The Scotland Chikhwawa Health Initiative a collaborative ...The Scotland Chikhwawa Health Initiative a collaborative project between the University of Strathclyde, Ministry of Health

The Scotland Chikhwawa Health Initiative a collaborative project between the University of Strathclyde, Ministry of Health (Malawi), Chikhwawa District Assembly and the University of Malawi helping rural communities to attain healthy setting for all of their households.

1

Kalonga Village

The community falls under the care the Chief Kalonga and the health surveillance assistant, Phylis Navitcha.

Essential Statistics: • Population of 470 people living in 98 households. • 68% household coverage for latrines. • Kalonga is serviced by 1 borehole and 1 gravity fed tap located within the village.

• Kalonga is located 500 metres off the main East Bank Road at the base of the Thyolo escarpment.

• Distance to the nearest health facility is approximately 2.5kms.

• Committees represented in the community include: DAPP women’s group, Forestry and Nursery committees, ASCAR, Village Health Committee, Water Point Committees (borehole and tap).

• Transport in the village is limited to bicycles

Overview There were only a few recurring themes discussed by people in Kalonga: health, food insecurity, water access, hygiene and child abuse, many other issues were raised but they varied from group to group.

Kalonga demographics:

Organisations working in Kalonga Kalonga has, and continues to, beneYit from the work of a number of organisations within the community including: • DAPP (Development from People to People, Danish NGO) has supported agricultural development in the community through the formation of women’s groups.

• World Vision distributes maize during drought periods

• Rural Infrastructure Development Programme (RIDP) support the growth and planting of tree seedlings, a programme which is supported by the Forestry Department.

• Evangelical church • ASCAR

Energy Currently mains electricity runs parallel to the community however only a limited number of households and businesses have a connection to mains power. Tsabango has solar power. The use of cellphones is widespread and people can charge them at shops in Mpokonyola (approximately x km away depending on the location of the residence) for 50MK.

.

0 - 11 months

1 - 4 years

5 - 14 years

15 - 49 years

50+ years

Male 5 29 90 79 10

Female 8 34 88 101 26


2

Health Access Kalonga Village is located 2.5 kms from Mfera Health Facility where the community can access all primary health care services including maternal health services. The health surveillance assistant Phylis Navitcha resides in the village. The community visits traditional healers in neighbouring villages. Health issues were important to people in Kalonga during group discussions, the predominant recurring health issue at the health centre is the shortage of drugs, people complained that they are being advised to buy them elsewhere. Another key health issue raised by women and female youth was family planning “no proper family planning methods are followed”, it was unclear whether this was due to pressure from men as some of the girls said that a lot of men in the village think that bearing children is [a sign of] wealth as a result they don’t follow proper methods of family planning. There is also inadequate provision of contraception products and advice by healthcare workers, who usually prescribe what is currently available. Women also complained about incorrect medications being prescribed by the medical assistant because he “starts prescribing before the client Yinishes explaining what he/she needs, men also reported that health workers can be “very rude” to community members. Lack of health education provision was highlighted by male youth speciYically the need for hand-‐washing. The distance from the village to the centre was also raised.

Diseases discussed by community members were HIV/AIDS, people living with HIV are sometime isolated in the community; malaria which was blamed on the stagnant water around most houses and diarrhoea and cholera – the high number of cases were linked to the lack of safe, clean water available.

Project staff observed people with both physical and mental disabilities in the village.

Commerce The main activities within the community are subsistence farming and animal rearing, particularly goats, pigs, chickens and cattle. Food crops are maize, beans and pigeon peas while cash crops are cotton, maize, rice and vegetables. There is a forest in the community with a nursery.

Beekeeping is also carried out by community members.

The community has food stalls selling maize, fruit, Yish and meat, 1 carpenter, 2 builders and a beer seller, while the walk through survey reported no market in the village, leaders and others talked about market hygiene during discussions.

Food Security and Food Hygiene Food insecurity was highlighted as a key problem for the community due to lack of land, and the extreme climate including droughts, Ylooding and lack of money due to unemployment (although this Yinal factor was only mentioned by female youth who talked about earning small amounts through selling Yirewood). Leaders said they “need implementation of schemes”, but no detail is recorded about the format of these schemes. Male youths in the village complained that parents eat better food than youths.

Lack of food for orphans in the village is an issue. A couple of groups wanted more information about food groups and growing relevant crops for better nutrition for their families. Interestingly men did not mention food insecurity but requested health education on how to achieve the six food groups.

Lack of market hygiene was described and the lack of follow

up by the District Council. The leaders said, “it is so embarrassing the way our market area is looking right now.” The market lacks proper cleaning arrangements, bins/rubbish pits, latrines and there is indiscriminate disposal of waste.

Religion and Recreation There are 9 bars selling traditional spirits and beers, they are owned by local people. There is also a video/music centre open from 6am-‐7pm, playing music. Observers reported that people were drinking by 11am and loud music was playing however community members did not report any problems with the drinkers. There are no sports recreation facilities so the village uses Mpokonyola’s sports pitches.

Churches in the village include New Life, Evangelical and Ana Amulungu.


3

Water, Sanitation and Hygiene Access to drinking water is limited because Kalonga only has one functioning borehole and one gravity fed tap for 101 households. In spite of the lack of a safe water source, community members said that the chief of the area closes the borehole at 6:00pm each day. “We are asked to pay 100 kwacha each month but we don’t see any bene?it”.

Hygiene issues for example lack of knowledge about hand-‐washing, the lack of latrines and poor construction was raised by several groups as well as the absence of pit latrines at the market.

Education and Child Abuse Under 5 nursery provision is available in Mfera, the contribution is a packet of sugar or MK100. Children from the village attend Mfera Primary and Secondary schools, Thabwa primary and Chikwawa Secondary school. Little was said about education during focus groups however women did highlight that the biggest problem in the area was that a lot of male teachers have secret affairs with young girls (Please note this was not captured in P-‐Index data).

Housing The poor standard of housing was highlighted by women and the elderly. Housing is pred-‐ ominantly built from unburnt bricks with grass thatched roofs.


4

Measuring priorities and social capital Priority Index Groups within the village were identiYied to outline issues and challenges in terms of the social determinants of health, development and barriers for the village as a whole. Areas outlined as issues were then measured to determine their level of priority for the speciYic group. Groups were categorised as leadership, men, women, elderly and marginalised, youth (male) and youth (female). The priorities for each group are outlined on pages 4 and 5 of the community proYile.

It is difYicult to draw many conclusions from the data on Kalonga as the detail was scarce and also focus groups and P-‐Index topics did not always correlate for example there are no references to Yinancial resources as a discussion topic yet it is listed in both youth groups as a P-‐Index issue.

Some P-‐Index issues raised in Kalonga need further exploration for example family planning was raised by both female groups yet was given a very low ranking in spite of the impact on their lives. This raises questions about whether P-‐Index can be used successfully as a tool with more sensitive cultural/sexual behaviour issues like this?

High priorities for the community as a whole are the drug shortages at the health centre, and food insecurity. While water is a priority for the elderly, some other groups did not mention it as a priority at all (male youth and women) and men gave it a negative priority. Other priorities varied from group to group with Einancial resources highlighted by both youth groups, poor housing by women and the elderly and transport was another issue highlighted by women.

0" 2" 4" 6" 8" 10"Priority'value''

Issue'raised

'in'FGD

'

Priority'areas'for'leadership'in'Kalonga'Village''

Bicycle'ambulance'

Shortage'of'drugs'

Hygiene'

Health'care'

Toilets'

Borehole'contribu8ons'

92' 0' 2' 4' 6' 8' 10'Priority'Value'

Issues'ra

ised

'in'FGD'

Priority'areas'for'men'in'Kalonga'Village''

Food$insecurity$

Transport$

Shortage$of$drug$

Poor$housing$

Family$planning$methods$

82$ 0$ 2$ 4$ 6$ 8$ 10$Priority'value''

Issues'ra

ised

'in'FGD'

Priority'Areas'for'Women'in'Kalonga'Village'


5

Leaders did not give any issue a high ranking, but food security and latrines were ranked 7.5 and 7 respectively. This would seem to imply it could be difYicult to motivate this group.

Men did not give any issues a high ranking (like the leaders). Their top priority was the distance to the health centre and drug shortage (both 5.5). This is in contrast to the women’s group who gave high priority to drug shortages at the health centre (9), food insecurity (9), poor transport and roads (9) and poor housing (8). 0" 1" 2" 3" 4" 5" 6" 7" 8" 9" 10"

Priority'Value''

Issues'ra

ised

'in'FGD

s'

Priority'Areas'for'Marginalised'Groups'in'Kalonga'Village'

0" 2" 4" 6" 8" 10"Priority'Areas'

Issues'ra

ised

'in'FGD

s'

Priority'Areas'for'Youth'(Male)'in'Kalonga'Villlage''

0" 2" 4" 6" 8" 10"Priority'value'

Issues'ra

ised

'in'FGD

s'

Priority'Areas'for'Youth'(Female)'in'Kalonga'Village'Meanwhile the elderly and marginalized were keen to emphasise several high priorities including: food insecurity, water and housing healthcare in that order of importance.

Priorities for male youths was the lack of Yinancial resources and food insecurity (again only ranking 8 and 7 respectively), female youth also only had a couple of high priority issues include drug shortage and Yinancial resources.


6

Community Index and Social Capital

A further assessment of the main social determinants of health was made to assess current levels of satisfaction for 14 key components. The outcomes of these are outlined in Pages 6 and 7. In Kalonga the picture varied considerably from group to group. Food security was the recurring area of least satisfaction for all groups except for male youth, while water, healthcare and income also received very low satisfaction rankings from several groups. In terms of determinants they were satisYied with, recreation scored highly with all but the male youth group and sanitation also ranked highly with leaders, women and male youth. Unlike in many other communities several groups (leaders and male youth) were dissatisYied with religion.

In addition to the challenges, community groups were also asked key questions to determine their current level of social capital and community bonding. These are integral to achieving sustainable success to any development initiatives SCHI seeks to implement. In Kalonga social capital levels much like other C-‐Index responses varied from group to group only the elderly had consistently good social capital. There was a sense that the ability to rely on the wider community was lacking among leaders, men and female youth, although women and elderly groups disagreed with this view. InYluence on local decision-‐making was also lacking for male youth, women and even the leadership.

Interpreting the C Values Each group within the village was asked to define how satisfied they are with the key elements of daily life. These are outlined on the graphs (left) with the responses marked by the blue line. The lower the value for the issue (i.e. the nearer to the perimeter of the circle) the less satisfied the respondents were with that area of their lives, and vice versa. The orange circle defines how well bonded the group are in terms of working together, feeling part of the community and feeling empowered. Again the closer the circle is to the middle of the graph, the stronger the bond is within the group.

0"1"2"3"4"5"6"7"8"9"

10"11"

Housing"

Health"care"

Sanita;on"

Water"

Food"

Energy"

Income"

Educa;on"

Religion"

Environment"

Welfare"

Transport"

Safety"

Recrea;on"

Kalonga'Village'Leadership'

C"value"

Bonding"

0"1"2"3"4"5"6"7"8"9"

10"11"

Housing"

Health"care"

Sanita;on"

Water"

Food"

Energy"

Income"

Educa;on"

Religion"

Environment"

Welfare"

Transport"

Safety"

Recrea;on"

Kalonga'Village'Men'Group''

C"value"

Bonding""

0"1"2"3"4"5"6"7"8"9"10"11"

Housing"

Health"care"

Sanita;on"

Water"

Food"

Energy"

Income"

Educa;on"

Religion"

Environment"

Welfare"

Transport"

Safety"

Recrea;on"

Kalonga'Village'Women'Group'

C"value"


7

When assessing the levels of satisfaction in the key social determinants of health, and evaluating the level of community bonding, the community members highlighted the following:

The leadership was satisYied with areas including education, welfare, recreation and sanitation, while highlighting religion, food, safety and water as areas of concern. As a group the level of social capital was average however with little reliance on the community as a whole and the leaders had a surprisingly low sense of inYluence over local decisions.

The elderly and marginalized group highlighted several areas of satisfaction including religion, environment, welfare and recreation but at the other end of the spectrum water, food, income, education and safety were all areas of deep dissatisfaction. Levels of social capital were high among the group including their inYluence over local decisions.

The men ranked most determinants with average to low scores their highest satisfaction scores for housing, healthcare and safety while food, water, energy and environment were highlighted as areas of concern. Their sense of bonding was low especially their sense of reliance on other community members. Women overlapped with their concern about food but were satisYied with water provision unlike men (which needs further explanation as water provision is lacking in the village). They also had opposing views on housing and healthcare that were both areas of concern for women.

Female youth reported healthcare, food, energy, income and education as key areas of concern while housing, recreation and religion were areas of satisfaction. Their areas of concern overlapped with male youth on healthcare and income but in the main they had diverse opinions. Male youth also highlighted religion, welfare and recreation. Both groups had above average social capital (the best in the village after the elderly) however while male youth felt they lacked inYluence over local decisions female youth highlighted their lack of reliance on the wider community.

All data collected in Kalonga during Windshield Survey in November 2013, and Focus group discussions and Schutte scale data collection in February 2014.

0"1"2"3"4"5"6"7"8"9"10"11"

Housing"

Health"care"

Sanita;on"

Water"

Food"

Energy"

Income"

Educa;on"

Religion"

Environment"

Welfare"

Transport"

Safety"

Recrea;on"

Kalonga'Group'Elderly/Marginalised'Group'

C"value"

0"1"2"3"4"5"6"7"8"9"

10"11"

Housing"

Health"care"

Sanita;on"

Water"

Food"

Energy"

Income"

Educa;on"

Religion"

Environment"

Welfare"

Transport"

Safety"

Recrea;on"

Kalonga'Village'Youth'(male)'Group''

C"value"

Bonding""

0"1"2"3"4"5"6"7"8"9"10"11"

Housing"

Health"care"

Sanita;on"

Water"

Food"

Energy"

Income"

Educa;on"

Religion"

Environment"

Welfare"

Transport"

Safety"

Recrea;on"

Kalonga'Village'Youth'(female)'

C"value"

Bonding""

Documents

The Scotland Chikhwawa Health Initiative a collaborative ...The Scotland Chikhwawa Health Initiative a collaborative project between the University of Strathclyde, Ministry of Health