Non-use of Formal Health Services in Malawi: Perceptions from Non-users

Abstract

Background
The study upon which this paper is based was undertaken to understand
users’ and non-users’ perceptions concerning facilitators and barriers to
equitable and universal access to health care in resource-poor countries
such as Malawi. In this study, non-users of health services were defined as
people who were not in need of health services or those who had stopped
using them due to significant barriers.

Methods
A total of 80 interviews with non-users of health services were conducted
in Rumphi, Ntchisi, Phalombe and Blantyre Districts of Malawi.
Interviews focused on why informants were not using formal health
services at the time of data collection. In order to identify non-users,
snowballing was used health surveillance assistants, village headmen and
community members also helped. One focus group discussion was also
conducted with non-users of health services who were members of the
Zion Church.

Results
Informants described themselves as non-users of health services due to
several reasons: cost of health services; long distances to health facilities;
poor attitude of health workers; belief in the effectiveness of traditional
medicines; old age and their failure to walk. Others were non-users due to
their disability; hence they could not walk over long distances or could not
communicate effectively with health providers. Some of these non-users
were complete non-users, namely members of the Zion Church and those
who believed in traditional medicine, and they stated that nothing could
be done to transform them into users of health services. Other non-users
stated that they could become users if their challenges were addressed e.g. for those who were non-users of health services due to poor attitudes of health workers, they stated that if these health workers were transferred
they would be able to access health services.

Conclusions
Public health education targeting both health workers and non-users,
ensuring a functional outreach program and addressing other health
system challenges such as shortage of drugs and human resources would
assist in transforming non-users into users of health services.