Service availability and readiness for out-patient integrated management of multimorbidity in public primary health facilities in Malawi: A mixed methods analysis
1
Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
2
Malawi Liverpool Wellcome Programme, Blantyre, Malawi
3
Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
4
Kilimanjaro Clinical Research Institute, Moshi, Tanzania, United Republic of
5
University of Manchester, Manchester, United Kingdom
6
Duke University, Durham, United States
7
Medicine, KCMC University, Moshi, Tanzania, United Republic of
8
Kamuzu University of Health Sciences, Blantyre, Malawi
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Multimorbidity is an emerging public health priority in Africa, driven by the growing co-existence of communicable and non-communicable diseases (NCDs). 1Health systems in low-resource settings must adapt to provide integrated, person-centred chronic care at primary healthcare (PHC) level to advance universal health cove rage. 2This study assessed service availability and readiness of public PHC facilities in Malawi to manage multimorbidity, using HIV, type 2 diabetes, hypertension and chronic kidney disease (CKD) as tracer conditions, and explored healthcare workers’ perceived capacity to deliver integrated care.
METHODS:
A mixed-methods cross-sectional study was conducted in 12 public PHC facilities in Blantyre and Chiradzulu districts. Service availability and readiness were assessed using a modified WHO Service Availability and Readiness Assessment tool covering 44 tracer items. Facilities with ≥70% tracer item availability were classified as ready to manage multimorbidity. Condition-specific readiness scores were calculated. In-depth interviews were conducted with 12 purposively selected facility leads to explore health system constraints and opportunities.
RESULTS:
Most facilities (83%) offered services for all four conditions, yet only 30% met minimum readiness thresholds for integrated multimorbidity care. Mean readiness was highest for type 2 diabetes (65.7%) and HIV (63.8%), followed by hypertension (60.4%), while CKD readiness was markedly low (22.9%). Major barriers included non-functional diagnostic equipment, frequent medicine stock-outs, insufficient staffing and supervision, and absence of integrated clinical guidelines.
CONCLUSIONS:
Public PHC facilities in Malawi remain inadequately prepared to deliver equitable, integrated care for multimorbidity. Strengthening diagnostic capacity, ensuring reliable medicine supply, and embedding routine quality assurance and multimorbidity-focused audits are critical to support effective PHC-led chronic care and progress toward UHC.
Multimorbidity is an emerging public health priority in Africa, driven by the growing co-existence of communicable and non-communicable diseases (NCDs). 1Health systems in low-resource settings must adapt to provide integrated, person-centred chronic care at primary healthcare (PHC) level to advance universal health cove rage. 2This study assessed service availability and readiness of public PHC facilities in Malawi to manage multimorbidity, using HIV, type 2 diabetes, hypertension and chronic kidney disease (CKD) as tracer conditions, and explored healthcare workers’ perceived capacity to deliver integrated care.
METHODS:
A mixed-methods cross-sectional study was conducted in 12 public PHC facilities in Blantyre and Chiradzulu districts. Service availability and readiness were assessed using a modified WHO Service Availability and Readiness Assessment tool covering 44 tracer items. Facilities with ≥70% tracer item availability were classified as ready to manage multimorbidity. Condition-specific readiness scores were calculated. In-depth interviews were conducted with 12 purposively selected facility leads to explore health system constraints and opportunities.
RESULTS:
Most facilities (83%) offered services for all four conditions, yet only 30% met minimum readiness thresholds for integrated multimorbidity care. Mean readiness was highest for type 2 diabetes (65.7%) and HIV (63.8%), followed by hypertension (60.4%), while CKD readiness was markedly low (22.9%). Major barriers included non-functional diagnostic equipment, frequent medicine stock-outs, insufficient staffing and supervision, and absence of integrated clinical guidelines.
CONCLUSIONS:
Public PHC facilities in Malawi remain inadequately prepared to deliver equitable, integrated care for multimorbidity. Strengthening diagnostic capacity, ensuring reliable medicine supply, and embedding routine quality assurance and multimorbidity-focused audits are critical to support effective PHC-led chronic care and progress toward UHC.
| eISSN: | 2654-1459 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
