Emmanuel Njikho, Project Officer for Temwa’s health programme, recently took time out of his busy day to speak to the Temwa UK team on the excellent progress of the Malawi team. Emmanuel leads our Water, Sanitation and Hygiene (WASH) and HIV projects, helping people in Nkhata Bay North gain access to clean water, sanitation facilities and hygiene education as well as HIV testing and support for HIV – the latter having a crucial positive impact on the local HIV prevalence rate.
The current situation in Nkhata Bay North
Sixty percent of people in Nkhata Bay North contract waterborne diseases every year due to a lack of basic facilities, healthcare, and public health education. Access to safe water and sanitation are fundamental human rights, the lack of which negatively impacts a community’s health, education, and economic prospects. But since our WASH project began in 2017, Temwa has seen an amazing 80% reduction in instances of waterborne diseases in the targeted villages.
And our HIV support project is also showing great results. Malawi has one of the worst prevalence rates in the world, with 8% of the population diagnosed as HIV positive. The prevalence rate is even higher in Nkhata Bay North, now at 13%. The region’s isolated location, stigma, and again a lack of education and healthcare services all contribute to this. But since beginning our project Temwa has seen increased awareness and a 70% drop in test refusals. This is having a positive effect on the prevalence rate, which has gone down by 3% since our project began.
Emmanuel answered some key questions the UK team had for him and told us in more detail how Temwa is making these positive changes happen.
Why do you like working for Temwa?
Emmanuel: “Temwa is more than just work. I like engaging with the community every day and learning from people. Temwa’s given me a platform where I can work in a hands-on environment, meeting new people, interacting, and generating ideas.”
What do you think are the most impactful activities Temwa carries out?
Emmanuel: “Implementing HIV Outreach Clinics has been one of the hugely important activities. Due to difficult transportation in the area, people are easily isolated from healthcare services. So we have helped take healthcare facilities to people, and this increases the number of people that are tested for HIV.
“The outreach clinics also provide other screening and treatment services such as Tuberculosis, cervical screening, and STIs. This has brought a massive improvement in local healthcare and has helped reduce HIV rates. We have also started weekend clinics and this has been hugely influential, as people who are working during the week can still access needed healthcare. People feel less stigma as they are quieter during the weekend and this gives people an opportunity to test without shame”.
How does the community feel about Temwa’s presence in Malawi?
Emmanuel: “We do not have many organisations that are working with people in Nkhata Bay North, and they most likely go there once or twice a month or a quarter. We are the only organisation that works there full time.
“Temwa’s community-driven approach has also helped create a strong bond between us and community members. Community members have a voice in deciding what activities are done and how. They own the projects fully and are engaged at every stage, because change is driven by the community and we are there to support”.
How has the WASH project helped communities in Nkhata Bay North?
Emmanuel: “The communities we work in often do not have access to clean drinking water. In the two villages where we are currently working in Ruarwe, the only water available is Lake Malawi, which is not clean. And there are no water treatment methods available there.
“In Ruarwe we delivered a water filter for every household in each village. This significantly increased the number of households with access to clean water and it is hugely appreciated. This is leading to reductions in waterborne diseases, so this positive change has been noticed by surrounding villages and has led more people to ask Temwa for support.”
Why does Malawi have such a high HIV prevalence rate in comparison to other African countries?
Malawi has one of the highest HIV rates in the world with 8% of the population living with HIV. For context the UK’s HIV prevalence rate is 0.1% (UK Health and Security Agency, 2020).
Jo Hook: “In the 1980s when HIV became highly prevalent, there was a large push in some countries to pursue safe sex. Many countries on the African continent tried to encourage safe sex practices too, but Malawi’s response was slow due to economic resources. And HIV had already taken hold by the time Malawi’s big campaigns finally started. The situation is improving, but this is a slow process as HIV had already become so prevalent among the population.”
In Nkhata Bay North, HIV prevalence is even higher than nationally in Malawi. Why is that, and how can we help to improve this?
Nationally, HIV prevalence has now come down from 14 to 8% in Malawi. In Nkhata Bay North, the prevalence rate recently reduced from 16% to 13%, but it is still very high and affects almost every family. The challenge is persisting due to high levels of poverty and isolation. Emmanuel describes some of the challenges and solutions in more detail:
Emmanuel: “Lake Malawi is an important financial resource for people. This means people are aware that men fishing will have money to spend. Also, there are large farms in the upland areas of Nkhata Bay North, with young people making good money. Some women end up doing sex work to sustain their families, which is a situation that is massively impacted by low household incomes. Young men also prefer unprotected sex and so HIV continues spreading.
“On top of this, HIV is largely passed on through mothers who are HIV-positive and not receiving antiretroviral treatment. The chances of children surviving who are born with HIV are small.
“Temwa could support more income-generating activities through our current Livelihoods project. This gives people alternative, sustainable income sources. The District Health Office has also recommended contact tracing. Temwa has already reached out and helped trace a number of people most likely to be impacted. But we also need to work with healthcare providers and trace the contacts of people who have tested positive for HIV.
“Young people are at the highest risk of contracting HIV. So children and youth are a key group to educate before they become sexually active. Working with young people and providing sexual health education are vital to creating behavioural change. Availability of treatment and provision of youth-friendly services are also really important.”
How have attitudes towards HIV changed in recent years as a result of Temwa’s work? Are people talking more openly about HIV?
Emmanuel: “HIV support groups that Temwa used to run for HIV-positive teens and adults created a safe space where people could speak about their HIV status. So, when we are conducting activities, people are now more open about talking about their status.
“Our projects are helping to combat the prejudice of living with HIV. Numbers of new infections are going down and people are really grasping the knowledge. So we are hoping to work towards and create an HIV-free generation.”
How have national food shortages impacted people taking HIV medication?
In the past, it has been reported that people on antiretroviral treatments need to eat regularly to take their medication. How is the current food crisis affecting them?
Emmanuel: “This is definitely something of concern and will become an even bigger challenge nearer to the harvest. Having access to food is really, very crucial for people living with HIV.”