By Susan Davis, Executive Director
Last week I had a brief meeting with Dr. Chihana Mughogho, Director of Ekwendeni Hospital, which is part of the CCAP Malawi network. This is one of the hospitals and health centers at which CCAP and Emory University recently evaluated WASH conditions. I was interested to hear her perspectives on addressing the challenges identified. She shared with me some bigger challenges and had some interesting ideas for solutions.
Water reliability challenges: While they have a piped water source, there are a couple of challenges. One is that the water doesn’t come regularly (in fact, a few hours after I met her, the electricity and water went out across Mzuzu). The other is that the cost for this unreliable water has doubled in the past year or so. She would like to be able to pre-pay for the water. While they do have a borehole for emergencies, she said she would like supplemental water source, perhaps rainwater harvesting, which could be used for non-drinking purposes (this is the type of thing the CCAP SMART Centre could help with).
Finance challenges: The hospital’s annual budgeted Income is 800 million Kwacha (about 1.1 million USD). There is no separate budget line for water. Patients are supposed to pay for services but often can’t afford to. Salary grants from the Christian Health Association of Malawi (CHAM) contribute about 40% of their budgeted income. They have an agreement with the Malawi government that all women should be able to go to the hospital for free for childbirth in an effort to decrease maternal and neonatal mortality. But the government owes them 25 million Kwacha (about 34,000 USD). This along with the soaring water prices, means the hospital is in debt. Their vehicles need maintenance and they can’t buy medicine on credit anymore. Part of her proposed solution is to build a guest house; they have lots of visitors – doctors, students, supporters, and they could charge them a small income. Another idea is to install solar panels to reduce their reliance on the electrical grid.
Setting priorities: I asked her what her priorities would be if she got more money. She said she would:
- Pay debts on medicines
- Install alternative water source
- Convert to solar to reduce electricity bills
- Maintain vehicles
The main takeaway for me was that it’s important for us in the WASH sector to understand the broader challenges that facilities must deal with when we try to help them. Also, we should support local creativity and solutions.
To learn more about US activities in WASH and Healthcare Facilities, visit this page.