The Demand and Supply Side Determinants of Access to Maternal, Newborn and Child Health Services in Malawi

Matthews, Anne; Walsh, Aisling; Brugha, Ruairi; Manda-Taylor, Lucinda; Mwale, Daniel; Phiri, Tamara; Mwapasa, Victor; Byrne, Elaine

doi:10.1007/s10995-019-02791-8

Published: 25 June 2019

The Demand and Supply Side Determinants of Access to Maternal, Newborn and Child Health Services in Malawi

Anne Matthews ORCID: orcid.org/0000-0002-4845-869X¹,
Aisling Walsh²,
Ruairi Brugha²,
Lucinda Manda-Taylor³,
Daniel Mwale³,
Tamara Phiri⁴,
Victor Mwapasa³ &
Elaine Byrne²

Maternal and Child Health Journal volume 23, pages 1556–1563 (2019)Cite this article

379 Accesses
1 Citations
2 Altmetric
Metrics details

Abstract

Objectives In order to improve maternal and neonatal outcomes, it is important to understand how to maximise the utilisation of MNCH services. The supply side (service-driven) factors affecting access to MNCH services are more commonly studied and are better understood than the demand side (community led) factors. The aim of this study was to identify demand and supply determinants of access to MNCH services in Malawi. Methods Research was conducted in two districts of the Central Region of Malawi (Nkhotakota & Mchinji). Qualitative interviews (n = 85) and focus group discussions (n = 20) were conducted with a range of community members, leaders and health workers. Data were managed in NVivo (v10) and analysed using framework analysis, using Levesque et al. (2013) access framework. Results Community members clearly recognise their need for and seek out MNCH care from the formal health system. Women experience difficulties reaching health services and when reached find them limited, characterised by many indirect costs. There are many technical and interpersonal deficits, which results in poor satisfaction and reportedly poor outcomes for women. Conclusions for practice Women are seeking and utilising MNCH services which they find under-resourced and unwelcoming. Utilising the Levesque et al. (2013) framework, a granular analysis of demand and supply factors has identified the many challenges that remain to achieving equitable access to MNCH services in Malawi. Community members experience lack of availability, acceptability and appropriateness of these essential services.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

Bailie, J., Schierhout, G., Laycock, A., et al. (2015). Determinants of access to chronic illness care: A mixed-methods evaluation of a national multifaceted chronic disease package for Indigenous Australians. British Medical Journal Open, 5, e008103. https://doi.org/10.1136/bmjopen-2015-008103.
Article Google Scholar
Bisika, T. (2008). The effectiveness of the TBA programme in reducing maternal mortality and morbidity in Malawi. East African Journal of Public Health, 5(2), 103–110.
PubMed Google Scholar
Brenner, S., Wilhelm, D., Lohmann, J., Kambala, C., Chinkhumba, J., Muula, A. S., et al. (2017). Implementation research to improve quality of maternal and newborn health care, Malawi. Bulletin of the World Health Organization, 95(7), 491–502.
Article PubMed PubMed Central Google Scholar
Butrick, E., Diamond-Smith, N., Beyeler, N., Montagu, D., Sudhinaraset, M. (2014). Strategies to increase health facility deliveries: Three case studies. Global Health Group, Global Health Sciences, University of California, San Francisco. Retrieved June 17, 2019 from https://globalhealthsciences.ucsf.edu/sites/globalhealthsciences.ucsf.edu/files/pub/pshi-strategies-to-increase-health-facility-deliveries.pdf.
Campbell, Oona, M. R., et al. (2016). The scale, scope, coverage, and capability of childbirth care. The Lancet, 388(10056), 2193–2208.
Article Google Scholar
Chanza, D., Chirwa, E., Maluwa, A., Malata, A., & Masache, G. (2012). Factors affecting the choice for home deliveries in Malawi. African Journal of Midwifery and Women’s Health, 6(3), 125–130.
Article Google Scholar
Godlonton, S., & Okeke, E. N. (2016). Does a ban on informal health providers save lives? Evidence from Malawi. Journal of Development Economics, 118, 112–132.
Article PubMed PubMed Central Google Scholar
ILO. (2014). World Social Protection Report 2014/15. Retrieved June 17, 2019 from https://www.ilo.org/wcmsp5/groups/public/—dgreports/—dcomm/documents/publication/wcms_245201.pdf.
Kerr, R. B., Dakishoni, L., Shumba, L., Msachi, R., & Chiwa, M. (2008). “We grandmothers know plenty”: Breastfeeding, complementary feeding and the multifaceted role of grandmothers in Malawi. Social Science and Medicine, 66(5), 1095–1105.
Article Google Scholar
Koblinsky, M., et al. (2016). Quality maternity care for every woman, everywhere: A call to action. The Lancet, 388, 2307–2320.
Article Google Scholar
Koenraads, M., Phuka, J., Maleta, K., et al. (2017). Understanding the challenges to caring for low birthweight babies in rural southern Malawi: A qualitative study exploring caregiver and health worker perceptions and experiences. BMJ Global Health, 2, e000301.
Article PubMed PubMed Central Google Scholar
Kumbani, L., Bjune, G., Chirwa, E., Malata, A., & Odland, J. O. (2013). Why some women fil to give birth ay health facilities: A qualitative study of women’s perceptions of perinatal care in rural South Malawi. Reproductive Health, 10(1), 1. https://doi.org/10.1186/1742-4755-10-9.
Article Google Scholar
Kumbani, L. C., Chirwa, E., Malata, A., Odland, J. Ø., & Bjune, G. (2012). Do Malawian women critically assess the quality of care? A qualitative study on women’s perceptions of perinatal care at a district hospital in Malawi. Reproductive Health, 9(1), 30.
Article PubMed PubMed Central Google Scholar
Levesque, J., Harris, M., & Russell, G. (2013). Patient-centred access to healthcare: Conceptualising access at the interface of health systems and populations. International Journal of Equity in Health, 12, 18. https://doi.org/10.1186/1475-9276-12-18.
Article Google Scholar
Ministry of Health of Malawi. (2011). Malawi Health Sector Strategic Plan (HSSP, 2011–2016). Retrieved June 17, 2019 from http://www.nationalplanningcycles.org/sites/default/files/country_docs/Malawi/2_malawi_hssp_2011_-2016_final_document_1.pdf.
National Statistical Office (NSO) [Malawi] and ICF. (2017). Malawi Demographic and Health Survey 2015–16. Zomba, Malawi, and Rockville, Maryland, USA. NSO and ICF. Retrieved April 1, 2019 from https://dhsprogram.com/pubs/pdf/FR319/FR319.pdf.
Rishworth, A., Dixon, J., Luginaah, I., Mkandawire, P., & Prince, C. T. (2016). ‘I was on the way to the hospital but delivered in the bush’: Maternal health in Ghana’s upper west region in the context of a traditional birth attendants’ ban. Social Science and Medicine, 148, 8–17. https://doi.org/10.1016/j.socscimed.2015.11.018.
Article PubMed Google Scholar
Sialubanje, C., Massar, K., Hamer, D. H., & Ruiter, R. A. C. (2015). Reasons for home delivery and use of traditional birth attendants in rural Zambia: A qualitative study. BMC Pregnancy and Childbirth, 15, 216.
Article PubMed PubMed Central Google Scholar
UNICEF. (2016). Maternal and Newborn Health Disparities. Retrieved June 17, 2019 from https://data.unicef.org/wp-content/uploads/country_profiles/Malawi/country%20profile_MWI.pdf
Uny, I. (2017). Weighing the options for delivery care in rural Malawi: Community actors’ perceptions of the 2007 policy guidelines and redefined Traditional Birth Attendants’ roles. PhD thesis. Queen Margaret University. Retrieved June 17, 2019 from https://eresearch.qmu.ac.uk/bitstream/handle/20.500.12289/7469/2618.pdf?sequence=1&isAllowed=y.
Walsh, A., Matthews, A., Manda-Taylor, L., Brugha, R., Mwale, D., Phiri, T., Phiri, T., & Byrne, E. (2018). The role of the traditional leader in implementing maternal, newborn and child health policy in Malawi. Health Policy and Planning, 33(8), 879–887.
Article Google Scholar
WHO. (2018). Global Health Observatory data repository. Retrieved June 17, 2019 from http://apps.who.int/gho/data.
Yaya, S., Bishwajit, G., Uthman, O. A., & Amouzou, A. (2018). Why some women fail to give birth at health facilities: A comparative study between Ethiopia and Nigeria. PLoS ONE, 13(5), e0196896. https://doi.org/10.1371/journal.pone.0196896.
CAS Article PubMed PubMed Central Google Scholar
Yuan, E. D., Cherukuri, A. R., Ssembatya, R., Naylor, M. R., & DeStigter, K. K. (2017). An open conversation with traditional birth attendants in rural Uganda: The potential for collaborative care. Journal of Global Radiology, 3(1), 3.
Article Google Scholar

Download references

Author information

Affiliations

School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
Anne Matthews
Royal College of Surgeons in Ireland, Dublin, Ireland
Aisling Walsh, Ruairi Brugha & Elaine Byrne
College of Medicine, University of Malawi, Blantyre, Malawi
Lucinda Manda-Taylor, Daniel Mwale & Victor Mwapasa
Mzuzu University, Mzuzu, Malawi
Tamara Phiri

Authors

Anne Matthews
View author publications
You can also search for this author in PubMed Google Scholar
Aisling Walsh
View author publications
You can also search for this author in PubMed Google Scholar
Ruairi Brugha
View author publications
You can also search for this author in PubMed Google Scholar
Lucinda Manda-Taylor
View author publications
You can also search for this author in PubMed Google Scholar
Daniel Mwale
View author publications
You can also search for this author in PubMed Google Scholar
Tamara Phiri
View author publications
You can also search for this author in PubMed Google Scholar
Victor Mwapasa
View author publications
You can also search for this author in PubMed Google Scholar
Elaine Byrne
View author publications
You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anne Matthews.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Matthews, A., Walsh, A., Brugha, R. et al. The Demand and Supply Side Determinants of Access to Maternal, Newborn and Child Health Services in Malawi. Matern Child Health J 23, 1556–1563 (2019). https://doi.org/10.1007/s10995-019-02791-8

Download citation

Published: 25 June 2019
Issue Date: November 2019
DOI: https://doi.org/10.1007/s10995-019-02791-8

Keywords

Maternal, Newborn and Child Health (MNCH)
Access
Malawi
Community systems