Endline Report Quality HIV and RMNH services Malawi available

July 18, 2017

From 2014 to 2016 Aidsfonds, in collaboration with ICCO Cooperation and local organizations in Lilongwe, Malawi, designed and implemented the ‘Quality HIV and Reproductive Maternal and Neonatal Health (RMNH) services for women in Malawi through Good Clinical Governance and Community-Driven Accountability’ Project. The Project aimed to improve the quality of RMNH and HIV services offered to women living with HIV in Malawi. The end line report provides a summary of the project and its impact as evaluated by a longitudinal study conducted by Invest in Knowledge (IKI).

Quality reproductive, maternal and neonatal health (RMNH) services, including HIV care, are imperative to improving the quality of life and health outcomes for women and children throughout sub-Saharan Africa. Women living with HIV experience more rights violations in RMNH services than HIV negative women. Rights violations within clinic settings may discourage women from seeking HIV and RMNH services, contributing to vertical transmission of HIV and maternal mortality. 

Project outcomes

Data was collected between May-July 2014, March-June 2015 and January-February 2016. Findings show that the Project was successful at engaging multiple partners to improve the quality of care provided. The Project was positively associated with:

  • perceptions of empowerment among women who participated in HIV support groups,
  • provider acceptance of community-based accountability strategies,
  • improved patient-provider interactions within standard HIV and RMNH consultations,
  • increased uptake of HIV and RMNH services at participating health facilities. 

Importantly, combining trainings for women living with HIV with structural changes within health facilities provided the greatest change in:

  • perceived empowerment among women living with HIV and
  • successful action taken by Women's Rights Protection Committees.

The primary outcome of interest was improved quality of HIV and RMNH services at intervention facilities. The Project was associated with improved quality care on multiple fronts. First, women living with HIV who accessed care at intervention facilities reported kinder interactions and higher levels of satisfaction with healthcare providers after Project implementation as compared to before the Project's implementation. Second, both survey and exit interview respondents reported more open, friendly environments within the health facility after the intervention. Post-intervention consultations were more likely to include time for clients to ask questions and clients were more likely to have their questions answered. Finally, intervention facilities experienced a greater increase in the number of clients receiving HIV and RMNH services after the Project was implemented, potentially reflecting a decrease in unmet needs within facility catchment areas. 

Remaining barriers to quality care included poor integration of RMNH services within ART services, potential coercion of pregnant women to use HIV testing and/or treatment services, and limited resources within the health facility to adequately handle high client loads. The primary complaint of clients before and after the Project was delayed start times and long wait times in the health facility, with clients waiting on average 3 hours for one consultation.

Please see the end line report for further details, with chapter six providing a summary (bullets) and chapter seven recommendations for further programming.

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