Partners in Health, Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi.
Neno District Health Office, Ministry of Health, Neno, Malawi.
BMC Palliat Care. 2024 May 23;23(1):132. doi: 10.1186/s12904-024-01455-x.
Palliative care remains key in assisting patients who have life-threatening conditions. In most low- and middle-income countries, it is often offered through a centralized system with limitations, including Malawi. In 2014, the World Health Organization called for improving palliative care access through primary health care and community models. Malawi and Neno District subsequently decentralized palliative care delivery to local health centers. This qualitative study explored the decentralization of palliative care services in Neno District, Malawi.
The descriptive qualitative study was conducted between 2021 and 2022 in two conveniently selected health centers providing palliative care in the Neno District. Fourteen healthcare workers were purposefully selected to participate in two focus groups. Fifteen patients were conveniently selected and participated in three focus groups. Data was analyzed using deductive and inductive approaches. Focused group discussions were conducted in Chichewa (Malawi's official local language), audio recorded, transcribed, translated into English, and analyzed thematically.
Four main themes emerged from the focus groups. Patients described positive relationships with healthcare workers built on trust and holistic care over time. Accessing care included transport, social support, time constraints, and distance issues. Facilities effectively responded to needs through coordinated care and follow-up. Decentralization was perceived to benefit patients by reducing travel challenges and improving local access to efficient and inclusive palliative care services. However, challenges with resources, distance, and social support remained. Limitations in sampling and missing participant details necessitate further research with broader sampling.
Overall, the study provides empirical evidence that can optimize palliative care delivery in similar low-resource contexts by informing policies to address barriers through decentralized approaches.
姑息治疗仍然是帮助患有危及生命疾病的患者的关键。在大多数中低收入国家，它通常通过集中系统提供，存在局限性，马拉维就是其中之一。2014 年，世界卫生组织呼吁通过初级卫生保健和社区模式改善姑息治疗的可及性。马拉维和涅诺区随后将姑息治疗的提供去中心化到当地卫生中心。本定性研究探讨了马拉维涅诺区姑息治疗服务的去中心化。
这项描述性定性研究于 2021 年至 2022 年在涅诺区提供姑息治疗的两个方便选择的卫生中心进行。有 14 名医护人员被有目的地选中参加了两个焦点小组。15 名患者被方便地选中并参加了三个焦点小组。使用演绎和归纳方法分析数据。焦点小组讨论以奇契瓦语（马拉维的官方当地语言）进行，录音、转录、翻译成英文，并进行主题分析。
四个主要主题从焦点小组中浮现出来。患者描述了随着时间的推移，在信任和整体护理的基础上与医护人员建立的积极关系。获得护理包括交通、社会支持、时间限制和距离问题。设施通过协调护理和随访有效地应对需求。去中心化被认为使患者受益，因为它减少了旅行挑战，并改善了当地获得高效和包容的姑息治疗服务的机会。然而，资源、距离和社会支持方面的挑战仍然存在。抽样限制和缺失参与者细节需要进一步进行更广泛抽样的研究。
总体而言，该研究提供了实证证据，可以通过分散方法制定政策来解决障碍，从而优化类似资源匮乏环境中的姑息治疗提供。
