Malawi COVID-19 restrictions threaten interfaith mobile clinic gains

On a cold Friday morning, Egret Samson, a volunteer health care worker, from Kunsaka village in the Mangochi district of southern Malawi collects health passports from her fellow villagers at a weekly mobile health clinic run by the Global AIDS Interfaith Alliance. As a volunteer health worker, Egret’s duty is to organize her fellow villagers during the weekly mobile clinic so that medical personnel are only tasked with consulting patients.

Kunsaka village is over 30 kilometers (18.6 miles) from the nearest hospital in Monkey Bay. Before the area started having the weekly mobile health clinics, villagers had to travel to reach the nearest health facility — Monkey Bay Community Hospital.

According to Samson, a round trip to the health facility costs around 3,000 kwacha ($3.78). “Getting such an amount of money was challenging for a sickly person,” he said, adding that this prevented a lot of people from going to the hospital.

But since GAIA started implementing the integrated essential health care mobile clinic service, community volunteers have observed that there has been an increase in health-seeking behavior. But the COVID-19 pandemic and restrictions imposed to control the pandemic have forced GAIA to cut back on some services. Health workers are concerned that this may lead to the reversal of critical gains.

Maria Majawa, a community volunteer from Mangochi who monitors TB and HIV patients, told Devex that apart from reducing the travel costs to the health facility, the GAIA mobile clinics have also improved health outcomes.

“We used to lose people to curable ailments but since these mobile clinics began, we have witnessed a reduction in the death rates of people from diseases such as tuberculosis and other HIV and AIDS-connected ailments,” she said.

But Nelson Khozomba, a program manager at GAIA Malawi, said that while their operations in Malawi have been steadily growing over the past few years in terms of program focus, the COVID-19 pandemic has forced the organization to scale down services such as proactive community HIV case finding and follow up of people living with HIV to ensure adherence to antiretroviral medication.

Khozomba said since the government imposed COVID-19 restrictions, GAIA has been forced to halt some outreach operations for over six months, and services that require follow-up to people’s homes have been particularly affected.

The result is that over 1,000 people that rely on these services, and their immediate families were greatly affected, he said.

The organization also experienced a 4% decline in funding for non-COVID activities, mostly from private donors and grants, but this was cushioned by a 20% increase in restricted funding for COVID activities, according to Khozomba.

GAIA was founded in 2000 to mobilize the faith community to proactively respond to the HIV/AIDS epidemic that was affecting most sub-Saharan countries, including Malawi. Since its inception it has expanded its programs to include supporting health worker training programs and mobile health clinics.

The organization engages community volunteers to organize the mobile health sites and relies on faith leaders and the community to provide venues for the clinics and to increase the uptake of services through their engagement with the community.

Malawi has recorded a total of 61,171 COVID-19 cases with a case fatality rate of 3.67%. So far, the country has fully vaccinated 2.35% of the population — which is a far cry from the continental target of vaccinating 60% of the population to reach herd immunity. In response to a reduction in active cases, the government recently eased COVID-19 restrictions and has increased the number of people that are allowed to meet at gatherings from 50 to 100.

But Khozomba said GAIA’s mobile clinics see an average of 200 patients per day.

“This means that while gatherings of over 100 people as per government limit remain suspended, we are unable to address the critical health needs in the communities that we serve. This has forced us to provide more sessions with fewer clients, increasing the time needed to complete activities and the cost to deliver services,” he said.

Health rights activist George Jobe said that while GAIA has managed to reach up to 1.5 million people using the community-based mobile clinic approach, COVID-19 restrictions mean that there will be a 50% reduction in the number of people the organization reaches.

This could push patients to start seeking treatment from traditional healers — a situation that would lead to an increase in deaths from curable ailments and lead to “a reduction in the access of health education which is essential to promoting positive health outcomes,” he said.

A study by Public Health Action found that the long distances that patients travel to reach the nearest health facility in rural Malawi has a negative impact on health-seeking behavior and leads many people to resort to seeking health care from traditional healers. Researchers found that many patients in such areas visit health facilities when their health has greatly deteriorated leading to many dying of curable ailments.

Carolyn Kassam, program director at the Malawi Network of Religious Leaders Living with or Affected by HIV, or MANERELA+, said that in addition to easing restrictions to allow access to health care there is also a need to organize sensitization campaigns on the benefits of urgently seeking medical care when one feels signs of an illness to maintain the gains already made.

Devex, with support from our partner GHR Foundation, is exploring the intersection between faith and development. Visit the Focus on: Faith and Development page for more. Disclaimer: The views in this article do not necessarily represent the views of GHR Foundation.