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Background Complaints mechanisms are key components of healthcare accountability in health systems across the world. They can help identify structural problems and poor service by individual health workers and can support equitable access and ensure that patient safety is a priority. As part of a larger study on accountability and anti-corruption, the aim of this study was to explore and understand the role of the different channels for complaints that are available to Malawian healthcare users. It aimed to explore how they function, and what undermines their use. Methods We conducted a qualitative study in Blantyre district using participant observations, in-depth interviews and focus group discussions. We spent 8 weeks at health facilities and the Blantyre district health office (Directorate of Health and Social Services) and then explored the challenges of accessing and using patient complaints mechanisms. Results Healthcare users continuously encounter numerous challenges within the Malawian health system. We identified 32 mechanisms for complaints handling and redressal which are also meant to act as tools for checks and balances. At the same time, interviews with health providers, stakeholders and document analysis demonstrated that the complaints and redressal system has multiple weaknesses. These include geographical barriers, lack of trust and visibility of these mechanisms, and limited capacity in institutions to manage the complaints and redress process, as well as lack of political will to adopt changes within the health system. Conclusion The weaknesses of the health complaints and redress system in Malawi pose obstacles to delivering quality primary healthcare to the most disadvantaged communities. Urgent interventions to redesign these mechanisms, ensuring that they are not constrained by power differentials and lack of trust is needed.
Chilumpha et al. (Fri,) studied this question.