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Building homegrown health care, brick by brick

Malawian MP Moses Kukuyu (centre) moulding bricks for a hospital he's building with constituency members. Photo by Philippa Croome.

By Philippa Croome

Thousands of freshly molded reddish-brown bricks lie baking under the hot Malawian sun.

“Self-help project! Self-help project!” one young boy declares to me proudly. He holds a wet brick high over his head, smiling broadly from under the dripping mud. “We need to build here for medicine!”

He’s one of hundreds of children, women and men that have gathered to mould bricks for a health centre in Blantyre’s Manase township. Residents of Manase, like too many other villages in Malawi, have seen members of their communities die while travelling to faraway medical clinics. But the Manase residents are determined to see themselves into better health, even if it means building their own hospital from scratch.

Malawi’s population is 85 per cent rural and poor access to medical care is all too common among villagers far removed from hospitals. According to the Ministry of Health, Blantyre fares better than most districts with 18 public health centres. By contrast, Phalombe, a community of 300,000 about an hour outside of Blantyre, has none. Districts were put in charge of hospitals when Malawi embraced decentralization along with a multiparty system in 1994. But critics say they are often left without the funds from the top to respond to the needs on the ground—the most basic of which is access.

Martha Kwataine, Director of the Malawi Equity Health Network (MEHN) characterizes the coordination between the District Assembly and the Ministry of Health as “there, but quite weak.”

“Some health facilities have been constructed but up until now they have not been used because according the ministry, they were not held to the required standards,” she warns. “Some communities have been helped, some are left along the way.”

Blantyre City South MP Moses Kunkuyu refuses to let that happen in his community. The self-described “Manase boy” already knew his annual allotted K3 million ($20,477 CAD) budget wouldn’t be enough for a health centre. When he took the project on less than a year into office, he showed an incredible amount of faith in the system.

“We have the bricks but we haven’t identified any funds. We just have the need and we just have the desire to see the thing take shape,” he says. “We’re going to use whatever possible funds we have.”

Kunkuyu says he has consulted the district and has the go-ahead from ministry officials. But in the interests of time, he says he had to pursue other avenues. Instead of waiting for help, he enlisted community members to build the hospital.

“We are two weeks into molding bricks and they are almost done…if we had waited for someone to come and help us, we would have waited for years,” he says.

Group Village Headman in a nearby village, Kampala, says the villages can’t afford to wait. The journey to the nearest health centre has for years been a challenge at best. With no money for transport, it’s a two-hour walk. Some who have braved the hike at night have fallen prey to attackers, injury, or even death. “We were suffering a long time to find a hospital,” says Kunkuyu.

The villagers that surround us murmur in agreement.

On a trip to Zomba earlier in the month, residents in a rural fishing village said it is commonplace for their elected MPs to be voted in, and then never return to field concerns of the people.

Harriet Stima runs a grocery in Zomba-Likangala, and says she hasn’t seen her MP since his campaign.

“In terms of development, there is nothing he has done,” she says. “I’m not surprised at his behaviour, it’s typical of MPs.”

Kunkuyu refuses to fall into that categorization. Instead, he demonstrates the power of personalized politics. The drawbacks to decentralization have shown just how necessary the persistence of local players is to ensure basic services at the grassroots level.

“There is always something that we can do,” he says. “We can evolve ourselves."

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