Safety and dignity in Malawi’s maternity wards remain a tall order. At many public health facilities, mothers and newborns are welcomed not by clean water and safe toilets, but by blocked systems, dry taps, and prolonged stock-outs of basic supplies. The result is predictable yet preventable: women giving birth in unsafe conditions, frontline healthcare workers struggling without gloves or soap, and communities quietly accepting that broken systems cannot be fixed.
To break this cycle, White Ribbon Alliance for Safe Motherhood Malawi (WRASM) and WaterAid Malawi (WAMA), in a landmark partnership, have joined forces to spearhead the Women’s Health Campaign in Malawi. The campaign aims to empower women and frontline healthcare workers to voice their rights to clean, safe, and dignified healthcare environments. At its core, it seeks to shift the conversation from “needs” to “entitlements,” placing women’s voices and lived experiences at the center of solutions.
WRASM ED, Margaret Loma Phiri (L) & WaterAid CD, Peter Phiri during MoU signing
The partnership started the journey, on 5 February, 2025, by convening a high-level consultative meeting, bringing together officials from the Ministry of Health and the Ministry of Water and Sanitation. The session drew experts from reproductive health, nursing and midwifery, community services, and policy planning to shape the Women’s Health Campaign.
Speaking during the meeting, Deputy Director of Nursing and Midwifery Services, Emily Gama, described the campaign as a “game changer,” noting its potential to spotlight the challenges women and healthcare workers face in public health facilities and to make maternal and child health a national priority.
MOH & MOWS Entry meeting group photo: Emily sitting next to WRASM ED
The Approach
The campaign rolled, soon after the productive meeting, with listening sessions between February and March 2025, reaching 25 public healthcare facilities in Chitipa, Kasungu, Ntchisi, Mangochi, and Balaka. Over 820 women maternity facility users and frontline health workers including Nurses and Midwives, Hospital Attendants, Disease Control and Surveillance Assistants and Facility In-Charges. Using the approach “Ask, Listen and Act” three questions were asked and listened to: what is the current status of WASH at your facility, how does it affect you, and what can be done to improve it? The “Listened Voices” revealed sobering realities.
From the five districts visited during the listening sessions, a consistent picture emerged: unsafe or absent water systems, inadequate sanitation, shortages of basic supplies, and weak accountability mechanisms continue to compromise maternal and newborn care. Women spoke of walking long distances to fetch water [which is even from “unsafe” sources], of overcrowded and broken toilets, and of being denied dignity in delivery rooms without water or soap. Frontline health workers, too, described struggling to maintain hygiene without gloves, disinfectants or functioning waste systems.
Several facilities revealed that only one solar-powered tank was functional, woefully insufficient for the size and demand of large hospitals. And at this point, during prolonged outages, it is when women were forced to fetch water from distant community boreholes.
Demand by one of the community users from Chitipa during the listening sessions
A woman seeking maternal services in December 2024 at Khuwi Health Centre in Ntchisi recalled: “I found water from the first day to the third day… but on the fourth day there was no water since it was cloudy. It was even difficult to wash hands, and the toilets were not smart. We were using pit-latrines. Two patients even had stomach upsets since the environment was not smart.”
Demand by Hospital Attendant during the listening sessions
Frontline health workers echoed the frustration too. In one striking account, a nurse explained: “At one point in time when we had no water, we had to ask Hospital Attendants to fetch water from a nearby village so that we could clean a bed on which a woman had delivered. This delayed the next woman to deliver and we had to make her wait at the pre-natal ward. Such delays are not hygienic and underestimate the dignity of our clients.”
A woman at Nthondo Health Centre in Ntchisi testifying of availability of water due to earlier WaterAid interventions
Yet within these challenges, some facilities showed that improvement is possible when communities and partners invest in WASH. Building on this evidence, the Women’s Health Campaign will start with mobilising champions in Ntchisi, Kasungu and Mangochi, to serve as the springboard for the campaign’s advocacy and training efforts, before scaling up to other districts.
