Aims Observational assessment of the change in number and type of admissions after an increase in fees at Trinity Hospital in rural, Southern Malawi.
Methods Trinity Hospital is a (not for profit) Mission hospital. The local population are mainly subsistence farmers. It is 70 km from the nearest free government hospital. For 60 years the medical care has been subsidised by a small Christian charity. By 2011, the charity had been unable to provide funding for over a year. Government support for under five care was withdrawn. From February 2011 fees were increased to cover costs.
The number of patients admitted for the six months from February, and their final diagnosis were recorded and compared to the previous 3 years. Analysis was done using MS Excel 2010.
Results There was a 54% fall in paediatric admissions, compared with a one-third decrease in adult admissions and outpatient attendance. This was despite an increase in admissions for meningitis (117%) and malnutrition (29%). The results are summarised in the table 1 below.
In-hospital mortality fell during the same period.
Conclusion Increased cost of admission and treatment made the hospital financially inaccessible, particularly for children. Although clinical management changes made during this period would account for some of the fall in admissions, the increase in the number of patients with malnutrition and meningitis implies that there was a delay in seeking medical attention. The disproportionate fall in paediatric admissions compared with adult admissions, suggests children were affected more than adults. This shows that the cost of providing basic medical care to the rural population of Malawi is too great to be funded by individual families in rural areas, and extra support is required. The management and governors of the hospital have been made aware of the fall in admissions and are seeking ways to increase funding. The current global economic situation could result in similar problems at other small hospitals in the developing world.