Our health systems strengthening programme in Malawi piloted an innovative scheme which gave community-based health groups small grants to be spent on things that they felt were most needed at their health centres. This initiative, known as Health Centre Improvement Grants (HCIG) has enabled these groups to make direct improvements to health facilities.
The UKAid-funded Malawi Health Sector Programme – Technical Assistance component (MHSP-TA) has been working since 2016 to strengthen accountability in Malawi’s health sector, with a focus at community level. We collaborated with Health Centre Advisory Committees (HCACs), made up of community members and health centre officers, to strengthen their capacity through training and mentoring. By including nurses and health workers from the local health team, the HCACs have been able to increase community participation in the activities of health centres.
Following this training, MHSP-TA piloted the six-month HCIG initiative, which gave HCACs small grants of MK 500,000 (GBP 500) to be spent on improvements that the community felt were most needed at their health centres, such as toilets and bathrooms for maternity units.
From December 2017, three HCACs in Mwanza were trained on HCIG guidelines and developed budgets based on the community’s priorities. By June 2018, most of the grants had been spent acquiring equipment and building facilities which had long been requested from the District Health Office. These included building an access ramp to the Outpatients Department for people with disabilities, and purchasing much-needed medical equipment and supplies.
The HCIG pilot demonstrated that when community members play a leading role in the management of health centres, they are able to prioritise how funds are used and achieve results. Projects were completed within one-and-a-half months of receiving the grant; far quicker than the usual process of going through the local authority. They also achieved better value for money and high standard construction. HCACs had direct control over contractors and negotiated prices. Budgets and financial reports were posted on notice boards, strengthening accountability and transparency at the community level.
Community empowerment and ownership of health centres
HCAC mentoring, complemented by the HCIGs, has led to community empowerment and ownership of their health centres. “MHSP-TA advisors have been so valuable in guiding and mentoring us,” says Enock Mwangalika, Chair of the Thambani HCAC in Mwanza district. “Before, we didn’t know our responsibilities. Now we know that the health centre is ours and it is the duty of community members to be involved. We have brought sand and rocks from the riverbanks to repair and improve our health centre. We have monitored drugs and instilled trust in health centre staff, leading to better relationships between them and the community.”
“Indeed, HCACs are the bridge between the community – the heart of local development - and the health centre,” said George Munthali another HCAC Chair. “In togetherness, there is great power. Together, we have managed to advocate for funds from well-wishers, that were used to build toilets. We have also successfully lobbied for a water pump, electricity supplies and other resources. I am so proud of my involvement in the HCAC and having been elected by the community.”
Quantifying the social return on investment and scaling up investment in HCACs
The MHSP-TA has established that investing in HCAC training presents a good return on investment. By conducting a study, the programme found that for every MK 1 invested by the HCAC pilot, a social value of MK 8.45 was created, meaning it took just four months for the benefits to exceed the investment.
Bright Sibale, Managing Director of the Centre for Development Management, explained what this means; “We are shedding the mindset that investing in building the capacity of community structures takes a long time. The HCAC and HCIG pilots has shown that in just two years, we can effect change.
“If we invest in HCACs, there will be a lot of capacity within community structures to mobilise resources,” Sibale continues. “In the long term, this could mean reducing the need for government budget or reprioritising government funds.”
So, what next? Sibale believes that the Ministry of Health and Population (MOHP) should scale up efforts to support HCACs. “The Government could include HCAC training in the national budget so that District Councils are mandated to support these HCACs directly with public finances. Once we do that, the benefits will be more than what the budget has provided for in the long term.”
As the MHSP-TA programme comes to an end, part of the programme’s legacy will be the firm position HCACs now hold as a key component of community health. Wina Sangala, MHSP-TA Deputy Team Leader, remarked how before, HCACs did not have an institutional home. “Now,” Sangala says, “HCACs are under the supervision of the Community Health Services Section within the Directorate of Preventive Health Services and are clearly articulated in the MOHP’s Community Health Strategy. This will hopefully build more momentum to make HCACs more effective and further utilise the tools and guidelines that the programme has developed, in partnership with the Ministry of Health and Population.”