Pumping Health Services Back into Life in Malawi

When a blackout occurred after Pilirani Kabango ended her shift one September evening in 2017, she did not anticipate any unusual consequences. Power outages during this time of year are not uncommon in Malawi, and despite high temperatures and the fact that the rivers supporting electricity generation were drying up, demand for power continues. The three water tanks at Lilongwe’s Mitundu Rural Hospital, where Pilirani works as a nursing supervisor—among the biggest rural public hospitals in Malawi—had a combined capacity of 30,000 liters. They held enough water to adequately run services until electricity returned.

Although power returned the following day, no water was flowing into the tanks. The maintenance officer’s report was bleak: the electric submersible pump had blown, probably due to the power outage. Bleaker still, the US$1,500 gadget could not be repaired. Pilirani called the Lilongwe District Health Office to inform staff of the situation, with little expectation of a quick solution. Ten years as a cadre had taught her that limited finances meant non-clinical emergencies like broken pumps were low priority.

This was an emergency. This water was the hospital’s only supply, and shortages in a maternity unit raise the risk of infection. Without water, certain services stop altogether.

“A few days into the crisis, we scaled down the maternity services, encouraging those who were closing in on their delivery to make plans to go to Bwaila,” Pilirani said. But the hospital delivers on average 25 babies daily, so scaling down maternity and closing the operating theatre caused difficulties. Attempts to draw water from a borehole achieved little, as the water could not be readily stored.

Pilirani called the Lilongwe District Health Office. A team arrived two days later, but without a new pump. Instead, they brought a quality manager from the Organized Network of Services for Everyone’s Health (ONSE), a USAID-funded project led by MSH, working to reduce maternal, newborn, and child morbidity and mortality. Two weeks later, a new surge-protected Grundfos electric submersible water pump (also operable on solar power) was installed, costing US$2,267 and pumping twice as fast as its predecessor.

In her office, Pilirani pulled out two photocopies of a maternity register.

 “At the height of the water crisis, between September and October, we recorded 15 and 19 neonatal deaths, respectively. A significant jump from the 11 and 12 deaths recorded for July and August,” Pilirani said.

She said most of the deaths could be attributed to neonatal sepsis or asphyxia. Without running water,  hospital staff could not help newborns with breathing or other health complications as quickly and as hygienically as possible.

“All our services are now back to normal,” she said. “I’m thankful that our efforts for excellent service delivery are increasing, thanks to ONSE.”