The year is 2018. On this particular day, Canaan Kamanga, a 53-year old man from Chifya Village, Traditional Authority Mankhambira in Nkhatabay wakes up with a severe headache.
The problem persists and before long, he feels hot in the legs and feet. He has no choice, but decides to go to Nkhatabay District Hospital.
Today, Kamanga, now 59 years old, narrates how his journey with hypertension, has been in the past six years.
“I was diagnosed with hypertension, and started receiving treatment the same year, 2018,” narrates Kamanga.
He has, however, revealed that for many years, considering the distance that is there between his home village and Nkhatabay District Hospital, it has been a tall order to access drugs for the Non-Communicable Disease (NCD), which is commonly known as high blood pressure (BP).
“It was not easy to access drugs and other services that could help me in my condition. I could spend K3,500 going to Nkhatabay District Hospital and another K3,500 when going back home,” he says.
Things went from bad to worse when in 2023 he also got diagnosed with diabetes. The need for constant medical care grew, yet the dietary needs of the two conditions meant that he needed more money.
However, early this year, Nkhatabay District Council collaborated with the Christian Health Association of Malawi (CHAM) to decentralise NCD services to selected facilities. The initiative has become a relief to Kamanga and other NCD clients in Traditional Authority Mankhambira. They are now able to access services at Chilambwe Health Centre, a facility which is 25 kilometres away from Nkhatabay Boma.
“Since I started coming here, I have managed to save money as I can just walk to this place. My only appeal is that government should provide us with drugs of other ailments for free so that when we come for NCD services, but we have other issues, we should be also accessing the other services for free, the way we do at the district hospital,” he says.
Another 59-year-old hypertension patient, Gloria Manda, who was diagnosed with the condition in 2023 says the decentralisation of the service is a great idea.
“I started feeling the symptoms in 2023. When I went to Chilambwe Health Centre, I was told that I had hypertension. I started coming to this facility and I was getting medication which cost K3,500. I went to the district hospital once. I spent K6000 for transport to and from the hospital,” she says.
For Washington Mzumara, a 60-year-old man from Kachipapa Village, T/A Mankhambira, the free access to hypertension and diabetes drugs coupled with spending nothing on transportation has freed money, which he is using to adhere to dietary restrictions associated with the two diseases.
“When I was going to the district hospital, I could pay K10,000 or K11,000 to and from the hospital. I am happy that I am accessing the services closer to us. I am not spending any money. The money we used to spend when going to the hospital is now being used at home, for example to buy food which is recommended for my condition,” he says.
According to the World Health Organisation (WHO) NCDs, which include cardiovascular diseases, chronic respiratory diseases, and diabetes kill 41 million people each year, equivalent to 74% of all deaths globally. It says out of these deaths, 17 million die before the age of 70, with 86% of the deaths occurring in low and middle income countries.
However, WHO highlights that detection, screening and treatment of NCDs, and palliative care are key components of the response to NCDs. This is in line with United Nations (UN) Sustainable Development Goal (SDG) Number 3, which among its key targets is to reduce by one third premature mortality from NCDs diseases by 2030, through prevention and treatment and promotion of mental health and well-being.
The intervention at Chilambwe Health Centre in Nkhatabay is under CHAM’s Phindu Project whose goal is to enhance and strengthen NCD systems for hypertension and diabetes care. Apart from Nkhatabay, the project, is also being implemented in Mzimba North and Mzimba South.
The project, which is being financed by Sanofi, a French multinational pharmaceutical and healthcare company headquartered in Paris, specifically intends to reach 300,000 adults with NCD messages by 2025. The project also plans to increase coverage of NCD clinics in the supported districts from 9 to at least 25 facilities by 2025.
Chilambwe Health Centre NCD clinic, which started early this year with 60 patients, now serves 165 patients. According to facility in-charge, Queen Vumu, the numbers have been growing because following the decentralisation of the service, patients have been getting transfers from the district hospital.
“After conducting sensitisation with the help of community influencers trained by the Phindu Project, the numbers started going up. They started getting transfers from the district hospital. We also started registering new clients identified during outreach clinics supported by the project,” she says.
Vumu says the facility has gone beyond treatment as they are now taking advantage of community meetings to do health talks on NCD.
“We sensitize them on the dangers of excessive salt and fat consumption and so the clients are able to make healthier food choices, leading to a reduction in hypertension and diabetes case complications,” she says.
She, however, admits that they are experiencing a number of challenges, as numbers of people accessing NCD services are rising.
“We sometimes tell our clients to buy drugs whenever those the government gives us are out of stock. Even at the district hospital, they are experiencing the same challenge. There are some who cannot manage to buy what they have been told to,” she adds.
NCD Coordinator at Nkhatabay District Hospital, Jotham Cross, says their partnership with CHAM has eased provision of NCD treatment and related services in the district’s remote areas.
“Previously we had one NCD clinic at the district hospital only. But then with the help of CHAM, we have managed to decentralise six more clinics. We have seven clinics in total that are offering NCD services,” he said.
Apart from Chilambwe Health Centre, and Nkhatabay District Hospital, NCD clinics are also being conducted at Chintheche Rural Hospital, Mzenga Health Centre, Liwuzi Health Centre, Maula Health Centre and Chikwina Health Centre.
“CHAM facilities normally provide services at a fee but in this partnership, we supply drugs for free. Once they have drug stock outs, we always link up with the facilities. We usually go there for supervisions,” Cross says.
He also highlights that apart from capacity building of health personnel, CHAM supports the hospital with diagnostic materials. He adds that CHAM also supports them with Information, Education and Communication (IEC) materials.
CHAM’s Monitoring and Evaluation Lead for Phindu Project, Mathias John, says they are impressed with the impact the project has had so far.
“We are happy that we are achieving remarkable progress in the battle against NCDs in northern Malawi,” he says.
According to John, since July 2023, the project has managed to sensitize 164,000 community members on NCDs, screen 74,600 individuals for hypertension and diabetes and enroll 5,600 clients into comprehensive care across the three districts.