Access and Barriers to Health Care Services in rural Malawi

Abstract

Background: In its Vision 2020, the Malawi Sustainable Development Network Programme (SDNP) acknowledges that lacking access to quality health care services is one of the most serious problems of Malawi's health sector. In order to achieve better health, SDNP aims to provide comprehensive access to health care services at each level of the delivery system. Identifying barriers and facilitators, which influence sick people's decision-making processes for seeking health care, can be a first step to improve access to these services. On that basis, also the health status of a population can be tackled. One rural area that struggles with the provision of access to health care is the district Phalombe in Malawi's Southern Region. Due to limited services and a high burden of disease, the access and use of the health care system seem to be a big issue in the rural district Phalombe. <br /> Objectives: When falling ill and deciding to seek health care, people in settings like Phalombe can face hardships regarding access to health care services. In order to overcome these hardships, this study aimed to reveal the patients' level of information regarding health care service provision in their district. Furthermore, this study shall create an understanding of vulnerabilities, perceived access, and barriers to health care services in rural regions in Malawi. Strategies and enabling factors for the visit of the facility are under investigation. <br /> Methodology: Empirical research was carried out by applying a mixed-methods approach in order to examine the degree of access, patients' perceptions, and health-seeking behaviour. Quantitative research: Questionnaire-based interviews were carried out among patients and accompanying people of the district's only hospital. The study population consisted of 75 participants that were selected by random sampling. Qualitative research: To gain a better understanding of the population's health seeking behaviour, focus group discussions (FGD) were conducted in three villages of Phalombe district. Two semi-structured interviews with health care workers and an FGD with the hospital's management provided insight from the point of view of health care professionals. <br /> Results: Severe hardships regarding the dimensions awareness, spatial accessibility, affordability, availability, accommodation, and acceptability were revealed. Cultural misbeliefs and lacking awareness regarding the individual's health status, prevented people to seek health care services. Communities faced barriers to access health care services within formal facilities due to long distances to facilities, lacking means of transport, and high cost for transport and consultation. Poor patient-provider interactions and lacking resources within facilities, including staff, drugs, equipment, and services, limited the trust in competencies of formal facilities. <br /> Discussion and Conclusions: In order to tackle identified barriers of accessing health care services within Phalombe, people's vulnerabilities and gaps of the supply-side need to be addressed. Interventions, which were found to be helpful to diminish various hardships, include community-based programs, a reformed management of health personnel, an ensured readiness of resources, and defined standards for referrals and emergencies. However, overcoming access-related gaps within the health care sector is a complex issue as many of the supply-side gaps are rooted in the limited economic development of the districts and the country. Managing these access-related hardships in rural Malawi, requires economic empowerment, increased international involvement, and higher budget allocation for the health care sector.