The Malawi emergency and critical care survey: A cross-sectional national facility assessment

Abstract

Summary Background Data on emergency and critical care (ECC) capacity in low-income countries (LICs) are needed to improve outcomes and make progress towards realizing the goal of Universal Health Coverage. Methods We developed a novel research instrument to assess public sector ECC capacity and service readiness in LICs. From January 20th to February 18th, 2020 we administered the instrument at all four central hospitals and a simple random sample of nine of 24 district hospitals in Malawi, a landlocked and predominantly rural LIC of 19·1 million people in Southern Africa. The instrument contained questions on the availability of key resources across three domains and was administered to hospital administrators and clinicians from outpatient departments, emergency departments, and inpatient units. Results were used to generate an ECC Readiness Score, with a possible range of 0 to 1, for each facility. Findings A total of 114 staff members across 13 hospitals completed interviews for this study. Three (33%) district hospitals and all four central hospitals had ECC Readiness Scores above 0·5 ( p -value 0·070). Absent equipment was identified as the most common barrier to ECC Readiness. Central hospitals had higher median ECC Readiness Scores with less variability 0·82 (interquartile range: 0·80–0·89) than district hospitals (0·33, 0·23 to 0·50, p -value 0·021). Interpretation This is the first study to employ a systematic approach to assessing ECC capacity and service readiness at both district and central hospitals in Malawi and provides a framework for measuring ECC capacity in other LICs. Prior ECC assessments potentially overestimated equipment availability and our methodology may provide a more accurate approach. There is an urgent need for investments in ECC services, particularly at district hospitals which are more accessible to Malawi's predominantly rural population. These findings highlight the need for long-term investments in health systems strengthening and underscore the importance of understanding capacity in LIC settings to inform these efforts. Funding Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Department of Emergency Medicine, Brigham and Women's Hospital.

Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic

“…For example, in Kenya only two out of five facilities had protective face masks and aprons widely available, compounding wider problems of overcrowded, poorly maintained hospital buildings often with limited water provision 9 10. Our findings in Kenya and Tanzania are consistent with those from other low-resource settings 11…”

“…Not surprisingly, staff described frequently feeling‘overwhelmed’. The lack of skilled staff and high patient-to-clinician ratios emphasise the need to prioritise improving staffing as well as organisational processes, if facilities are to deliver effective EECC 11 14…”

“…9 10 Our findings in Kenya and Tanzania are consistent with those from other low-resource settings. 11 …”

Strengthening Cultural Competence in Health Professionals Through Partnerships: A Case Study of a Health Collaborative Exchange Between Malawi and Norway in Trauma Care and Emergency Medicine

“…Severe and advanced health cases were reported in Malawi compared to Norway. While this may not be a very surprising findings given many various health systems challenges in Malawi, 12 the Norwegian participants were able to learn that there are other important social, cultural, and religious factors that may contribute to the health seeking behaviors of patients. Some people in the Malawian context only seek care from health facilities after they have tried other options available to them, which may include traditional medicine, herbs, religious inquiries, and other related home remedies.…”

“…While this partnership between Malawi and Norway is largely defined in terms of technological and expertise exchange, 12 , 13 which in this understanding and strict definition makes this partnership more beneficial to Malawi than Norway, the partnership can also be seen in terms of socio-cultural benefits to the health professionals as working in a different social and cultural context can contribute to strengthening their cultural competence. Culturally responsive and sensitive health systems are now being significantly considered as central in solving inequalities in health care provision.…”