Behind the successful initiative is resourceful midwife Mary Sibande, who took a Sida-funded training programme run by Lund University.
A couple of weeks ago Mary Sibande was in Stockholm to talk about her experiences for representatives of Sida (the Swedish International Development Cooperation Agency) and the Ministry for Foreign Affairs, among others. Anette Agardh, senior lecturer at the Division of Social Medicine and Global Health and programme director of the University’s Mater’s in Public Health, also attended the meeting. She and her colleague Karen Odberg-Pettersson have been responsible for a number of training programmes on “Sexual and reproductive health and rights”. The aim has been for the local population in Malawi and other countries to get started with improvements on their own.
“The project in Malawi is a fantastic example. The villagers have been very committed and involved, and the results show that the method chosen was money well spent”, says Anette Agardh, who has been to Malawi to study the project.
Midwife Mary Sibande lives and works in the Mongochi district of southern Malawi. Malawi is one of the poorest countries in Africa and women in Malawi have an average of five children. Even if the situation has improved, the country is still struggling with high maternal mortality and high infant mortality. Mary Sibande recounts the conditions that made her want to take action:
“I was deeply moved by my experiences when I started working with maternity care in the villages and communities of Mongochi. One day on the way to the village where I worked, my car got stuck because of the poor state of the roads, and this opened my eyes to the huge distances between the villages and the health centres. On another occasion, I met a man and a woman who had carried a woman in labour on their shoulders for eleven hours to get to the nearest health centre. She was tired and bleeding – I gave them a lift”, she says.
The problem for pregnant women in Mongochi and various other parts of Malawi to get to somewhere safe to give birth in time has to be seen from more than one angle:
“It is not only a question of the actual transport, with the distance between health centres, poor roads and difficult terrain where cars cannot go. First, a decision on the actual birth and how it will happen must be made. Traditionally, the uncle or another male relative of the pregnant woman is contacted to decide where and how the birth is to take place.”
Therefore, the home has long been the obvious and most common place to give birth, often with a lack of both professional help and hygiene.
When the opportunity arose to attend the training programme – through an alert manager at Mary Sibande’s workplace, the College of Medicine in Mongochi – she grabbed the chance.
Mary Sibande initially worked with three villages, Ngatala, Mitawa mindondo and Stambuli. She worked with the villagers and village elders to start a bicycle ambulance initiative linked to the shared health centres in the area. At the same time, the health centres were readied to provide better emergency care.
The results have not been slow in coming. In 2005 nine women in the district died in conjunction with pregnancy or childbirth. In 2008 the figure had dropped to zero. Major effects have also been seen in the surrounding region. Around 50 bicycle ambulances are now on the roads, linked to five health centres, and the death toll has fallen from 19 to two over the same period.
The work has subsequently spread to an even wider circle and the local project is now seen as a national model for how local involvement can improve maternity care.
Mary Sibande and her colleagues have also started local women’s networks which conduct outreach activities to provide information on maternal health and giving birth safely.
Despite the success of the project, their work capacity limits the future of the work. More people are needed at grassroots level. The Government and authorities have so far mainly focused on improving hospitals and health centres. However, Mary Sibande emphasises that more local involvement in towns and villages is needed.
When Anette Agardh sums up the work so far, she considers that the programmes have been a success. She is particularly pleased that the projects have had a wider impact at local, regional and national level in a number of the participating countries:
“We have visited all of the roughly 100 projects and seen the results on site; here at the conference we wanted to show the Swedish population, Sida and the Ministry for Foreign Affairs that the initiative has produced results. Now we are going to continue with the collaboration in a newly formed ‘global academy’.”
Footnote: According to statistics from the UN, maternal mortality in Malawi in 2008 was 510 women per 100 000 live births. The comparable figure for Sweden was 5 women.
Lund University, Sida and ITP
In November the final conference was held in Stockholm for Sida and Lund University’s international training programmes (ITP) in sexual and reproductive health and rights.
The programmes have involved midwives, gynaecologists and obstetricians from 33 countries on three continents. Together they have launched around 100 local projects in their home countries. Maternal mortality, family planning, young people’s clinics and HIV prevention/AIDS treatment are examples of areas covered by the projects.
The programmes have been offered by Lund University’s Division of Social Medicine and Global Health over the period 2005–2010. The University has given basic training in Sweden to the participants, who have then started projects for change in their home countries. Follow-up visits have been made to the projects and the programmes have concluded with a follow-up week in the region of the projects.
At a general level, the work of the ITP programmes will help to achieve the United Nations Millennium Goals.
– Text: Björn Martinsson
- Bicycle ambulance – A bicycle ambulance in Chiunda, Malawi. The ambulances have helped to significantly reduce maternal mortality.
- Pregnancy and childbirth are traditionally almost exclusively a matter for women in Malawi, but the local projects for safer maternity also involve the men. Pictured is a village meeting in Masanje.
- With training from Lund University, midwife Mary Sibande has been able to increase the impact of her work to reduce maternal mortality in inaccessible villages.