Healthcare service user-reported quality of care in Malawi: a national multi-facility cross-sectional study

Background: Improving healthcare service user satisfaction is one of the three core objectives of the Malawian governments health sector strategic plan. As such, robust understanding of service users perceptions of care quality is crucial to inform patient-centred services that can drive service improvements. Objective: This study aimed to explore how service users in Malawi perceive the quality of the healthcare they receive across services and facilities and to investigate the association between individual and health service characteristics and perceived quality of care. Design: A national multi-facility cross-sectional study using service user exit interview data. Setting(s): 30 health facilities across 15 districts in Malawi. Participants: 4,181 respondents surveyed after completing their visit and exiting healthcare facilities between January and May 2024. Methods: Descriptive statistics of service user-reported quality of care and multinomial logistic regression analyses to determine the association between patient and healthcare characteristics and perceived care quality. Results: Quality of care was reported as being high with 58% of respondents rating care as Good and 35% as Very good, with some variation by dimension of care (e.g. treatment availability). Positive or negative perceptions of care quality were associated with age, sex, education level, illness severity, previously seeking care, referral, facility type, non-governmental facility ownership, service area, access to medication and payment of fees. Conclusions: Most patients in Malawi report receiving high-quality care, although a minority perceive the quality to be inadequate. Action to address gaps in service delivery, such as improving the availability of required medicines, could address the poor perceptions of quality held by the minority of interviewed service users.