Pregnancy is supposed to bring joy and bliss to every woman. But in Malawi, pregnancy comes with its own complexities, including the fear that a woman would die while giving life.

A story of a 25-year-old Maria Mapoto of Chiwongo Village, Traditional Authority (TA) Njewa in Lilongwe district is a typical example of what pregnant women have to endure in a country where maternal mortality continues to remain an issue.

While expectant and at seven months, Mapoto, who is epileptic visited Mbabvi Health Centre to access antenatal services. Due to her condition, medical personnel referred her to Kamuzu Central Hospital, one of Malawi’s three biggest referral facilities. She had to cough K10,000 to reach the referral facility, which is at a distance of 18 kilometers from the health centre. Under normal circumstances, a government ambulance should have ferried her to the hospital in the city.

So, she waited for two more months in the city to give birth. On April 4, 2025, a baby girl arrived.  

The lack of the ambulance at the facility has complicated matters so much that sometimes, women give birth on the way and prepare to go to the Kamuzu Central Hospital. Mapoto, a mother of two, says she faced her situation, owing to the unavailability of an ambulance at the facility.

She said, “The facility has no ambulance except for the one which comes on call from the referral facility during emergencies".

This is just a tip of the iceberg as most health centres in Malawi are facing a peculiar situation of lacking essential medical supplies, including transport.

As for Mapoto, she was lucky that she made it to the referral hospital two months before giving birth, but this situation is exposing thousands of women and children to death during labour. 

Aaron Kalumo, 33, a father of two from Kandama village in the same area, says the lack of ambulance services is dangerous for expectant women. He adds that many cannot afford the transportation cost to the referral hospital. 

Kalumo is deeply concerned that Mbabvi health facility is facing other challenges, such as a shortage of drugs. He said, “We are forced to dig deep into our pockets to buy drugs from private pharmacies, since most of the times the prescribed essential drugs are not available”. 

Similarly, another villager and a father of four, who plies Kabaza business, Yusuf Damiano, 33, concurres with the two that lack of an ambulance and drugs at the facility is a burden to the community which struggles to earn a living. He states that they are forced to buy most of the drugs, which are pegged around K7,500 in the local pharmacies.

A fiscal analysis of the National Budget has established that for years, the Malawi government has been allocating inadequate funds to the health sector against the Abuja Declaration which calls for states to put at least a 15 percent of the fiscal plan to the health sector. In the 2025/2026 budget, the health sector has been allocated K741 billion, which is about nine percent of the national budget. Notably, this allocation is meant for the completion of the Cancer Centre, Mponela Community Hospital, implementation of Malawi Emergency project to protect essential health services and contribute to the health sector joint fund.

This clearly shows that the health sector will continue to operate on deficit, forcing the health sector managers to prioritize a few critical areas while leaving unattended most of the important services.

John Moyo, a medical assistant at Mbabvi Health Centre, apart from attesting that the hospital has no ambulance, he says that they really struggle to run the facility which saves a catchment population of 54,458 from T/As Kabudula and Njewa. 

“There is no proper infrastructure to install laboratory equipment to diagnose diseases, such as Tuberculosis and other Non-Communicable Conditions (NCDs),” he decrying that people with symptoms of such diseases are referred to Kamuzu Central Hospital for diagnosis services. 

Moyo adds that the facility lacks structure for the environmental department to conduct under-five clinic services as well. A tree acts as their structure.

By all means, it is against the United Nations Sustainable Development Goal No 3, which calls for ‘Good Health and Wellbeing for All’, to which Malawi is a signatory.

During the 2019 campaign trail, this government pledged to construct 900 health posts every five kilometers to ensure that Malawians access health care within their vicinity in accordance with Universal Health Coverage (UHC).

However, five years down the line, the government discloses that it has constructed less than 200 health posts, including those constructed by its stakeholders. According to this year's budget, the government will construct 55 health posts.

According to the Ministry of Health Public Relations Officer, Adrian Chikumbe, the government is aware of the challenges that have engulfed the health sector. He says the government is committed to ensuring that there is quality health care for all. 

He, however, indicates that the government has constructed at least 200 health posts across the country as one way of ensuring that patients are not walking long distances to access health services. 

“We are trying our best to make sure that all the health facilities have good infrastructure, equipment, and medical personnel so that they can assist patients timely,” said Chikumbe. 

Chikumbe thus admits that the KCH is supposed to assist patients from the district hospitals, but due to lack of resources in health centers, the patients are referred to Kamuzu Central Hospital, which is also congested. 

Malawi Health Equity Network (MEHN) executive director George Jobe said it is sad that the patients are walking long distances to access health services.

 “Patients should not pay money to access health service even walking long distance. Currently, the budget is less than what is required with an Abuja Declaration where 15 percent needs to be put in the nation budget,” said Jobe. 

Jobe has thus challenged the government to walk the talk on campaign promises of ensuring an improved health system. 

It is evident that although political parties continue promising to improve the health sector once in power, there is little to show on the ground. Obviously, it is a matter of lip service to the citizenry, who bears the cost of poor health services.