Novel application of multi-facility process map analysis for rapid injury care health system assessment in Northern Malawi
Objectives We used the process mapping method and Three Delays framework, to identify and visually represent the relationship between critical actions, decisions and barriers to access to care following injury in the Karonga health system, Northern Malawi.Design Facilitated group process mapping wor...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/6/e070900.full |
| _version_ | 1827175574625320960 |
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| author | Andrew J M Leather Justine Davies John Whitaker Rory F Rickard Albert Dube Abena S Amoah Lindani Chirwa Boston Munthali |
| author_facet | Andrew J M Leather Justine Davies John Whitaker Rory F Rickard Albert Dube Abena S Amoah Lindani Chirwa Boston Munthali |
| author_sort | Andrew J M Leather |
| collection | DOAJ |
| description | Objectives We used the process mapping method and Three Delays framework, to identify and visually represent the relationship between critical actions, decisions and barriers to access to care following injury in the Karonga health system, Northern Malawi.Design Facilitated group process mapping workshops with summary process mapping synthesis.Setting Process mapping workshops took place in 11 identified health system facilities (one per facility) providing injury care for a population in Karonga, Northern Malawi.Participants Fifty-four healthcare workers from various cadres took part.Results An overall injury health system summary map was created using those categories of action, decision and barrier that were sometimes or frequently reported. This provided a visual summary of the process following injury within the health system. For Delay 1 (seeking care) four barriers were most commonly described (by 8 of 11 facilities) these were ‘cultural norms’, ‘healthcare literacy’, ‘traditional healers’ and ‘police processes’. For Delay 2 (reaching care) the barrier most frequently described was ‘transport’—a lack of timely affordable emergency transport (formal or informal) described by all 11 facilities. For Delay 3 (receiving quality care) the most commonly reported barrier was that of ‘physical resources’ (9 of 11 facilities).Conclusions We found our novel approach combining several process mapping exercises to produce a summary map to be highly suited to rapid health system assessment identifying barriers to injury care, within a Three Delays framework. We commend the approach to others wishing to conduct rapid health system assessments in similar contexts. |
| first_indexed | 2024-03-12T15:33:57Z |
| format | Article |
| id | doaj.art-f64bf7ff48174807bb6a9958e7e1ecad |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2025-03-21T04:13:37Z |
| publishDate | 2023-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-f64bf7ff48174807bb6a9958e7e1ecad2024-07-28T23:05:09ZengBMJ Publishing GroupBMJ Open2044-60552023-06-0113610.1136/bmjopen-2022-070900Novel application of multi-facility process map analysis for rapid injury care health system assessment in Northern MalawiAndrew J M Leather0Justine Davies1John Whitaker2Rory F Rickard3Albert Dube4Abena S Amoah5Lindani Chirwa6Boston Munthali7King`s Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King`s College London, London, UKInstitute of Applied Health Research, University of Birmingham, Birmingham, UKInstitute of Applied Health Research, University of Birmingham, Birmingham, UK3 Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK8 Malawi Epidemiological and Intervention Research Unit, Chilumba, Malawi6 Department of Parasitology, Leiden University Medical Center, Leiden, The NetherlandsKaronga District Health Office, Karonga, MalawiLilongwe Institute of Orthopaedic and Neurosurgery, Lilongwe, MalawiObjectives We used the process mapping method and Three Delays framework, to identify and visually represent the relationship between critical actions, decisions and barriers to access to care following injury in the Karonga health system, Northern Malawi.Design Facilitated group process mapping workshops with summary process mapping synthesis.Setting Process mapping workshops took place in 11 identified health system facilities (one per facility) providing injury care for a population in Karonga, Northern Malawi.Participants Fifty-four healthcare workers from various cadres took part.Results An overall injury health system summary map was created using those categories of action, decision and barrier that were sometimes or frequently reported. This provided a visual summary of the process following injury within the health system. For Delay 1 (seeking care) four barriers were most commonly described (by 8 of 11 facilities) these were ‘cultural norms’, ‘healthcare literacy’, ‘traditional healers’ and ‘police processes’. For Delay 2 (reaching care) the barrier most frequently described was ‘transport’—a lack of timely affordable emergency transport (formal or informal) described by all 11 facilities. For Delay 3 (receiving quality care) the most commonly reported barrier was that of ‘physical resources’ (9 of 11 facilities).Conclusions We found our novel approach combining several process mapping exercises to produce a summary map to be highly suited to rapid health system assessment identifying barriers to injury care, within a Three Delays framework. We commend the approach to others wishing to conduct rapid health system assessments in similar contexts.https://bmjopen.bmj.com/content/13/6/e070900.full |
| spellingShingle | Andrew J M Leather Justine Davies John Whitaker Rory F Rickard Albert Dube Abena S Amoah Lindani Chirwa Boston Munthali Novel application of multi-facility process map analysis for rapid injury care health system assessment in Northern Malawi BMJ Open |
| title | Novel application of multi-facility process map analysis for rapid injury care health system assessment in Northern Malawi |
| title_full | Novel application of multi-facility process map analysis for rapid injury care health system assessment in Northern Malawi |
| title_fullStr | Novel application of multi-facility process map analysis for rapid injury care health system assessment in Northern Malawi |
| title_full_unstemmed | Novel application of multi-facility process map analysis for rapid injury care health system assessment in Northern Malawi |
| title_short | Novel application of multi-facility process map analysis for rapid injury care health system assessment in Northern Malawi |
| title_sort | novel application of multi facility process map analysis for rapid injury care health system assessment in northern malawi |
| url | https://bmjopen.bmj.com/content/13/6/e070900.full |
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