The effects of environmental health services on patient well-being and quality of care: A qualitative study in Malawi’s public healthcare facilities

Healthcare facility environmental conditions - including water, sanitation, hygiene, waste management, cleaning, energy, and building design - contribute to safe and quality care delivery. However, how environmental conditions shape patient experiences have not been systematically assessed. We conducted a case study to examine the impacts of environmental conditions on patient well-being and quality of care through interviews with 56 patients and caregivers from all service delivery levels and geographic areas in public healthcare facilities in Malawi. We analyzed interview data to identify impacts of environmental conditions on multiple dimensions of well-being (physical, mental, social, and economic well-being) and quality of care (patient-centeredness, equity, safety, efficiency, and timeliness). Many participants reported poor environmental conditions and extensive impacts on well-being. Patients felt stress, fear of infection, and dissatisfaction with inadequate water, sanitation, and hygiene services. To cope with poor conditions, patients and family caregivers cleaned areas, fetched water, or spent money on supplies, leading to economic impacts. Facility conditions influenced perceptions of dignified and respectful care. Inadequate or overcrowded conditions led to negative encounters with other patients and healthcare workers. Patients felt more satisfied and respected when they observed healthcare workers performing hand hygiene or maintaining the facility. Findings demonstrate that environmental conditions influence numerous aspects of patient experience and well-being. The development of quantitative measures for well-being and quality of care would allow programs to routinely monitor these impacts and detect changes over time. Patient perspectives and priorities should be considered in future efforts to evaluate and improve environmental conditions in healthcare facilities.