Health care in Malawi faces many challenges. A free national hotline is helping address one of them.

A Chipatala Cha Pa Foni hotline worker giving health care advice in Malawi. Credit: Abdullah Sayidi.

It is mid-morning in Area 23, a busy township in Malawi’s capital Lilongwe, and the sun is already scorching. For Chikondi Juma, 42, the dry season brings back memories of the serious tummy pains she had during her pregnancy this time in 2020.

“The condition was unbearable, and I did not know what the problem was,” she recalls. “My husband had gone to work. When my neighbour learned of my condition, she called a toll-free hotline for help.”

The sympathetic health worker on the other end of the line advised her neighbour to quickly escort Juma to the nearest hospital for further assistance. While at the hospital, it was discovered that Juma, who was four months pregnant, had contracted a urinary tract infection. If left untreated, this could have developed into a serious kidney infection. But fortunately, Juma was treated with antibiotics. In five days, she was back on her feet.

“I’m glad she made that call because without doing that, I would have just suffered the tummy pains in silence,” says Juma, with her son, now two years old, sitting jovially on her lap.

Juma is one of thousands of women in Malawi to have benefited from the toll-free hotline known popularly in Chichewa as Chipatala Cha Pa Foni (CCPF). This “health centre by phone” service gives free health advice to pregnant women and parents of young children across the country. It also sends families text or voice messages with tips and reminders tailored to the week of pregnancy or a child’s age.

The idea was conceived in 2011 by VillageReach, Concern Worldwide, and Malawi’s Health Ministry. Malawi has high rates of maternal – estimated at 439 deaths per 100,000 live births – partly due to the limited availability of timely and reliable health information and services. As Abdullah Sayidi, the CCPF supervisor at the call centre, explains, the programme was largely designed around two problems. “Expectant mothers were having maternal complications because they lacked interface with health workers,” he says. “Secondly, there were instances where the women could not remember that they were due for antenatal visits.”

CCPF began in one district as a pilot. Today, the free hotline is available countrywide and fully operated by the Health Ministry.

Faith Chilima, 23, lives in the remote village of Makupete, in Zomba district. Like many in Malawi, travelling to the nearest hospital 6 km away would be costly for her, and she would likely face long queues once she got there. But Chilima could skip these stresses when she was pregnant. “I did it all on a phone call,” she says.  “For instance, I used to get nutrition tips. They advised me to follow all the six food groups.”

One health intervention but more needed

Situated in Lilongwe, CCPF’s call centre is staffed with 22 trained health workers. They respond to inquiries, keeping the phone lines open 24 hours a day. Florence Banda, one of those workers, believes the initiative is playing a crucial role in making sure that expectant women and mothers are equipped with essential information.

“We educate them about how to spot danger signs early,” she says. “Apart from that, we provide them with nutrition tips that they are supposed to follow during their pregnancy so that they stay healthy and deliver a healthy baby as well. Similarly, for mothers that have just given birth, we provide them with breastfeeding advice.”

A 2018 survey found that 75% of pregnant CCPF users started antenatal care during the first trimester compared to 49% of non-users. CCFP users also started breastfeeding earlier on average, while 61% of callers had knowledge of their delivery date compared to 46% of non-callers.

CCFP’s impacts are not only limited to women. Men are also encouraged to participate in their families’ health.

“I heard of Chipatala Cha Pa Foni, but at first, I did not take it seriously at all,” says Happy Komintha, a father who called the hotline when his wife was pregnant. “That all changed when I saw how helpful this service was. For instance, we could get messages on when to go for antenatal care.”

Dorothy Ngoma, a health expert on maternal health and former president of the National Organisation of Nurses and Midwives of Malawi, says that hotlines can be one way to reduce maternal and neonatal mortality rates. “Chipatala Cha Pa Foni is a great idea because travelling is very expensive and sometimes there could be a crisis and women may need someone to direct them on what they can do,” she says.

Ngoma emphasises, however, that addressing high maternal mortality requires a wide range of interventions and cautions that not everyone has a phone. Another problem faced by CCPF is network problems, which can lead to calls being cut short. Demand for the hotline has also overtaken the capacity of the call centre. This issue became particularly severe at the onset of the Covid-19 pandemic as CCPF was seen as a rare, trusted source of information. The hotline expanded to offer advice on Covid, as it had regarding other issues such as sexual and reproductive health and malaria. “We saw an average of 400 calls in a day to over 20,000,” says supervisor Sayidi.

He explains that the team has had to adapt to this rise in demand. “We have created an automated recording which addresses frequently asked questions so users do not have to make a call but just listen to the audio,” he says.

Looking ahead, Sayidi says that the programme wants to develop new dimensions too. He is optimistic that soon, for instance, CCPF will be able to dispatch ambulances from the nearest health facility to where the caller is if necessary.

“That’s the direction we are heading to,” he says. “We do not want to leave anyone behind.”