Understanding the barriers to setting up a healthcare quality improvement process in resource-limited settings: a situational analysis at the Medical Department of Kamuzu Central Hospital in Lilongwe, Malawi
Open accessAbstract
BACKGROUND: Knowledge regarding the best approaches to improving the quality of healthcare and their implementation is lacking in many resource-limited settings. The Medical Department of Kamuzu Central Hospital in Malawi set out to improve the quality of care provided to its patients and establish itself as a recognized centre in teaching, operations research and supervision of district hospitals. Efforts in the past to achieve these objectives were short-lived, and largely unsuccessful. Against this background, a situational analysis was performed to aid the Medical Department to define and prioritize its quality improvement activities. METHODS: A mix of quantitative and qualitative methods was applied using checklists for observed practice, review of registers, key informant interviews and structured patient interviews. The mixed methods comprised triangulation by including the perspectives of the clients, healthcare providers from within and outside the department, and the field researcher's perspectives by means of document review and participatory observation. RESULTS: Human resource shortages, staff attitudes and shortage of equipment were identified as major constraints to patient care, and the running of the Medical Department. Processes, including documentation in registers and files and communication within and across cadres of staff were also found to be insufficient and thus undermining the effort of staff and management in establishing a sustained high quality culture. Depending on their past experience and knowledge, the stakeholder interviewees revealed different perspectives and expectations of quality healthcare and the intended quality improvement process. CONCLUSIONS: Establishing a quality improvement process in resource-limited settings is an enormous task, considering the host of challenges that these facilities face. The steps towards changing the status quo for improved quality care require critical self-assessment, the willingness to change as well as determined commitment and contributions from clients, staff and management.
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The availability of multidimensional and interdisciplinary therapies is limited.
“Moreover, the availability of multidimensional and interdisciplinary therapies is limited.27–29”
From Clinical and cost-effectiveness of a guided internet-based Acceptance and Commitment Therapy to improve chronic pain-related disability in green professions (PACT-A): Study protocol of a pragmatic randomised controlled trial (2020) · cites this paper as [27]
The Discussion section (“Patient flow, statistics and care”; page unavailable) says the department can offer tertiary care for only a few conditions, supporting a limitation in available care at this hospital. The paper does not establish that multidimensional or interdisciplinary therapies specifically are limited. (LLM, conf=0.76)
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- Authors
- Agyeman-Duah, J. N. A., Theurer, A., Munthali, C., Alide, N., & Neuhann, F.
- Affiliations
- Kamuzu Central Hospital (MW)
- Heidelberg University (DE)
- Corresponding author
- Agyeman-Duah, Josephine Nana Afrakoma
- Venue
- BMC Health Services Research
- Published
- 2014-01-02
- Volume
- 14
- Issue
- 1
- Pages
- 1-1
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC3880175
- OpenAlex
- W2121395472
- Cited by
- 345
- References
- 31
- Citations by year
- 2026: 13 · 2025: 17 · 2024: 21 · 2023: 21 · 2022: 26 · 2021: 48 · 2020: 37 · 2019: 33 · 2018: 37 · 2017: 46 · 2016: 29 · 2015: 15 · 2014: 2
- FWCI
- 56.06
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Greater South Information System
- Funders
- Universität Heidelberg
- Katholischer Akademischer Ausländer-Dienst
- Topics
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- healthcare quality improvement, resource-limited settings, barriers to quality improvement, human resource shortage, employee attitudes, medical equipment shortage, internal communication, quality culture, teaching hospitals, Kamuzu Central Hospital, Malawi
- MeSH terms
- Attitude of Health Personnel, Developing Countries, Hospital Administration, Hospitals, Hospitals, Teaching, Humans, Interviews as Topic, Malawi, Personnel, Hospital, Quality of Health Care, Quality Improvement
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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