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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Constraints to implementing the Essential health package in Malawi
PLoS ONE, Volume 6, No. 6, Article e20741, Year 2011
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Description
Increasingly seen as a useful tool of health policy, Essential or Minimal Health Packages direct resources to interventions that aim to address the local burden of disease and be cost-effective. Less attention has been paid to the delivery mechanisms for such interventions. This study aimed to assess the degree to which the Essential Health Package (EHP) in Malawi was available to its population and what health system constraints impeded its full implementation. The first phase of this study comprised a survey of all facilities in three districts including interviews with all managers and clinical staff. In the second and third phase, results were discussed with District Health Management Teams and national level stakeholders, respectively, including representatives of the Ministry of Health, Central Medical Stores, donors and NGOs. The EHP in Malawi is focussing on the local burden of disease; however, key constraints to its successful implementation included a widespread shortage of staff due to vacancies but also caused by frequent trainings and meetings (only 48% of expected man days of clinical staff were available; training and meetings represented 57% of all absences in health centres). Despite the training, the percentage of health workers aware of vital diagnostic and therapeutic approaches to EHP conditions was weak. Another major constraint was shortages of vital drugs at all levels of facilities (e.g. Cotrimoxazole was sufficiently available to treat the average number of patients in only 27% of health centres). Although a few health workers noted some improvement in infrastructure and working conditions, they still considered them to be widely inadequate. In Malawi, as in similar resource poor countries, greater attention needs to be given to the health system constraints to delivering health care. Removal of these constraints should receive priority over the considerable focus on the development and implementation of essential packages of interventions. © 2011 Mueller et al.
Authors & Co-Authors
Mueller, Dirk H.
Unknown Affiliation
Lungu, Douglas
Unknown Affiliation
Acharya, Arnab
Unknown Affiliation
Palmer, Natasha
Unknown Affiliation
Statistics
Citations: 100
Authors: 4
Affiliations: 3
Identifiers
Doi:
10.1371/journal.pone.0020741
e-ISSN:
19326203
Research Areas
Health System And Policy
Study Design
Cross Sectional Study
Study Approach
Quantitative
Study Locations
Malawi