Characterising the performance measurement and management system in the primary health care systems of Malawi.

Background:  Performance Measurement and Management (PMM) systems are levers that support key management functions in health care systems. Just like many low- and middle-income countries (LMICs), Malawi strives to improve performance via evidence-based decision making and a suitable performance culture.

Aim:  This study sought to describe PMM practices at all levels of primary health care (PHC) in Malawi.

Setting:  This study targeted three levels of PHC, namely the district health centres (DHCs), the zones, and the ministry headquarters.

Methods:  This was a qualitative exploratory research study where decision-makers at each level of PHC were engaged using key-informant interviews (KII) and focus group discussions (FGDs).

Results:  We found that there is a weak link among levels of PHC in supporting PMM practices leading to poor dissemination of priorities and goals. There is also failure to appropriately institute good PMM practices, and the use of performance information was found to be limited among decision-makers.

Conclusion:  Though PMM is acknowledged to be key in supporting health service delivery systems, Malawi's PHC system has not fully embarked on making this a priority. Some challenges include unsupportive culture and inadequate capacity for PMM.Contribution: This study contributes to the understanding of the PMM processes in Malawi and further highlights the salient challenges in the use of information for performance management. While the presence of policies on PMM is acknowledged, implementation studies that deal with challenges are urgent and imperative.