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. 2025 Dec;18(1):2451467.
doi: 10.1080/16549716.2025.2451467. Epub 2025 Feb 3.

Using maternal sepsis patient journeys to map and prioritise barriers to quality maternal healthcare in Malawi: a multidisciplinary stakeholder consultation workshop

Yamikani Chimwaza  1   2 , Dalisto Ndaferankhande  1 , Leonard Mndala  1   2 , Chifundo Ndamala  1 , Emily Lifa  1 , Mercy Machilika  1 , Esther Mwagomba  1 , Bernard Dossie  1 , Meliya Kwelepeta  1 , Bertha Maseko  1 , David Lissauer  1   2 , Maria Lisa Odland  1   2
Affiliations

Using maternal sepsis patient journeys to map and prioritise barriers to quality maternal healthcare in Malawi: a multidisciplinary stakeholder consultation workshop

Yamikani Chimwaza et al. Glob Health Action. 2025 Dec.

Abstract

Background: Malawi has made progress in improving access to maternity care services, shifting the focus to quality of care as an essential determinant of maternal health outcomes. However, no effective mechanisms exist to use patients' experiences of care at health facilities to inform and improve the quality of maternal healthcare.

Objective: To use maternal sepsis patient journeys in a workshop with maternal health stakeholders to identify and prioritise barriers in care and recommend interventions to improve maternal healthcare quality in Malawi.

Methods: In February 2024, in Blantyre, Malawi, using a modified nominal group technique, 28 stakeholders reviewed the patient journeys of three women hospitalised at Queen Elizabeth Central Hospital, who had sepsis after childbirth. Patient journeys narrate events experienced within a healthcare system in the patient's words. In a multiframework approach (Four Delays, Respectful Maternity Care, and WHO Quality of Care), stakeholders identified and prioritised barriers to care and recommended interventions to improve the quality of maternal healthcare. Content analysis of the workshop data linked barriers with stakeholders' suggested interventions.

Results: Nineteen barriers identified included various delays in receiving care, mistreatment by healthcare providers, and suboptimal quality of care. Stakeholders found patient journeys valuable and insightful for identifying gaps in the quality of care and promoting sepsis awareness among healthcare workers and the public.

Conclusions: Patient journeys are a novel tool for capturing the experience of care in Malawi. They have the potential to guide strategic improvements in maternal healthcare quality and ultimately reduce maternal morbidity and mortality.

Keywords: Malawi; Patient journey; barriers; delays; maternal healthcare; maternal sepsis; pregnant and postpartum women; prioritisation; quality of care.

Plain language summary

Main findings: In this workshop, we observed the benefit of incorporating patient journeys into maternal healthcare prioritisation exercises. This approach offers valuable insights into patients’ experiences, providing honest perspectives on the entire care journey. It could complement standard hospital audit data, enhancing the impact of quality improvement initiatives.Added knowledge: Serious delays in receiving appropriate care, mistreatment from healthcare providers, and suboptimal quality care are the experiences of maternal sepsis patients in Malawi.Global health impact for policy and action: Prioritisation exercises, informed by the patient journey, could guide strategically targeted interventions and a multifaceted approach to improve the quality of maternal healthcare in Malawi and globally.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Flow diagram of the modified nominal group technique for identifying delays, prioritising barriers, and proposing interventions for maternal sepsis.
Figure 2.
Figure 2.
Schematic excerpt from reviewing one patient’s journey and mapping delays and barriers in maternity care.
Figure 3.
Figure 3.
Workshop photo of an example of one of the group’s mapping and prioritisation layouts during the discussion phase.
Figure 4.
Figure 4.
Schematic diagram of maternal sepsis patient experience of care linked to barriers and proposed interventions.
See this image and copyright information in PMC

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