Non-use of Formal Health Services in Malawi: Perceptions from Non-users.

BACKGROUND: The study upon which this paper is based was undertaken to understand users' and non-users' perceptions concerning facilitators and barriers to equitable and universal access to health care in resource-poor countries such as Malawi. In this study, non-users of health services were defined as people who were not in need of health services or those who had stopped using them due to significant barriers. METHODS: A total of 80 interviews with non-users of health services were conducted in Rumphi, Ntchisi, Phalombe and Blantyre Districts of Malawi. Interviews focused on why informants were not using formal health services at the time of data collection. In order to identify non-users, snowballing was used health surveillance assistants, village headmen and community members also helped. One focus group discussion was also conducted with non-users of health services who were members of the Zion Church. RESULTS: Informants described themselves as non-users of health services due to several reasons: cost of health services; long distances to health facilities; poor attitude of health workers; belief in the effectiveness of traditional medicines; old age and their failure to walk. Others were non-users due to their disability; hence they could not walk over long distances or could not communicate effectively with health providers. Some of these non-users were complete non-users, namely members of the Zion Church and those who believed in traditional medicine, and they stated that nothing could be done to transform them into users of health services. Other non-users stated that they could become users if their challenges were addressed e.g. for those who were non-users of health services due to poor attitudes of health workers, they stated that if these health workers were transferred they would be able to access health services. CONCLUSIONS: Public health education targeting both health workers and non-users, ensuring a functional outreach program and addressing other health system challenges such as shortage of drugs and human resources would assist in transforming non-users into users of health services.

The denigration of women in Malawian radio commercials.

PIP: This article investigates the denigration of women in Malawi Broadcasting Corporation (MBC) commercials. A random sample of 100 commercials was tape-recorded, transcribed, and analyzed using a content-analysis method. Results showed that 36 of the 100 commercials portrayed females negatively. 41 commercials were judged to denigrate females; of these, 24 portrayed them as having little authority, 4 as dependent, 8 as home-oriented, 5 as noncompetitive, and 4 as sex objects. The large number of commercials featuring both female and male voices reflects the widespread and internalized acceptance of gender stereotypes, which favor men in wider Malawian society. In order to improve images of women, three actions must be taken: commercials must be conceived in a balanced manner, there must be an increase in the female-male ratio among MBC employees, and training on gender issues and on nonsexist advertising techniques should be introduced. While radio commercials are not the fundamental cause of the subordinate status of women, and women's status will not be transformed by the commercials alone, radio advertising can stimulate change.^ieng