Navigating primary health care challenges: Insights from older people with multimorbidity in Malawi

The global population is undergoing a significant surge in aging leading to increased susceptibility to various forms of progressive illnesses. This phenomenon significantly impacts both individual health and healthcare systems. Low and Middle Income Countries face particular challenges, as their Primary Health Care (PHC) settings often lack the necessary human and material resources to effectively address the escalating healthcare demands of the older people. This study set out to explore the experiences of older people living with progressive multimorbidity in accessing PHC services in Malawi. Between July 2022 and January 2023, a total of sixty in-depth interviews were conducted with dyads of individuals aged ≥50 years and their caregivers, and twelve healthcare workers in three public hospitals across Malawi’s three administrative regions. The study employed a stratified selection of sites, ensuring representation from rural, peri-urban, and urban settings, allowing for a comprehensive comparison of diverse perspectives. Guided by the Andersen-Newman theoretical framework, the study assessed the barriers, facilitators, and need factors influencing PHC service utilization by the older people. Three themes, consistent across all sites emerged, encompassing barriers, facilitators, and need factors respectively. The themes include: (1) clinic environment: inconvenient clinic setup, reliable PHC services and research in diabetic foods; (2) geographical factors: bad road conditions, lack of comprehensive PHC at local health facility and need for community approaches; and (3) social factors: encompassing use of alternative medicine, transport support, perceived health care benefit and support with startup capital for small-scale businesses. This research highlights the impact of multiple factors on the access to and utilization of PHC services among older individuals, emphasizing the urgent need for enhanced nationwide availability of such services. It strongly recommends a thorough investigation into successful practices implemented in diverse health facilities in Malawi, with a specific focus on addressing the unique healthcare needs of the older population.