Healthcare service user-reported quality of care in Malawi: a national multifacility cross-sectional study

Abstract Background Improving healthcare service user satisfaction is one of the three core objectives of the Malawian government’s health sector strategic plan. As such, robust understanding of service users’ perceptions of care quality is crucial to inform patient-centred services that can drive service improvements. Objective This study aimed to explore how service users in Malawi perceive the quality of the healthcare they receive across services and facilities and to investigate the association between individual and health service characteristics and perceived quality of care. Design A national multi-facility cross-sectional study using service user exit interview data. Setting(s) 30 health facilities across 15 districts in Malawi. Participants 4,181 respondents surveyed after completing their visit and exiting healthcare facilities between January and May 2024. Methods Descriptive statistics of service user-reported quality of care and multinomial logistic regression analyses to determine the association between patient and healthcare characteristics and perceived care quality. Results Quality of care was reported as being high with 58% of respondents rating care as ‘Good’ and 35% as ‘Very good’, with some variation by ‘dimension’ of care (e.g. treatment availability). Positive or negative perceptions of care quality were associated with age, sex, education level, illness severity, previously seeking care, referral, facility type, non-governmental facility ownership, service area, access to medication and payment of fees. Conclusions Most patients in Malawi report receiving high-quality care, although a minority perceive the quality to be inadequate. Action to address gaps in service delivery, such as improving the availability of required medicines, could address the poor perceptions of quality held by the minority of interviewed service users. What is already known on this topic Service user-reported quality of care is an important indicator of quality healthcare delivery and key for responsive and patient-centred systems. Previous assessments from Malawi are largely focused on single services, facilities or groups. What this study adds This study reveals that, across a variety of facilities and services, most Malawians rate the quality of care they receive highly whilst a minority reported quality of care to be neither good nor bad, bad, or very bad. We identified that non-governmental facility ownership and factors related to how services are delivered (i.e. availability of prescribed medication, patient referral, service area) are strongly associated with perceived quality. How this study might affect research, practice or policy Several important factors associated with service user-reported quality, including availability of medication and referral systems, are amenable to policy action and could drive improvements in both quality and health. Additionally, we highlight the need for research into the factors influencing perceived quality in non-governmental facilities in Malawi.