| Health aid projects have both expanded and constrained the capacity of health facilities to deliver malaria services to under-five children in Malawi |
| Authors: |
Carrie B Dolan |
| Source: |
BMJ Global Health, 3:e001051; DOI: 10. 1136/bmjgh- 2018- 001051 |
| Topic(s): |
Child health
Children under five
Health care utilization
Malaria
|
| Country: |
Africa
Malawi
|
| Published: |
NOV 2018 |
| Abstract: |
Objective This article examines the potential pathways
health aid may use to influence the availability of malaria
services at a facility level and the utilisation of malaria
services for children under five in Malawi.
Methods This work is grounded in a health services
research theoretical model and combines a subnational
census of health services available at Malawi health
facilities with individual-level data on health service
utilisation and the Government of Malawi’s official
source of data about health aid allocation at a childlevel
(n=2171). Logistic and multinomial logistic models
were used to assess the relationship between health aid,
malaria service readiness and malaria service utilisation.
Models were adjusted for predisposing, enabling and need
factors and accounted for the complex relationship using a
mediation approach.
Results The evidence presented suggests that health
aid translates into increased diagnostic capacity, but
not overall or training readiness. Results indicate that
increasing aid projects in a region boost its facilities’
diagnostic readiness, increasing each facility’s relative
likelihood of having a medium level of diagnostic readiness
by 12% (relative risk (RR)=1.118; 95% CI 1.060 to 1.179)
and its likelihood of having a high level of readiness by
23% (RR=1.230; 95% CI 1.161 to 1.303), but decreasing
its readiness to provide training by 8% (RR=0.925; 95% CI
0.879 to 0.974).
Conclusion The results of this research highlight the fact
that health aid is working to increase malaria diagnostic
capacity at a facility level, but that increasing facility
readiness to implement the diagnostic tests has been
neglected. |
|