Promoting Health and Agricultural Resilience while Caring for Expectant Mothers


By Joni Waldron, Palladium  | Jan. 9, 2019


                     
Malawi Snapshot
 Population: 18.6 million

Maternal mortality: 634 (per 100,000 live births)

GDP per capita (purchasing power parity): $1,200

Households dependent on agriculture: 83%

Households with inadequate food: 63%

Stunting in children ages 0-5: 37%

Expectant mothers and their caretakers eat a meal prepared from vegetables grown in the gardens surrounding the Area 25 Health Centre    


Two months ago, Lines Forstela arrived at the Area 25 Health Centre in Lilongwe with her daughter Ethelida, who was sick and seven months pregnant. Lines was worried about her daughter and her unborn baby and brought her daughter to stay at the center’s maternity shelter, where expectant mothers can stay close to doctors and emergency facilities. Most days, 15 to 30 expectant women, along with their caregivers and young children, can be found at the maternity shelter. Some, like Ethelida, come weeks or months before their due date because of complications in their pregnancy. Others arrive only days before as a precaution against challenges with traffic and transportation that can quickly become fatal if birth becomes complicated. 

For Ethelida and other women across Malawi, increasing dietary diversity can improve their chances of a safe delivery and a healthy baby. However, many Malawians do not have reliable access to nutritious food, with 63% of households in Malawi reporting inadequate food resources, and 37% of children under five stunted as a result. 
The Feed the Future Malawi Ag Diversification Activity (AgDiv), implemented for USAID by Palladium, is working to address poor nutrition, raise farmer incomes, and improve agricultural resilience across eight districts of Malawi. The Area 25 Health Centre, which serves as a referral clinic for more than 2 million people, provides an opportunity for AgDiv to demonstrate the technologies and approaches that have already helped 57,000 people in the eight districts covered by AgDiv to increase the quantity and diversity of food they produce, and in doing so become more agriculturally and economically resilient.

In addition to regular checkups with the doctor, Ethelida and Lines joined other expectant mothers and caregivers in training at the maternity shelter to learn about nutrition and agricultural practices, which they can apply in their own homes through a new partnership with AgDiv. “Since we came here, we learned that there are foods other than nsima [the traditional staple food made from maize] that we can eat,” says Lines. 

Promoting Innovation
Recognizing that training alone would not be enough to move Malawi from chronic food insecurity to growth, AgDiv has coupled traditional training on nutrition and agricultural practices alongside promotion of technological solutions. Since its start in 2016, AgDiv has cultivated strategic relationships and working coalitions with a variety of stakeholders, with an emphasis on private sector partners, to build awareness and promote use of proven technologies, while simultaneously strengthening supply chains to increase access for the average smallholder farmer. 

The Area 25 Health Centre is just one of AgDiv’s collaborations, under which AgDiv has been working with the government-operated clinic, staff from the Baylor College of Medicine, and private sector agri-inputs company Farmer’s World since June 2018. Together they have transformed the maternity shelter into a center of excellence to show how improving agricultural technology can boost yields and ultimately lead to greater resilience for households and communities. 

AgDiv has helped the health facility introduce new agro-technologies to its four acres of land; the gardens there serve as both a farm for the health facility and as demonstration plots. The technologies introduced include drip irrigation to improve farm resilience to drought as well as enable successful farming of nutritious foods such as soybeans and vitamin A-rich, orange-fleshed sweet potato; soy kits to produce soy milk to increase protein for children and pregnant women; and bamboo seedlings that can both help manage wastewater and soil erosion and provide a source of fuel. 

The shelter uses the fruits and vegetables grown in the Area 25 gardens to provide nutritious meals for the expectant mothers and their caregivers. Staff use a soy kit introduced by AgDiv to produce soy milk for residents and staff three times a week. As soy production from the gardens increases with the addition of drip irrigation, the facility expects to use soybeans grown in the gardens for soy milk production. 

Area 25 Health Centre patients and visitors gain much from their newly acquired knowledge. “In the village, they think the only place they can have a garden is near dams or streams,” explains Gabriel. “But when they come here [and see the drip irrigation], they realize that they can produce food in their own backyards. They are always asking us how can I do this when I go home? Where can I purchase a drip kit? We give them cuttings and seeds so that they can start their own gardens when they go home.” As a result of AgDiv’s support on the supply side, small-scale drip irrigation solutions for backyard gardens ($8 per kit) are available for the first time in Malawi.


   
Staff and expectant mothers at the Area 25 Health Centre in Lilongwe demonstrate their improved knowledge of household gardening for nutritious, year-round meals. A young girl staying with her mother at the Area 25 Health Centre maternity shelter tries soy milk for the first time.  Maggie Mzungu, AgDiv nutrition lead, conducts training on soy milk production for staff and patients at the Area 25 Health Centre. 


Transferring Knowledge
After receiving training from AgDiv staff on backyard garden designs (incorporating crops such as vetiver and lemongrass for soil and water conservation), soy milk production, mini-backyard irrigation and bamboo production, the staff of the maternity shelter is now conducting training twice a week for residents and caregivers. 

Gabriel Kalwuasha has worked at the Area 25 Health Centre for the past five years as the garden supervisor. Since the AgDiv activity began, he has been impressed by the interest from the women at the maternity shelter in learning more about the methods that the health clinic is promoting, “Patients are very happy when they come here,” notes Gabriel. “Many do not have access to good food where they are coming from, and they are happy to have the opportunity to learn how to produce it for themselves.”

Lines is preparing to go home with new ideas: “We have learned how to make a nice garden at home, and we are trying new foods and learning how to cook them for ourselves.” 

Yet the most important outcome of Lines and Ethelida’s stay at the maternity shelter is the effect it has had on Ethelida. “When we came here, my daughter was sick,” says Lines. “But with good food she has become strong. I am happy because the babies here are also becoming strong.” Lines grins. She has reason to be happy – her grandson Samson was born yesterday, and he and his mother are both healthy. 

Joni Waldron is a senior associate at Palladium, a global impact firm (thepalladiumgroup.com). 
 
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