The implementation of environmental health policies in health care facilities: The case of Malawi |
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Institution: | 1. Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom (Dr Merriel);2. Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom (Dr Larkin);3. Maternal Health, Aberdeen, United Kingdom (Dr Hussein);4. Fintray Gardens, Hatton of Fintray, Aberdeen, Scotland (Dr Hussein);5. Parent and Child Health Initiative, Lilongwe, Malawi (Mr Makwenda);6. Malawi University of Science and Technology, Limbe, Malawi (Dr Malata);7. Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom (Dr Coomarasamy);8. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom (Dr Merriel). |
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Abstract: | Establishing and maintaining safe and sufficient environmental health (EH) conditions in health care facilities (HCFs) is important to prevent and control infections. In 2018, the Government of Malawi finalized an environmental health policy that defines specific targets and programs for EH in healthcare settings. This and other related policies have been used since 2010 as a guide for EH practice in HCFs, but the implementation of these policies has been incomplete to-date. This study qualitatively examines the successes and shortcomings of implementing these policies in Malawi's public HCFs. Thematic analysis of interviews with 53 respondents from all levels of government was used to identify the successes of the policies and the barriers to effective implementation using Contextual Interaction Theory. The greatest identified strength lies in the design of the EH department and its ability to connect individual HCFs and EH actors directly to the policy-making level of government. Identified barriers to implementation include: insufficient financial support; lack of human resources; incomplete reporting; poor stakeholder coordination; and insufficient training of EH actors. We recommend refresher trainings for all EH actors, the establishment of a directorate level EH position, and strengthened coordination to improve the collection, analysis, and reporting of monitoring data to enable EH actors to advocate for the additional funding needed to develop programs for EH personnel and to apply effective EH interventions. |
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Keywords: | Policy implementation Environmental health Health care facilities Malawi Contextual interaction theory Decentralization |
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