The Implementation of Integrated Management of Childhood Illness ...

area show that both children and adults are more prone to seek service at
government-run facilities than CHAM facilities. The difference is statistically
significant and is most dramatic in the age group of 5-14 year olds. Consequently,
Nankumba and MBCH are very important health facilities providing health care for
those who cannot afford paying user fees and buying drugs. The user fees at the
CHAM facilities are of concern as user fees in neighbouring countries have
predominantly affected the poor (55, 56). To illustrate, an interview with a mother
attending MBCH outpatient department with her sick child walked all the way from
Malembo (where there is a CHAM facility) in order not to pay for the health care.
The difference between attendance at the government facilities and CHAM
facilities leads to an increased burden on the workers of the government-run
facilities who are generally few and poorly paid. Hence, it is important that
authorities in Malawi stay firm on the policy of free health care services and it is
important that in the future a larger proportion of health facilities become free of
charge for the user.
The vast difference in revisits among the health centres (from 0.3% in Malembo to
17% in Nankhwali) raises the question whether the revisit count is accurate.
Inaccurate register of revisits alters the diagnostic profile in such a way that the
proportion of illnesses that need more follow-up increases.
Female attendants were more numerous than males in all health facilities. A
significant sex difference in attendance was detected for adults but not for children.
It may be speculated that adult males are more reluctant to seek medical care than
females or females may more frequently suffer from illness. A more likely
explanation is that females get acquainted with health services through birth
delivery and are thus more prone to seeking health care for other reasons.
In order to get a better picture of the patient flow in the area, the outpatient
registry needs to be improved in the five health facilities, for example in
distinguishing all revisits from primary visits, and patients that attend outside office
hours should be included. Up-to-date population data is required for a more
accurate analysis.
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