GOAL On The Ground: Combating Covid-19 in Malawi

Malawi has recorded over 80 cases of Covid-19 and three deaths. (May 25^th 2020). GOAL’s Covid-19 response in Malawi, supported by Irish Aid, has focused on communicating the risks of the virus in the most vulnerable communities, and supporting the local authorities in their response. In addition, GOAL is monitoring food security and adapting its existing programmes to the new environment in which we operate.

The Challenges

Malawi has one of the weakest health systems in the world . It was one of the last countries to officially diagnose a case of Covid-19, with the first case reported on 2^nd April. Despite an early declaration of a state of disaster on 20^th March (before the confirmation of the first case), the situation regarding restrictions has been unclear. The Supreme Court overturned an early Government imposed lockdown on the basis of the potential negative economic repercussions, with the majority of the population lives from hand to mouth. Malawi is also in the midst of a Presidential election campaign, and on-going large political rallies are diluting public health messages about social distancing. On top of all this, Malawi recently experienced strikes by healthcare workers over the lack of Personal Protection Equipment (PPE), the effects of which are still being felt.

Malawi has considerable experience in dealing with infectious diseases. The country has one of the highest rates of HIV infection anywhere in the world with over 1 million people living with HIV. Over 9% of adults aged 15-49 have the disease. On top of this, Malawi regularly battles cholera outbreaks,  and in the past has prepared for possible outbreaks of Ebola. This experience, and our field teams remote risk communications campaigns, are the core of GOAL’s efforts to combat the spread of Covid-19 in Malawi.

GOAL’s COVID-19 actions in Malawi

Information Campaign

GOAL’s focus in Malawi is on providing information to vulnerable communities about COVID-19 infection prevention and control. In the absence of a vaccine, and with weak health infrastructure, the best defence against Covid-19 is informing the population of social distancing and encouraging improved.

GOAL has been communicating via mobile vans fitted with megaphones; poster campaigns; local radio and door to door conversations in densely populated areas of Blantyre city (where some of the first cases of COVID-19 were confirmed), as well as in Nsanje, Machinga and Chikwawa Districts. These messaging campaigns have so far reached over 165,000 people. In addition, we have worked with the local authorities to distribute over 2,500 Ministry of Health sanctioned posters.

Community Lead Action (CLA)

There is widespread scepticism in Malawi about the seriousness of COVID-19. As part of our Community-Led Action (CLA) approach, used with great effect to respond to the Ebola outbreak in West Africa in 2014, GOAL has been focusing on the most high-risk groups to stop the spread of the disease including market management committees, barbers, salons and other professions that see high volumes of people in close proximity. The CLA approach helps communities to understand the disease, and empowers them to take actions themselves to prevent the spread of the virus.

Joyce Kanyongolo, member of the Magoti Mothers’ Group in Nsanje District in Malawi.

GOAL is also working with the national government and local authorities to co-ordinate activities such as the distribution of personal protection equipment (PPE). GOAL has supported the Magoti Mothers Group in Nsanje District to expand it sewing circle to make reusable health masks. The group normally makes reusable sanitary pads for young girls, but now plan to make masks and sell in the local market.  300 mask will be purchased by GOAL. This enterprise will be an extra income stream for the women who are struggling to make ends meet.

Food Security

GOAL is monitoring nutrition needs in the areas in which we work. Thankfully, Malawi saw a good harvest this year and as 85% of people are subsistence farmers, hunger is not a priority concern in rural areas in the short term. However, there are fears that government restrictions and the subsequent slow down of the economy will affect the ability of the urban poor in particular to access  food. Many of these people live day to day in the informal economy and shop in markets. In the medium term, if the spread of the virus is not contained, it is also likely to have wider-spread socio-economic impacts in all parts of the country.

GOAL is also promoting the ‘family MUAC’ approach as a way of monitoring nutrition levels in children aged between 6 months and 5 years. This involves training community members (usually mothers) to use simple MUAC (Middle Upper Arm Circumference) tapes to check their children’s nutrition status on a regular basis, rather than waiting for medical screening. If the MUAC tape indicates the children are suffering from malnutrition, they are referred to a nutrition treatment centre. This is an approach we have been using before the start of the Covid-19 pandemic, but is particularly relevant during this protracted health crisis and is a valuable means of surveillance. So far, this has reached over 2,500 .

Effect of Covid-19 on GOAL operations

Although GOAL has obtained government permission to continue its operations in the event of a full lockdown, we have had to adapt our activities to protect our staff and the communities we serve. With inter-district travel limited and long-distance trips temporarily postponed, we rely more now than ever on our field teams who are already in location.

GOAL operations are normally centred in rural areas but as Covid-19 poses the greatest threat to densely populated urban areas, we have significantly scaled up  our presence in  Blantyre city, the country’s commercial capital, where a serious outbreak of the disease would have a devastating impact.

CASE STORY: COVID-19 response in Bangwe Market in Blantyre, Malawi

GOAL targeted 14 urban markets in Blantyre on COVID-19 awareness, partnering with Blantyre City Council with funding from Irish Aid.

Each market committee member was trained as a community mobiliser to lead on making their markets a safe place from COVID 19 transmission, using the Community-Led Action approach.

Bangwe Market, which has 550 vendors, was part of the programme with training conducted by GOAL. The market committee raised funds from its vendors to buy 68 tapped buckets, which were placed throughout the market including at the three main entrance gates. 

Blantyre Market Committee chairman and fish vendor, Mac Mussa, said placing the buckets in the market has had a big impact: “Buyers are now washing their hands before and after leaving Bangwe Market. This intervention has brought ownership and awareness to everyone on preventing the spread of the virus.”

Each market department has a chairperson whose responsibility is to ensure the hand washing facility functions properly and that soap and water are available at all times.

Vegetable department with hand washing facility

This activity has also prompted stall holders to  buy their own handwashing facilities, something which Blantyre City Council is especially pleased about.

According to Mac Mussa: “The CLA approach has really worked and helped to make the markets safe places. Without this approach people, would not have gained this knowledge. In total, the market has 82 hand washing stations, some provided b y the city council.”