Paper: Reconciling the perspectives of patients, NGOs, and the Ministry of Health on medical quality during the Covid-19 epidemic in Malawi

Paper details

Paper authors Elba Rahmouni
In panel on Medical quality and Patient-centered care
Paper presenter(s) will be presenting In-Person / Online


Fabrice Weissman

This presentation will describe the challenges encountered by MSF and Malawian Ministry of Health personnel in defining and achieving an “acceptable quality of care” in a Covid-19 field hospital managed by the Ministry of Health with MSF support in Blantyre district, Malawi, during the second wave of the Covid-19 epidemics (December 2020-March 2021).

After a mild first Covid-19 wave, Malawi experienced a short but brutal second wave between mid-December 2020 and February 2021, which put a high strain on the Malawian health system, especially in Blantyre district, where one third of all cases and death registered nationally happened. The only public facility hospitalizing Covid-19 patients for Blantyre district, the Queen Elizabeth Central Hospital (QECH), faced numerous challenges starting with the shortage of staff due to high rate of contamination among health workers, shortage of oxygen, lack of beds, difficulties to organize screening and triage of suspect Covid-19 patients. In addition, it had to cope with a growing distrust of the population toward the health system (accused of deliberately killing patients) which progressively overtook the Covid-19 outbreak as the main public health crisis. While violent incidents between care givers and patients’ families multiplied, attendance of all health facilities collapsed.

From January 8th onward, MSF responded to QECH call for support with the twin objectives to minimize mortality and maximize quality of life of suspect and confirmed Covid-19 hospitalized patients, starting with those stranded in the triage and observation department set-up under tents at the entrance of the hospital. Yet, MSF was only acting as “technical adviser” and “resource provider” with MoH remaining entirely in charge of the Covid-19 response. Agreeing on a common definition of “quality of care”, taking into consideration biomedical and patients perspectives, as well as transforming daily practices proved to be quite challenging. Not being able to implement straight away what they considered as minimal quality standards, some MSF expatriate resigned, while others found their ways to work with their MoH counterparts toward a gradual uplifting of nursing and clinical practices - at the price of uncomfortable compromises.

By July 2021, a 80 beds field hospital meeting both MSF and MoH criteria of “quality of care” was able to receive the patients of the third wave, who seemed to have regained some confidence in the health system, in part due to the development of a more “patient friendly” Covid-19 center.



Elba Rahmouni