Strengthening primary health care at district-level in Malawi - determining the coverage, costs and benefits of community-directed interventions

Makaula, Peter; Funsanani, Mathias; Mamba, Kondwani Chidzammbuyo; Musaya, Janelisa; Bloch, Paul

doi:10.1186/s12913-019-4341-5

Cited by 18 publications

(38 citation statements)

References 18 publications

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“…Engaging with patients and communities could serve as a strong multiplier in implementing these strategies for achieving UHC (19) and for establishing formal assessment approaches for health technologies. This expectation is corroborated through other examples with a proven impact of community engagement on the effectiveness of policy implementation (20–22).…”

Section: Discussionsupporting

confidence: 53%

Pilot approach to analyzing patient and citizen involvement in health technology assessment in four diverse low- and middle-income countries

Holtorf¹,

Mueller²,

Sousa

et al. 2021

Int J Technol Assess Health Care

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Background In low- and middle-income countries (LMICs) striving to achieve universal health coverage, the involvement of different stakeholders in formal or informal ways in health technology assessment (HTA) must be culturally and socially relevant and acceptable. Challenges may be different from those seen in high-income countries. In this article, we aimed to pilot a questionnaire for uncovering the context-related aspects of patient and citizen involvement (PCI) in LMICs, collecting experiences encountered with PCI, and identifying opportunities for patients and citizens toward contributing to local decision- and policy-making processes related to health technologies. Methods Through a collaborative, international multi-stakeholder initiative, a questionnaire was developed for describing each LMIC's healthcare system context and the emergence of opportunities for PCI relating to HTA. The questionnaire was piloted in the first set of countries (Brazil, Indonesia, Nigeria, and South Africa). Results The questionnaire was successfully applied across four diverse LMICs, which are at different stages of using HTA to inform decision making. Only in Brazil, formal ways of PCI have been defined. In the other countries, there is informal influence that is contingent upon the engagement level of patient and citizen advocacy groups (PCAGs), usually strongest in areas such as HIV/AIDS, TB, oncology, or rare diseases. Conclusions The questionnaire can be used to analyze the options for patients and citizens to participate in HTA or healthcare decision making. It will be rolled out to more LMICs to describe the requirements and opportunities for PCI in the context of LMICs and to identify possible routes and methodologies for devising a more systematic and formalized PCI in LMICs.

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Section: Discussionsupporting

confidence: 53%

Pilot approach to analyzing patient and citizen involvement in health technology assessment in four diverse low- and middle-income countries

Holtorf¹,

Mueller²,

Sousa

et al. 2021

Int J Technol Assess Health Care

View full text Add to dashboard Cite

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“…However, concerns have been raised (e.g. in academic and media outlets in 2019) about the predictability and sustainability of the health system, especially in its ability to finance and achieve its health objectives, including UHC [ 28 – 30 ]. For example, significant improvements in service delivery cannot be made whilst the staff vacancy rate for healthcare facilities remains very high (50%) and some communities are up to 35 km away from their nearest facility [ 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi

Masefield

Msosa

Grugel

2020

BMC Health Serv Res

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Background All countries face challenging decisions about healthcare coverage. Malawi has committed to achieving Universal Health Coverage (UHC) by 2030, the timeframe set out by the Sustainable Development Goals (SDGs). As in other low income countries, scarce resources stand in the way of more equitable health access and quality in Malawi. Its health sector is highly dependent on donor contributions, and recent poor governance of government-funded healthcare saw donors withdraw funding, limiting services and resources. The 2017 National Health Plan II and accompanying Health Strategic Plan II identify the importance of improved governance and strategies to achieve more effective cooperation with stakeholders. This study explores health sector stakeholders’ perceptions of the challenges to improving governance in Malawi’s national health system within the post-2017 context of government attempts to articulate a way forward. Methods A qualitative study design was used. Interviews were conducted with 22 representatives of major international and faith-based non-government organisations, civil society organisations, local government and government-funded organisations, and governance bodies operating in Malawi. Open questions were asked about experiences and perceptions of the functioning of the health system and healthcare decision-making. Content relating to healthcare governance was identified in the transcripts and field notes and analysed using inductive content analysis. Results Stakeholders view governance challenges as a significant barrier to achieving a more effective and equitable health system. Three categories were identified: accountability (enforceability; answerability; stakeholder-led initiatives); health resource management (healthcare financing; drug supply); influence in decision-making (unequal power; stakeholder engagement). Conclusions Health sector stakeholders see serious political, structural, and financial challenges to improving governance in the national health system in Malawi which will impact the government’s goal of achieving UHC by 2030. Stakeholders identify the need for improved oversight, implementation, service delivery and social accountability of government-funded service providers to communities. Eighteen months after the introduction of the policy documents, they see little evidence of improved governance and have little or no confidence in the government’s ability to deliver UHC. The difficulties stakeholders perceive in relation to building equitable and effective healthcare governance in Malawi have relevance for other resource-limited countries which have also committed to the goal of UHC.

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“…However, given the health service delivery and financial climate, it is not surprising that concerns have been raised (e.g. in academic and media outlets in 2019) about the predictability and sustainability of the health system, especially in its ability to finance and achieve its health objectives, including UHC (36)(37)(38). For example, significant improvements in service delivery cannot be made whilst the healthcare facility staff vacancy rate remains very high (50%) and some communities are up to 35km away from their nearest healthcare facility (37,38).…”

mentioning

confidence: 99%

Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi

Masefield

Msosa

Grugel

2020

Preprint

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Background: All countries face challenging decisions about healthcare coverage. The scare resources of low income countries prevent improvements in equitable access and quality. Malawi, one of the poorest countries in the world, has committed to achieving Universal Health Coverage (UHC) by 2030. The health sector is highly dependent on donor contributions, but recent poor governance of government-funded healthcare saw donors withdraw funding, limiting services and resources. The 2017 updated National Health Plan II and accompanying Health Strategic Plan II identify the importance of improved governance and strategies to achieve it, including greater harmonisation with health stakeholders. This study explores health sector stakeholders’ perceptions of challenges to improving governance in the national health system. Methods: A qualitative study design was used. Interviews were conducted with 22 representatives of the major international and faith-based non-government organisations, civil society organisations, local government and government-funded organisations, and governance bodies operating in Malawi. Open questions were asked about experiences and perceptions of the functioning of the health system and healthcare decision-making. The transcripts and field notes were analysed using inductive content analysis.Results: Stakeholders view governance challenges as a barrier to achieving a more effective and equitable health system. Three types of challenges were identified: accountability (enforceability; answerability; stakeholder-led initiatives); health resource management (healthcare financing; drug supply); influence in decision-making (unequal power; stakeholder engagement).Conclusions: Health sector stakeholders see a range of serious challenges to improving governance in the national health system in Malawi which will impact on the government’s goal of achieving UHC by 2030. These can be categorised as political, structural, and financial challenges. Stakeholders identify the need for improved oversight, implementation, service delivery and social accountability of government-funded service providers to communities. Eighteen months after the introduction of the NHP II and HSSP II, they see little evidence of improved governance and have little or no confidence in the government’s ability to deliver UHC in the timeframe set out by the Sustainable Development Goals (SDGs). The difficulties stakeholders perceive in relation to building equitable and effective health governance in Malawi have relevance for other resource-limited countries which have also committed to the goal of UHC.

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Strengthening primary health care at district-level in Malawi - determining the coverage, costs and benefits of community-directed interventions

Cited by 18 publications

References 18 publications

Pilot approach to analyzing patient and citizen involvement in health technology assessment in four diverse low- and middle-income countries

Pilot approach to analyzing patient and citizen involvement in health technology assessment in four diverse low- and middle-income countries

Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi

Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi

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