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. 2022 Jun 10;12(6):e051125.
doi: 10.1136/bmjopen-2021-051125.

Preparedness for and impact of COVID-19 on primary health care delivery in urban and rural Malawi: a mixed methods study

Mackwellings Maganizo Phiri  1 , Eleanor Elizabeth MacPherson  2   3 , Mindy Panulo  4 , Kondwani Chidziwisano  5   6 , Khumbo Kalua  7 , Chawanangwa Mahebere Chirambo  7 , Gift Kawalazira  8 , Zaziwe Gundah  8 , Penjani Chunda  8 , Tracy Morse  9   10
Affiliations

Preparedness for and impact of COVID-19 on primary health care delivery in urban and rural Malawi: a mixed methods study

Mackwellings Maganizo Phiri et al. BMJ Open. .

Abstract

Objective: Across Africa, the impact of COVID-19 continues to be acutely felt. This includes Malawi, where a key component of health service delivery to mitigate against COVID-19 are the primary healthcare facilities, strategically placed throughout districts to offer primary and maternal healthcare. These facilities have limited infrastructure and capacity but are the most accessible and play a crucial role in responding to the COVID-19 pandemic. This study assessed health facility preparedness for COVID-19 and the impact of the pandemic on health service delivery and frontline workers.

Setting: Primary and maternal healthcare in Blantyre District, Malawi.

Participants: We conducted regular visits to 31 healthcare facilities and a series of telephone-based qualitative interviews with frontline workers (n=81 with 38 participants) between August 2020 and May 2021.

Results: Despite significant financial and infrastructural constraints, health centres continued to remain open. The majority of frontline health workers received training and access to preventative COVID-19 materials. Nevertheless, we found disruptions to key services and a reduction in clients attending facilities. Key barriers to implementing COVID-19 prevention measures included periodic shortages of resources (soap, hand sanitiser, water, masks and staff). Frontline workers reported challenges in managing physical distancing and in handling suspected COVID-19 cases. We found discrepancies between reported behaviour and practice, particularly with consistent use of masks, despite being provided. Frontline workers felt COVID-19 had negatively impacted their lives. They experienced fatigue and stress due to heavy workloads, stigma in the community and worries about becoming infected with and transmitting COVID-19.

Conclusion: Resource (human and material) inadequacy shaped the health facility capacity for support and response to COVID-19, and frontline workers may require psychosocial support to manage the impacts of the COVID-19 pandemic.

Keywords: COVID-19; infection control; public health; qualitative research.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Outpatient service attendance 2019 versus 2020 with the number of positive confirmed cases of COVID-19 in Blantyre District (n=27 health facilities).
Figure 2
Figure 2
Tuberculosis service attendance 2019 versus 2020 with the number of positive confirmed cases of COVID-19 in Blantyre District (n=27 health facilities).
Figure 3
Figure 3
Child health (including immunisation) service attendance 2019 versus 2020 with the number of positive confirmed cases of COVID-19 in Blantyre District (n=27 health facilities).
Figure 4
Figure 4
Family planning service attendance 2019 versus 2020 with the number of positive confirmed cases of COVID-19 in Blantyre District (n=27 health facilities).
See this image and copyright information in PMC

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