One Health Clinic at a Time, Malawi Transforms the Patient Experience

by Amref Health Africa

Health worker trainings, community outreach efforts, and infrastructure upgrades improve infection control and prevention measures, strengthen cholera response, and safeguard the health of service providers and patients alike

Without access to safe and sustainable water and sanitation services, quality healthcare services and a safe operating environment for healthcare providers are impossible.

Reliable water and sanitation services support a dignified and respectful patient experience; if those fundamental services are absent in health care facilities (HCFs), patients may think twice about seeking treatment. Giving birth in a clean facility with running water, drinking a glass of safe water when taking oral medications, and having access to a functional toilet are all facets of the patient experience that improve health outcomes and increase patient satisfaction. Meanwhile, sustainable water and sanitation services in HCFs also protect healthcare workers by supporting a safe environment for service providers to provide quality care.

But in Malawi, insufficient water, sanitation and hygiene (WASH) in HCFs compounds health risks, especially among the most vulnerable — mothers, newborns, and young children (see chart below for details). Such conditions provide fertile ground for the spread of infections, which are among the third most common causes of death for mothers and among one of the top four contributors to newborn death globally.

Source: WHO/UNICEF 2021

Big challenges demand even bigger responses. That’s why the USAID MOMENTUM Tikweze Umoyo (Let’s Raise Health) project is tackling these issues head-on by training healthcare workers on infection prevention and control (IPC) measures, increasing community members’ awareness of their healthcare rights and helping upgrade WASH infrastructure to address cholera outbreaks in five districts (see map for details).

Map of Malawi showing the five districts where USAID Momentum Tikweze Umoyo is active. The map highlights the Kasungu district, where USAID is improving WASH-related infection prevention and control, and Salima district, where USAID is increasing awareness among community members of their health care rights.

Inclusive WASH training sets the stage for more effective infection prevention and control.

In Malawi’s Kasungu district, home to more than 840,000 people, USAID focuses on improving WASH-related IPC—a crucial component of any high-functioning healthcare environment. To that end, the project is using various interventions, ranging from targeted training to improved signage, to guide patients and staff to the appropriate waste disposal sites.

A healthcare worker demonstrates proper medical waste disposal.
Photo credit: USAID Momentum Tikweze Umoyo project, Amref Health Africa.

Training for health care staff has delivered a significant impact. Historically, Malawian HCFs have struggled to meet global standards for IPC and WASH practices. For example, a USAID baseline assessment at 11 HCFs revealed a troubling lack of knowledge among healthcare workers on best practices such as proper waste segregation and disposal.

Based on these findings, USAID engaged 209 medical staff from 26 HCFs from across Kasungu district in a series of capacity-strengthening workshops to accelerate the adoption of best practices for IPC and WASH. Post-workshop assessments of the original 11 HCFs found significant improvements in IPC and WASH compliance, revealing the district’s health care staff increasingly possess the skills and motivation to apply their learnings.

Mercy sanitizes her hands after interacting with a patient.
Mercy sanitizes her hands after interacting with a patient.
Photo credit: USAID Momentum Tikweze Umoyo project, Amref Health Africa

“The IPC training…reminded me of the importance of properly segregating and disposing of waste, differentiating between infectious, non-infectious, and food waste. It’s easy to overlook certain practices, but the training reinforced that every step is important. Whether it’s handwashing or any other procedure, we must adhere to all the necessary steps.”

– Mercy Anisha Mawazo, a clinician at Salima District Hospital

Exploring a systems approach to community empowerment and more accountable healthcare service.

Located in the central part of the country on the shores of Lake Malawi, the neighbouring Salima district is home to more than half a million people spread across nearly 150,000 households. In this district, USAID is embracing a systems approach for improving WASH practices by empowering patients and communities with the knowledge and tools to demand accountability from healthcare providers and ensure high-quality healthcare service delivery. 

In addition to improvements to WASH infrastructure, USAID hosts quarterly community awareness sessions across Salima that explain the roles and responsibilities of health workers and guardians and outline key patients’ rights in healthcare settings so that patients can better hold HCF accountable for delivering quality services. One critical component is increasing patient awareness about the role of the hospital ombudsman and explaining that patients have the right to express complaints related to the health services received. 

“I didn’t know that we had that privilege!” said Chief Mwanza, referring to patients’ ability to communicate with a public advocate. When concerns over patient care arose in the past, he added, “we did not know where to go.” But USAID’s outreach “has opened our eyes,” he said, “and from today onwards, we will convey our concerns to the office of the hospital ombudsman.”

Dialing up more effective responses to cholera outbreaks

Beyond persistent WASH challenges in HCFs, Malawi has also struggled with large-scale public health emergencies, including cholera outbreaks. 

As part of the emergency response, USAID has worked to rehabilitate 18 community boreholes in areas hard hit by the cholera outbreak, which will safeguard the health of more than 4,500 residents. 

Rehabilitated borehole at Kameme Health Center, located in Malawi’s Chitipa district.
Photo credit: USAID Momentum Tikweze Umoyo project, Amref Health Africa.

USAID also assists the Ministry of Health in preventing future transmission by sending out phone and radio messages about best practices for personal hygiene and upgrading water and sanitation infrastructure in HCFs and schools. The goal is to extend safe water access to roughly 90,000 residents.

A new day dawns for Malawi’s healthcare facilities

District by district, USAID MOMENTUM Tikweze Umoyo’s training, community awareness efforts, WASH infrastructure upgrades, and disaster preparedness initiatives are helping improve health outcomes both inside and outside of HCFs.

More than 560 medical staff and more than 860 non-medical staff from 72 HCFs have already received instructions about IPC and WASH guidelines. Routine assessments now reveal that targeted training are impacting in terms of changing WASH attitudes and behaviours. 

Through these interventions, USAID MOMENTUM Tikweze Umoyo is enhancing HCFs’ ability to deliver top-notch care to their patients — setting the stage for a new era of health care provision in Malawi. Thanks to the project’s efforts to improve sustained access to clean water and dignified sanitation at health facilities, strengthen HCFs’ ability to provide quality care by building workforce capacity, and establish mechanisms for patient complaints and feedback, USAID continues to build momentum behind its broader campaign to improve primary health care around the globe.

Article first published on

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