Level of access to primary healthcare services in informal settlements in Lilongwe city, Malawi

Abstract

Inhabitants of informal urban settlements have limited access to primary health care services. However, the level of access to primary health care services in Lilongwe city has not been assessed. This study assessed the level of access to primary health care services in two informal settlements in Lilongwe city namely Mgona and Kauma. The study recruited 427 household heads, 20 block leaders and 7 health workers in Mgona and Kauma areas. Quantitative data were collected through face-to-face interviews using structured questionnaires and geospatial mapping while qualitative data were collected through focus group discussions and key informant interviews. Quantitative data were analysed using descriptive statistics, independent samples t-test, geo-spatial analysis, Pearson’s’ correlation, and structural equation model (confirmatory factor analysis) with the aid of SPSS version 22 and Quantum GIS version 3.8. Thematic analysis was used to analyse qualitative data. Results indicate that the mean level of access to primary health care (PHC) services in Kauma was 51.52 (SD=7.402) and 53.53 (SD=5.694) in Mgona. Independent samples t-test showed that the level of access to PHC services was significantly higher in Mgona than in Kauma, t (416) = -3.078, p=0.002. 80% (n=212) of households in Kauma and 71.2% (n=109) of households in Mgona had low level of access to PHC services. Chi-square test of association revealed that proportion of households who had low level of access to PHC services was significantly lower in Mgona than in Kauma, X2 (1) =4.175, p=0.041. PHC service availability, PHC service coverage and PHC service acceptability and household composition were significant factors for access to PHC services, p<.05. The study concludes that the level of access to PHC remains low in informal settlements. The study recommends an increase of primary healthcare facilities and recruitment of skilled healthcare workers to deliver primary healthcare services in informal settlements.