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Preparedness for and impact of COVID-19 on primary health care delivery in urban and rural Malawi: a mixed methods study.
Phiri, Mackwellings Maganizo; MacPherson, Eleanor Elizabeth; Panulo, Mindy; Chidziwisano, Kondwani; Kalua, Khumbo; Chirambo, Chawanangwa Mahebere; Kawalazira, Gift; Gundah, Zaziwe; Chunda, Penjani; Morse, Tracy.
  • Phiri MM; Social Science Department, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi mackwellingsphiri@gmail.com.
  • MacPherson EE; Social Science Department, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
  • Panulo M; Liverpool School of Tropical Medicine, Liverpool, UK.
  • Chidziwisano K; Department of Enviromental Health and WASHTED Centre, Polytechnic, University of Malawi, Blantyre, Malawi.
  • Kalua K; Department of Environmental Health, Polytechnic, University of Malawi, Blantyre, Malawi.
  • Chirambo CM; Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow, UK.
  • Kawalazira G; Blantyre Institute for Community Outreach, Blantyre, Malawi.
  • Gundah Z; Blantyre Institute for Community Outreach, Blantyre, Malawi.
  • Chunda P; Blantyre District Health Office, Blantyre, Malawi.
  • Morse T; Blantyre District Health Office, Blantyre, Malawi.
BMJ Open ; 12(6): e051125, 2022 06 10.
Article in English | MEDLINE | ID: covidwho-1886763
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Qualitative research Limits: Humans Country/Region as subject: Africa Language: English Journal: BMJ Open Year: 2022 Document Type: Article Affiliation country: BMJOPEN-2021-051125

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Qualitative research Limits: Humans Country/Region as subject: Africa Language: English Journal: BMJ Open Year: 2022 Document Type: Article Affiliation country: BMJOPEN-2021-051125