Department of Health Systems and Policy, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre, Malawi.
London School of Hygiene and Tropical Medicine, United Kingdom.
Health Policy Plan. 2023 Nov 16;38(Supplement_2):ii14-ii24. doi: 10.1093/heapol/czad043.
A responsive health system must have mechanisms in place that ensure it is accountable to those it serves. Patients in Malawi have to overcome many barriers to obtain care. Many of these barriers reflect weak accountability. There are at least 30 mechanisms through which Malawian patients in the public sector can assert their rights, yet few function well and, as a consequence, they are underused. Our aim was to identify the various channels for complaints and why patients are reluctant to use them when they experience poor quality or inappropriate care, as well as the institutional, social and political factors that give rise to these problems. The study was set in the Blantyre district. We used qualitative methods, including ethnographic observations, focus group discussions, document analysis and interviews with stakeholders involved in complaint handling both in Blantyre and in the capital, Lilongwe. We found that complaints mechanisms and redress procedures are underutilized because of lack of trust, geographical inaccessibility and lack of visibility leading to limited awareness of their existence. Drawing on these results, we propose a series of recommendations for the way forward.
一个有响应能力的卫生系统必须有机制来确保其对服务对象负责。马拉维的患者在获得医疗服务时必须克服许多障碍。这些障碍反映了问责制薄弱。马拉维的公共部门患者至少有 30 种途径可以主张自己的权利，但很少有途径能很好地发挥作用，因此，这些途径很少被使用。我们的目的是确定各种投诉渠道，以及当患者遇到质量差或不适当的护理时，为什么他们不愿意使用这些渠道，以及导致这些问题的体制、社会和政治因素。该研究在布兰太尔地区进行。我们使用了定性方法，包括民族志观察、焦点小组讨论、文件分析以及与布兰太尔和首都利隆圭的投诉处理利益相关者的访谈。我们发现，由于缺乏信任、地理位置上的不便和缺乏可见性，导致对这些机制和补救程序的了解有限，因此这些机制和补救程序的利用率很低。根据这些结果，我们提出了一系列建议，以推动未来的发展。
