Quality of Basic Maternal and Neonatal Care Signal Function and Clients Perceived Care in Health Facilities in Malawi: An Analysis of the National Health Services Survey Using 2013-2014 Malawi SPA Survey Data

Background: Maternal and neonatal healthcare is a critical component of overall health services, and its quality profoundly influences health outcomes. This study examines the quality of basic maternal and neonatal care signal functions and assesses clients' perceptions of care in health facilities in Malawi, utilizing data from the 2013-2014 Malawi service provision assessment (MSPA) survey. Methods: A cross-sectional analysis was conducted using nationally representative data from the MSPA survey of 2013-14. Key signal functions related to essential maternal and neonatal care were evaluated, encompassing antenatal care, emergency and basic maternal and newborn care, and essential newborn care. Additionally, clients' perspectives on the antenatal care (ANC) received through exit interviews were analyzed. Statistical techniques, including descriptive statistics and multivariate regression models, were employed to identify factors influencing the observed variations in care quality and client satisfaction. Results: We found that most facilities do not have all the signal functions with 66.75% for public facilities and 77.5% for private facilities. We also discovered that hospitals highly performed than health centers and clinics. We also noted the presence of minor differences between public and private facilities. Generally, we found that for both facility managing authority types of facilities scored poorly in availability of basic quality of maternal and neonatal care signal functions and there are no significant differences in availability of basic quality of maternal and neonatal care signal functions in the country. Client’s perceptions on facility quality of services through ANC exit interviews were not consistently supported by services provided. Conclusion: This study contributes essential insights into the state of maternal and neonatal health care in Malawi, emphasizing both clinical signal functions and client perspectives. The results have implications for shaping policies and intervention aimed at improving the quality of maternal and neonatal care, ultimately enhancing health outcomes in Malawi.