Quality of Care in Malawi
Since the launch of the Quality of Care Network (the Network) in Lilongwe in February 2017, Malawi has been highly committed to improve the quality of Maternal, Newborn and Child health (MNCH) services across the health system and to achieve national maternal, neonatal, and under five mortality rate targets by 2030.
Good governance structures and leadership for quality of care (QoC) at national, district and facility level have been key in the implementation and scale-up of MNCH QoC. At national level, the Quality Management Directorate (QMD) in the Ministry of Health is in charge of Quality Improvement providing stewardship across all programmes. National Quality Management Policy (2017-2022) for the Health Sector is aligned to HSSPII (2017-2022) to set a framework for integrating and coordinating quality management initiatives. The Policy has accompanying policies, strategies and tools to guide and support district level implementation:
- Quality of Care National Strategy (2017 - 2022)
- Quality of Care Roadmap (2018 - 2022)
- Quality Improvement training manual (2018)
- MNCH Quality of Care standards and assessment tools (2017-2021)
- National Quality of Care Standards (2022)
Malawi was among the first countries in the Network to develop a National Quality Management Policy and MNCH has been a pathfinder for quality care in Malawi. Spearheaded by QMD and Reproductive Health Department (RHD), the MNCH specific standards have been adapted for implementation; WHO MNH standards and assessment tools for Malawi (2017), adapted WHO Standards for pediatric care (2019), adapted WHO standards for the care of small and sick newborns (2021) and MNCH guidelines were updated and disseminated in 2021.
Stakeholder engagement and National Coordination Committee were established to support QoC processes and 9 learning districts were selected (Mzimba South, Kasungu, Lilongwe, Thyolo, Zomba, Mangochi, Nkhatabay, Dedza, Blantyre). All learning sites have a QoC focal point to guide the work at the district level and support Quality Improvement Support Teams (QISTs) that lead the work at the point of care in facilities. QISTs and Work Improvement teams (WITs), who oversee and implement quality improvement projects at departmental level, were established dedicated to support facility level quality improvement activities. Overseen by the District Health Officers, quality improvement projects are being implemented in the learning sites and health facility teams are being continuously trained on QI.
Health workers have been capacitated over the years on QoC via continuous mentoring, supportive supervision and capacity building. As part of national efforts to build capacities on MNCH QoC, an online Continuing Professional Development (CPD) platform on MNCH QoC was finalized and launched in 2022. National and district learning collaborative sessions are held at national level, including health facility teams. Furthermore, a mentorship programme for District Health Officers (DHOs) and health workers on developing and implementing MNCH QI projects is showing promising results.
As part of national efforts to systemize the integration of community participation and accountability for QoC, when adopting the WHO Standards for QoC MNH and pediatric, Malawi added an additional ninth standard which focused on community engagement and social accountability activities and outcomes. Malawi established social accountability structures at national level to ensure the provision of quality MNCH services across all health facilities. The Hospital Ombudsman institution has been developed and is being used across all health facilities in the country to promote listening to community voices for improved health services, and to raise concerns of access and provision of health to facility management teams.
An evaluation to assess the implementation status of MPDSR and to explore the barriers and facilitators of MPDSR implementation was conducted in 2021 by RHD, MoH Malawi and found gaps in staff training and involvement in implementing MPDSR. The evaluation recommends the immediate integration of MPDSR within broader QI efforts to enhance follow up, implementation and monitoring of responses, as well as the institutionalisation of Perinatal Death audits and rolling out Community MPDSR (verbal autopsy).
An evaluation of impact of the QoC program is underway will include data quality assessments, mentorship and facility support plans evaluation.
Photo: A woman undergoing an antenatal check up at the maternity ward in Mangochi District Hospital in Blantyre, Malawi, in June 2009. ©UNICEF/ Pirozzi