Coping with ill-health while lacking access to health care: Acceptability of health service provision in rural Malawi – a qualitative study

ABSTRACT

Background

Large parts of Malawi`s population lack access to health care. A high burden of disease, chronic poverty, and a growing population accelerate the need for extending and improving health care. One region that is struggling with service provision is Malawi´s rural district Phalombe. In addition to adequate resources, acceptability of service provision and productive patient-provider engagements are crucial determinants of health-seeking behaviour.

Objective

This study aimed to better understand the interdependencies between acceptability, patient-provider engagement, and health-seeking behaviour in Phalombe. By targeting health care providers and community members, different perspectives were assessed and triangulated.

Methods

Following a qualitative approach, group interviews were conducted with community members of three rural villages (n = 21) in Phalombe. Semi-structured interviews (n = 2) and a group interview among management staff (n = 3) provided insight into experiences of health care providers.

Results

Community members perceived health care providers’ behaviour as disrespectful, resulting in power gaps between patients and providers. Providers blamed community members’ cultural beliefs and lack of awareness regarding health care as barriers to seek formal services. Systemic shortcomings diminished community members’ trust in service provision, while increasing frustration among providers and thus impacting patient-provider engagement. Due to insufficient resources, lack of acceptability and trust in receiving adequate services, potential patients turned into non-users of health care.

Conclusions

A patient-centred approach is needed that empowers communities by involving them in health care planning, in facility management, and by raising awareness towards health issues. Trainings for providers need to focus on improving communication and building trustful patient-provider interactions. Yet, without addressing systemic constraints, providers’ frustration and patients’ lack of trust in service provision will remain and impact their health-seeking behaviour. Thus, further budget needs to be allocated to Malawi’s health care sector in order to provide resources needed.

KEYWORDS:

• Health care system
• patient-provider engagement
• access and barriers to health care
• Sub-Saharan Africa
• SDG 3

Responsible Editor Maria Nilsson

Responsible Editor Maria Nilsson

Acknowledgments

The authors of this paper are grateful to all community members and service providers who shared their perspectives and experiences, and the support of the Holy Family Mission Hospital in Phalombe, Malawi. The views expressed in this paper represent the views of individuals interviewed and not necessarily the view of the hospital. The authors are thankful to Christoph Höser, University Hospital Bonn, Institute for Hygiene and Public Health, GeoHealth Centre, for developing the map of Malawi (Figure 1).

Author contributions

RR designed and initiated the study, led the collection of the qualitative data, the analysis, the writing, and the revisions of the manuscript. NN assisted in the data collection and analysis onsite and reviewed the manuscript. CA contributed to the design of the study, provided significant direction on the manuscript, reviewed, and revised the manuscript. TK supervised the research, contributed to the design of the study, provided significant direction on the manuscript, reviewed, and revised the manuscript. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics and consent

Ethical approval was obtained from the Ethics Committee of Bonn University (156/16) and the National Health Science Research Committee of Malawi (16/11/1687) prior to the onset of data collection. Informed consent on the process, purpose, aim, potential risks and expected benefits of the study was sought from potential participants. Participants were informed of participation being purely voluntary and made aware of their right to withdrawal from the study at any point of time. Anonymity and confidentiality were safeguarded.

Paper context

Few studies have been conducted to evaluate the level of acceptability towards health service provision in rural Malawi. Our research intends to contribute to a better understanding of acceptability, patient-provider engagement, and their effects on health-seeking behaviour by presenting perspectives of community members and health care providers in the Phalombe district. Findings suggest the need for a patient-centred approach, while addressing systemic constraints to enhance providers´ working environment and patients’ trust in service provision.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was self-funded by the corresponding author Regina Ritter.