said the project was initially driven by the government’s departments of water and agriculture through traditional leaders and community members.

"As a scheme, individual farmers worked in their own fields. They could only benefit from communal irrigation systems, but they were each others' competitors when it came to marketing their produce," Butao told IPS. During this time, the maintenance of irrigation structures such as drainage canals and irrigation canals was suffering.

The scheme was turned into a cooperative to improve marketing of the produce and for a more organized management of the project, according to Butao, but this also solved problems of maintenance.

"The farmers applied for funding from the European Union soon after forming the cooperative, and they used the money to upgrade their agricultural skills in irrigation farming and modern ways of crop production," said Butao.

The Ngolowindo farmers have also been trained in marketing fundamentals, financial management, organisation management and agro-processing.

The Cooperation for the Development of Emerging Countries (Cospe), an Italian non-governmental organisation, has also assisted the Ngolowindo Horticultural Cooperative Society in the constructing irrigation structures and in human resources. Butao, for instance, is an agricultural expert, employed by Cospe since 2002 to provide technical support to the cooperative.

"The Ngolowindo project has grown so much and it is now moving into agro-processing," Butao told IPS. She said in the absence of a processing project, there had been a lot of wastage of produce since the crops being grown are perishables.

"The cooperative has now diversified into the production of tomato juice and tomato sauce," said Butao.

The project has 18 people working in agro-processing, using hand-powered machines to process the agricultural products. "We are yet to make it big in the agro-processing business. Our products are not developed enough to compete on market but we are working hard towards advancing further," said Butao.

The cooperative is also working towards diversifying into livestock farming so as to use excess produce from the farming to feed the animals. "We also want to promote the use of animal manure in our farm," Butao said.

Another member of the cooperative, Ginacio Kamoto, explains that he has benefited a lot from the cooperative. "I am able to provide employment to some people in my area. I employ them as casual labourers to assist me with farming. I employ up to six people per growing season," said Kamoto.

But people like Tsekwe and Kamoto are still the exception in Malawi where up to 65 percent of the 13.1 million people live below the poverty line of less than a dollar per day.

According to the Ministry of Agriculture, the country is only irrigating 72,000 of 400,000 hectares of irrigable land. The country is yet to fully utilise Lake Malawi, a fresh water length which stretches the length of the country is the ninth largest lake in the world.

(END/2009)

Malawi's Women Challenge For Top Posts

by Pilirani Semu-Banda

LILONGWE, Mar 5 (IPS) - Sitting side by side, clothed in bright traditional outfits complete with headgear, they looked like any of the women who always dance and ululate for politicians at rallies.

But Loveness Gondwe and Beatrice Mwale are exceptional: with their newly formed Rainbow Coalition party, they are vying for the country’s top most positions of president and vice president respectively in Malawi’s May 19, 2009 presidential elections.

Malawi’s current president, Bingu wa Mutharika, has also picked a woman, Joyce Banda, to be his running-mate in the elections. But it is yet to be seen if the women will indeed make it to the top.

Such political positions have so far been a domain for men in Malawi - a woman’s role has mainly been limited to dancing and cheering for their leaders - mostly men.

For instance, Gondwe, the country’s first female presidential aspirant, has not had it easy in politics. She formed the Rainbow Coalition Party because the Alliance for Democracy (Aford), the party she has represented since 1994 - rising higher than any woman before her in the national assembly, where she was voted to the position of First Deputy Speaker - refused to endorse her as presidential candidate.

"I am an achiever and capable of bringing positive change to people’s lives and I am qualified to lead this nation," Gondwe told the local media upon presenting her presidential nomination letter to the Malawi Electoral Commission.

She said if elected, she would like to make more employment opportunities available to the youth, in a country where the unemployment rate is at 45.5 percent.

Gondwe also aims to improve the conditions of service for civil servants who are the lowly paid and to support small holder farmers who play a big role in Malawi’s economy, which is predominantly agricultural.

"I would also like to see the maternal death rate going down so that women are able to participate in development work," Gondwe said. Malawi's maternal mortality is one of the highest in the continent at 807 deaths per 100,000 live births.

Banda, President Mutharika’s running-mate, who was Malawi’s foreign minister before her appointment, also told the media that she has been fighting a hostile environment as a female politician.

"I have had to learn how to navigate and find my way. People have seen my performance as a member of parliament. I am not emotional but solid and realistic. I have done my best as a cabinet minister and I will prevail in any political, social and economic storm," said Banda.

All women vying for political positions in Malawi are benefitting from the support being rendered by the 50:50 Campaign, a national programme on increasing women's participation in politics and decision-making positions. The campaign is being coordinated by the Ministry of Women and Child Development with support from international donors including the United Nations.

The programme provides campaign finances and materials to women aspiring to political positions, to expose them to the public through media and to provide them with training in personal development. Up to 150 women have presented their nominations papers to contest for the 193 parliamentary seats. Currently, there are only 27 women out of the 193 members in Malawi’s Parliament.

Programme coordinator for the 50:50 Campaign in the Ministry of Women and Child Development, Bertha Sefu, admits that it is an uphill battle to achieve equal participation for women in decision-making positions.

Sefu told IPS that Malawian society favours men more than women but that the 50:50 Campaign has managed to position women well and that the country is now realising that women can be trusted with decision-making positions.

"We have seen that the women candidates for political positions are getting more and more support from both men and women and we hope this means that the situation is changing. We are optimistic that we will have women in the very top positions of government by May," said Sefu.

Beyond the selection of Banda as Mutharika’s running-mate, people have to wait for the elections results in May to see if indeed more women are being given the opportunity to be political leaders.

While the situation seems to be growing more favourable for women in politics; it is a different story in the civil service and private sector. Currently, only seven women out of 38 are in ministerial positions - only four are full ministers and three are deputies. Just five out of 38 permanent secretaries in government ministries are women and just 21 percent in other top level positions are held by women. In the judiciary, women are not well represented either, since there are only four female judges out of 27.

On the positive side, the positions of chairperson of Malawi electoral commission, clerk of parliament, chairperson of Malawi Human Rights commission, attorney General and parliamentary draftsperson are currently being held by women.

Gender specialist for the United Nations in Malawi Veronica Njikho says the focus now is on the forthcoming elections but once that is over, there will be a review of the 50:50 campaign to start focusing on the participation of women in all levels of decision-making including the private sector.

"We will also be lobbying for the participation of women in trade union movements," said Njikho.

Meanwhile it seems like the women of Malawi would still want to continue dancing for political leaders; whether male and female and Banda, the vice president nominee, is one of them.

"Because I am an African, we dance as part of our culture and identify. We dance during birth, we dance when we brew beer, we dance when we praise God, we dance when there is death, we dance when we install chiefs. We dance as a form of appreciation and expression of our feelings," said Banda.

She said dancing is part of who Malawians are. "It does not take away anybody’s dignity. I will dance alone as an African. I have advised my children that when I die, nobody should cry, but celebrate my life, I expect people to dance in celebration of my life. Dancing is part of who we are and we cannot stop that," said Banda.

It is yet to be seen if men will be forming dance groups for women politicians.