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Public Health Action. 2014 Dec 21;4(4):252-8. doi: 10.5588/pha.14.0064.

Bringing care to the community: expanding access to health care in rural Malawi through mobile health clinics.

Author information

1
Global AIDS Interfaith Alliance, San Francisco, California, USA, and Limbe, Malawi.
2
International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK.
3
International Union Against Tuberculosis and Lung Disease, Paris, France ; School of Population Health, University of Auckland, Auckland, New Zealand.
4
Médecins Sans Frontières, Medical Department, Operational Centre Brussels, MSF-Luxembourg, Luxembourg.

Abstract

in English, French, Spanish

SETTING:

Malawi has chronic shortages of health workers, high burdens of human immunodeficiency virus (HIV) infection and malaria and a predominately rural population. Mobile health clinics (MHCs) could provide primary health care for adults and children in hard-to-reach areas.

OBJECTIVES:

To determine the feasibility, volume, and types of services provided by three MHCs from 2011 to 2013 in Mulanje District, Malawi.

DESIGN:

Cross-sectional retrospective study.

RESULTS:

The MHCs conducted 309 492 visits for primary health care, and in 2013 services operated on 99% of planned days. Despite an improvement in service provision, overall patient visits declined over the study period. Malaria and respiratory and gastro-intestinal conditions constituted 60% of visits. Females (n = 11 543) significantly outnumbered males (n = 2481) tested for HIV, yet males tested HIV-positive (27%) more often than females (14%). Malaria accounted for 26 421 (35%) visits for children aged <5 years, with a significant increase in the rainy season. Implementation of rapid diagnostic testing was associated with a decline in numbers treated for malaria. Antibiotic stockouts at government clinics were associated with increased MHC visits.

CONCLUSION:

MHCs can routinely provide primary health care for adults and children living in rural Malawi and complement fixed clinics. Moving from a complementary role to integration within the government health system remains a challenge.

KEYWORDS:

HIV testing; SORT IT; malaria; operational research; primary health care

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