Healthcare service user-reported quality of care in Malawi: a national multifacility cross-sectional study
Joseph H Collins, Wiktoria Tafesse, Precious Chitsulo, Timothy B Hallett, Eva Janoušková, Joseph Mfutso-Bengo, Emmanuel Mnjowe, Sakshi Mohan, Watipaso Mulwafu, Victor Mwapasa, Dominic Nkhoma, Bingling She, Mariana Suarez, Tim ColbournObjective
Improving healthcare service user-reported quality of care is one of the three core objectives of the Malawian government’s health sector strategic plan. As such, a robust understanding of service user-reported quality is crucial to inform the development of patient-centred services. This study aimed to explore how service users in Malawi evaluate the quality of the healthcare they receive across services and facilities and to investigate the association between individual and health service characteristics and reported quality of care.
Design
A national multifacility cross-sectional study using service user exit interview data in which all central hospitals were sampled and remaining facilities were selected via random stratified sampling. Participants were recruited via random selection based on daily patient load within sampled facilities. Descriptive statistics of service user-reported quality of care were estimated in addition to multinomial logistic regression analyses used to determine the association between patient and healthcare characteristics and perceived care quality.
Setting(s)
30 health facilities across 15 districts in Malawi.
Participants
4181 respondents surveyed after completing their visit and exiting healthcare facilities between January and May 2024.
Primary outcome measures
Overall service user-reported quality of care for the facility visit as a categorical variable. This was derived from the Likert scale survey statement assessing ‘overall’ quality of the participant’s visit, with three responses: ‘very good’, ‘good’, ‘neutral–very bad’.
Results
Quality of care was reported as being high with 58% of respondents rating care as ‘good’ and 35% as ‘very good’, with some variation by ‘dimension’ of care (eg, treatment availability). Positive or negative perceptions of care quality were associated with age, sex, education level, illness severity, previously seeking care, referral, facility type, non-governmental facility ownership, service area, access to medication and payment of fees.
Conclusions
Most healthcare service users in Malawi report receiving high-quality care, although a minority report the quality to be inadequate. Action to address gaps in service delivery, such as improving the availability of required medicines, could address the poor perceptions of quality held by the minority of interviewed service users.