How an Innovative Testing Approach in Malawi is Promoting Health Equity

Grivin Frank was reluctant to get tested for HIV. Although he wanted to know his HIV status, Grivin, a 66-year-old man living in Malawi’s Mangochi district, wasn’t willing to wait in the overcrowded outpatient department (OPD) he experienced every time he visited the Mangochi District Hospital. For Grivin, working his part-time job as a builder and providing for his family were more important than taking the time to test for HIV.

Grivin is not alone. Many Malawians are reluctant to get tested for HIV and other diseases due to overcrowding at the OPDs in public hospitals. Patients often travel long distances and arrive as early as 6am, despite the OPDs usually not opening until 8am, in order to get to work on time after their consultation with a health professional. Because of the long waiting times, many patients are unwilling to forgo an extra hour to get checked for additional health conditions — such as high blood pressure, diabetes, and cervical cancer — beyond the illness that originally brought them in.

The Ministry of Health in Malawi (MOH) has recently partnered with non-governmental organizations that offer various health services in public hospitals, such as screening, tests, and treatment for HIV, cervical cancer, malaria, TB, and more. To receive these services, however, patients must visit departments outside of the OPD where they are to be treated for the illness that originally brought them to the facility. Many patients and health professionals have complained about the disrupted flow of this system, as patients are pulled from the crowd at the OPD and moved from one department to another before consulting medical assistants. In light of these challenges, the MOH has recommended that the health facilities, in collaboration with partner organizations, come up with strategies to close these gaps.

In the past few years, some organizations started implementing strategies that ensured a smoother flow in these clinics, as well as increased uptake of offered services. For instance, in September of 2018, Baylor College of Medicine Children’s Foundation Malawi, under the USAID-funded Tingathe program, improved its early morning services by offering HIV testing and treatment from 6am to 8am while clients are waiting for the OPD to open. The initiative has increased the efficiency of early morning testing and now accounts for 13% of all HIV tests done in Mangochi District.

Furthermore, early morning testing has increased the uptake of HIV services in some health facilities, as patients are more willing to use their waiting period as an opportunity to learn their status. For instance, Grivin Frank, who accepted early morning testing at Mangochi District Hospital, described his experience as follows:

“I was very happy and satisfied with the whole process. When I arrived at the hospital, I was offered the HIV health talk at 6:15am. Thereafter, one health worker screened my health passport book and found I was eligible for testing. I was willing to use my waiting time to test to find out my HIV status. I was escorted to the testing point and offered counseling before and after testing. I was also very happy to be found negative and get to know that my sickness was not caused by HIV.”

Initiatives like this have proven to be an efficient and effective way of increasing uptake of services and can be used as an opportunity to test for HIV as well as other medical check-ups in general. It is imperative that health facilities use early morning wait times as an opportunity to expand access to various services including screening for TB, diabetes, blood pressure, cervical cancer, and other health conditions. As a result, health facilities will be able to increase the uptake of services and reach people who would otherwise not have the opportunity to check for such medical conditions.

Kettie Sambani is a 2018–2019 Global Health Corps fellow in Malawi.

Global Health Corps (GHC) is a leadership development organization building the next generation of health equity leaders around the world. All GHC fellows, partners, and supporters are united in a common belief: health is a human right. There is a role for everyone in the movement for health equity. To learn more, visit our website and connect with us on Twitter/Instagram/Facebook.