Utilization of family members to provide hospital care in Malawi: the role of hospital guardians
Hoffman, M.; Mofolo, I.; Salima, C.; Hoffman, I.; Zadrozny, S.; Martinson, F. & Van Der Horst, C.
Like most of sub-Saharan Africa, Malawi suffers from a paucity of human
resources in the health sector. With an average of one physician for every
50,000 persons, and a health care professional to in-patient population
ratio of 1:277, patient care suffers. At Kamuzu Central Hospital (KCH)
of Lilongwe, Malawi, family members, termed Hospital Guardians, are
utilized to provide basic care for patients. The aim of our study is to
characterize this population and explore their role in the health care
system of KCH.
Seventy three semi-qualitative surveys and nineteen in-depth interviews
were conducted with hospital administrators, Guardians, nurses, and
physicians from these wards. The results were analyzed using descriptive
analysis and emergent coding.
It was found that Hospital Guardians were primarily female family
members of patients and have a low literacy rate. They performed a wide
range of daily tasks in patient care from wound care to advocacy. Despite
their essential role in the health care system, the Guardians were provided
with little support from the hospital. There was often conflict between the
Guardians and hospital personnel due to overcrowding with more than
one Guardian per patient; a lack of understanding of hospital rules and
regulations; and a lack of respect for the Guardian role by hospital staff.
Until their role can be reduced by additional trained health care
professionals, patient care could be improved by institutional support
including a clarification of the role of the Hospital Guardians.
Recommendations include a one-patient one-guardian policy; Guardian
education; and enhancing Guardian resources.