Addressing child malnutrition through free nutrition services


Yosefe playing with a scooter in the Nutrition Rehabilition Unit at St Gabriels Hospital
© UNICEF Malawi/2018/Lulutani Tembo

By Lulutani Tembo

Beata Bignos was shaken when she saw her child’s feet, stomach, and cheeks were swelling. He had kwashiorkor, a severe form of acute malnutrition.  After being treated at Gabriel’s Hospital in Namitete in rural Lilongwe, her son, Yosefe, is now healthy and bouncy again, as should every 2-year-old.

“I was so worried when I saw that my child was swelling from his feet upwards. I immediately took him to St. Gabriel’s hospital because the services in the children’s Nutrition Rehabilitation Unit (NRU) are free. The free services we received were consultation, admission as well as the medicine including therapeutic milk.  We stayed there for a week before being discharged to Outpatient program. Now my son is a lot better,” Beata said with a smile.

St. Gabriel’s Hospital is one of the 182 health facilities under the Christian Health Association of Malawi (CHAM), and one of the 54 CHAM NRUs. There are 105 NRUs in Malawi. The free services that little Yosefe received after being diagnosed with severe malnutrition, was possible through a partnership between CHAM and UNICEF. This partnership developed when Malawi experienced the harsh effects of the 2015 El Niño phenomenon which caused dry spells and drought-like conditions in the country. The number of severe acute malnutrition cases rose across Malawi.   Most of the children with severe malnutrition in the surrounding areas of CHAM facilities could not access treatment because they could not afford to pay for the services.  With the hike in deaths of children, coupled with overwhelmed public hospitals, treatment and services to vulnerable communities were provided free of charge. Children with severe malnutrition from hard to reach areas were able to get treatment in all health service points from January 2017 to June 2018.

The initiative has been so successful that the government has agreed to continue paying for the services for the next 2 years.  This means that vulnerable children like Yosefe can now receive quality-free nutritional services in CHAM facilities.

Children suffering from severe acute malnutrition with medical complications requires specialized in-patient management in health facilities. In most cases, parents avoid taking their children to health facilities for treatment because of the fees they have to pay. St Gabriel’s Hospital director, Dr. Phleya Mbeya describes this as one of the main reasons why the partnership between UNICEF and CHAM has been so beneficial to communities. “Due to hospital bills, many parents would choose to stay home when their children are malnourished, which leads to many children in the village dying from something that they could be treated for” Dr. Mbeya said. “When the partnership providing free access to nutrition services began, we did several awareness-raising activities in the surrounding villages with the help of local chiefs.  Since then, the number of children we receive seeking care on nutrition issues has increased greatly. This is encouraging because it means children are being treated and can grow into healthy adults.”

A child being screened for malnutrition in Phalombe District
© UNICEF Malawi/2018/Thoko Chikondi

For Beata, the free services in the NRU were a huge relief. Coming from an impoverished background, she would have never been able to pay for Yosefe’s medical bills. “I am the second wife to my husband, so I receive little support from him and I don’t work. I would’ve never been able to afford staying in the hospital for a week or even pay for the medicine and nutrition treatment that was given to my son”, Beata explained. “When we were discharged, we were told to come every Friday to get ready-to-use-therapeutic-food (RUTF) until my son recovered fully.”

Health workers in CHAM facilities have also benefited from the partnership with UNICEF. CHAM’s Head of Health Programmes, Dr. Titani Dzowela said the partnership has helped them to learn more about treating nutrition-related illnesses. “Following the agreement with UNICEF, we had to make sure health workers in our facilities get training on the updated guidelines on the management of acute malnutrition. This greatly improved the quality of care that children receive,” explains Dr. Dzowela. “We also think that UNICEF handing over the responsibilities of free nutrition services in CHAM facilities to the Government is the right move because it means the programme will be sustained and more children from impoverished backgrounds will continue to be assisted,” he added.

Yosefe and his Mom Beata having a checkup at St. Gabriels Hospital after his recovery
© UNICEF Malawi/2018/Lulutani Tembo

The one year partnership between CHAM and UNICEF commenced in 2017. As part of the partnership, UNICEF took over responsibility for under 5 children’s access to Nutrition Rehabilitation Units(NRU), Out-patient Therapeutic Programmes  (OTP), Supplementary Feeding Programmes (SFP) and any other conditions related to malnutrition.  “This partnership has been extremely beneficial for vulnerable children whose families cannot afford to pay for life-saving nutrition services. With the Government of Malawi now stepping in, we are assured of sustainability, that children from the remotest areas now have a chance to access nutrition services from CHAM facilities,” says UNICEF’s Chief of Nutrition, Sangita Jacob.

The Ministry of Health- Nutrition Unit also views the partnership as a big achievement for Malawi. “This partnership is valuable because we’re talking about the life of a child at stake,” says Janet Guta, Deputy Director of Clinical Services and Nutrition. “Malnutrition is one of the leading cause of child deaths in Malawi, the successes of the partnership will allow us to continue to treat children and save lives.”

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