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

  • Maternal and Child Health Journal, Volume 23, No. 11, Year 2019

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Study Justification:
The study aimed to identify the demand and supply determinants of access to Maternal, Newborn, and Child Health (MNCH) services in Malawi. This research is important because understanding how to maximize the utilization of MNCH services is crucial for improving maternal and neonatal outcomes. While the supply side factors affecting access to MNCH services are well-studied, the demand side factors are less understood. This study aimed to fill this knowledge gap and provide insights into the challenges faced by communities in accessing MNCH services.
Highlights:
– The study was conducted in two districts of the Central Region of Malawi, namely Nkhotakota and Mchinji.
– Qualitative interviews and focus group discussions were conducted with community members, leaders, and health workers.
– The findings revealed that community members recognize their need for MNCH care and actively seek it from the formal health system.
– However, women face difficulties in reaching health services, and when they do, they find them limited and characterized by indirect costs.
– Technical and interpersonal deficits were identified, leading to poor satisfaction and reportedly poor outcomes for women.
– The study utilized the Levesque et al. (2013) access framework to analyze demand and supply factors comprehensively.
Recommendations:
– Increase the availability of MNCH services: Address the lack of resources and ensure that health facilities are adequately equipped to meet the demand for MNCH services.
– Improve the acceptability and appropriateness of services: Enhance the quality of care provided by health workers, focusing on technical and interpersonal skills.
– Reduce indirect costs: Implement measures to minimize the financial burden on women seeking MNCH services, such as transportation subsidies or fee waivers.
– Strengthen community engagement: Involve community leaders and members in decision-making processes related to MNCH services to ensure their needs and preferences are considered.
Key Role Players:
– Ministry of Health: Responsible for policy formulation and implementation of strategies to improve MNCH services.
– Health facility administrators: Oversee the management and operations of health facilities, ensuring the availability and quality of MNCH services.
– Community leaders: Act as advocates for their communities, raising awareness about the importance of MNCH services and facilitating community engagement.
– Health workers: Provide direct care to women and children, requiring training and support to deliver high-quality MNCH services.
Cost Items for Planning Recommendations:
– Infrastructure and equipment: Budget for the construction, renovation, and maintenance of health facilities, as well as the procurement of medical equipment and supplies.
– Training and capacity building: Allocate funds for training programs to enhance the technical and interpersonal skills of health workers.
– Transportation subsidies: Include a budget for providing transportation support to women who face difficulties reaching health services.
– Community engagement activities: Set aside funds for community awareness campaigns, meetings, and workshops to involve community members in MNCH decision-making processes.
Please note that the cost items provided are general categories and may vary depending on the specific context and priorities of the Malawian health system.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study conducted qualitative interviews and focus group discussions with a range of community members, leaders, and health workers, which provides valuable insights into the demand and supply determinants of access to MNCH services in Malawi. However, the abstract does not mention the sample size or the specific findings of the study. To improve the evidence, the abstract should include more details about the research methodology, sample size, and key findings.

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.

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Innovation 1: Mobile Clinics
Implementing mobile clinics in remote areas can help address the lack of availability of maternal health services. These clinics can travel to underserved communities, providing essential maternal health services and reducing the need for women to travel long distances to access care.

Innovation 2: Telemedicine
Introducing telemedicine services can improve access to maternal health services by allowing women to consult with healthcare providers remotely. This can be particularly beneficial for women in rural or remote areas who may have limited access to healthcare facilities.

Innovation 3: Community Health Workers
Training and deploying community health workers can help improve access to maternal health services. These workers can provide education, support, and basic healthcare services to women in their communities, bridging the gap between communities and formal healthcare facilities.

Innovation 4: Public-Private Partnerships
Establishing partnerships between public and private healthcare providers can help increase the availability of maternal health services. This collaboration can leverage the resources and expertise of both sectors to expand access to care and improve the quality of services.

Innovation 5: Digital Health Solutions
Leveraging digital health solutions, such as mobile applications or SMS-based reminders, can help improve the acceptability and appropriateness of maternal health services. These technologies can provide women with information, reminders for appointments, and access to educational resources, empowering them to make informed decisions about their maternal health.

By implementing these innovations, access to maternal health services in Malawi can be improved, ensuring that women have timely and appropriate care, leading to better maternal and neonatal outcomes.
AI Innovations Description
Based on the research study titled “The Demand and Supply Side Determinants of Access to Maternal, Newborn and Child Health Services in Malawi,” the following recommendation can be developed into an innovation to improve access to maternal health:

1. Strengthening the availability of maternal health services: Address the lack of availability of essential maternal health services by increasing the number of healthcare facilities, improving infrastructure, and ensuring the availability of necessary medical equipment and supplies.

2. Enhancing the acceptability and appropriateness of services: Improve the acceptability and appropriateness of maternal health services by training healthcare providers to provide culturally sensitive care, promoting respectful maternity care, and involving community members in the design and delivery of services.

3. Reducing indirect costs and financial barriers: Address the financial barriers faced by women by implementing strategies to reduce indirect costs associated with accessing maternal health services, such as transportation costs. This can be achieved through the provision of subsidized or free transportation services or the establishment of mobile clinics in remote areas.

4. Improving the quality of care: Address the technical and interpersonal deficits identified in the study by implementing quality improvement initiatives. This can include training healthcare providers on best practices in maternal health care, implementing clinical guidelines, and monitoring and evaluating the quality of care provided.

5. Increasing community awareness and education: Promote community awareness and education on the importance of maternal health services through targeted health promotion campaigns, community engagement activities, and the use of community health workers. This can help increase demand for services and empower women to seek timely and appropriate care.

By implementing these recommendations, it is expected that access to maternal health services in Malawi can be improved, leading to better maternal and neonatal outcomes.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Baseline Data Collection: Collect data on the current state of access to maternal health services in Malawi, including information on the availability, acceptability, and utilization of services, as well as financial barriers and quality of care. This can be done through surveys, interviews, and focus group discussions with community members, healthcare providers, and other stakeholders.

2. Intervention Design: Based on the recommendations outlined in the research study, design interventions that target the identified barriers to access. This may include increasing the number of healthcare facilities, improving infrastructure, training healthcare providers, implementing quality improvement initiatives, and promoting community awareness and education.

3. Simulation Modeling: Develop a simulation model that incorporates the baseline data and the proposed interventions. This model should consider factors such as population demographics, geographic distribution, healthcare facility capacity, transportation infrastructure, and financial resources.

4. Parameter Estimation: Estimate the parameters of the simulation model using available data and expert input. This may involve determining the number of additional healthcare facilities needed, the cost of improving infrastructure, the impact of training programs on healthcare provider performance, and the effectiveness of community awareness campaigns.

5. Scenario Testing: Run the simulation model with different scenarios to assess the potential impact of the interventions on access to maternal health services. This can involve varying parameters such as the number of healthcare facilities, the level of community engagement, and the availability of financial support.

6. Outcome Evaluation: Evaluate the outcomes of the simulation model to determine the potential improvements in access to maternal health services. This can include measures such as the number of women able to access services, the reduction in indirect costs, the improvement in quality of care, and the increase in community awareness and education.

7. Sensitivity Analysis: Conduct sensitivity analysis to assess the robustness of the simulation results. This involves varying the input parameters within a plausible range to determine the impact on the outcomes.

8. Policy Recommendations: Based on the simulation results, provide policy recommendations on the most effective interventions to improve access to maternal health services in Malawi. These recommendations should consider the feasibility, cost-effectiveness, and sustainability of the proposed interventions.

By using this methodology, policymakers and stakeholders can gain insights into the potential impact of the recommended interventions and make informed decisions on how to improve access to maternal health services in Malawi.


Statistics:
Citations: 1
Identifiers:
DOI: 10.1007/s10995-019-02791-8
ISSN: 10927875
Research Areas:
Community Interventions, Health System and Policy, Maternal and Child Health, Quality of Care
Study Countries:
Malawi
Study Approach:
Qualitative
Participants Gender:
Female
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