Millions left without professional nursing-midwifery care

Community health nurse-midwives (CHNMs) have long been the backbone of primary healthcare in Malawi. But their dwindling numbers over the past two decades have quietly weakened service delivery, leaving thousands without consistent and nearby professional nursing and midwifery care. Interviews with stakeholders and analysis of available data show that many rural communities increasingly feel abandoned as nurse-midwives disappear from the frontline of community healthcare, often redeployed to fill staffing gaps in already understaffed public health facilities.

As their presence declines, health surveillance assistants (HSAs) are being forced to shoulder heavier responsibilities—often beyond their training—and frequently with limited supervision. However, public health data indicates that Malawi has faced a chronic shortage of nurse-midwives for more than two decades, with the crisis becoming particularly acute in the early 2000s. Paramount Chief Kawinga of Machinga says the shortage is already affecting rural communities.

“The shortage of community nurses has become a big challenge. Previously, they played a pivotal role in primary healthcare by managing chronic conditions and bringing nursing and midwifery services closer to villagers,” he said in an interview on Wednesday. He noted that communities now receive fewer home visits, limited follow-up care and delayed referrals, steadily weakening the country’s primary healthcare system.

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“Everyday we are losing people because community nurses are no longer readily available as the primary point of contact for timely healthcare. Their role in bridging the gap between villagers and the formal health system has been eroded and government needs to reflect on this,” he said. Because of the shortage, many rural residents are forced to travel long distances to access healthcare services that previously would have been available closer to home through outreach activities.

Ministry of Health spokesperson Adrian Chikumbe confirmed that the country faces a critical shortage of CHNMs, most of whom are currently stationed at district facilities rather than within communities. He said Malawi currently has only 344 CHNMs serving a population of about 19 million people—equivalent to roughly one nurse-midwife for more than 55 000 people. This figure is far above the recommended ratio of one nurse-midwife for every 5 000 people.

“It is clear that the health system has gaps in responding to community health needs, forcing many people to travel long distances to access services,” Chikumbe said. He added that although there has been no policy shift away from community-based care, the limited number of CHNMs has forced the health system to concentrate them at district level.

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