"We cant develop standards for a thing which doesnt belong to us": Assessment of infrastructure, behaviours and user satisfaction of Guardian Waiting Shelters for secondary level hospitals in southern Malawi.

BackgroundGuardian Waiting Shelters (GWSs) are an essential component of the Malawis health care system as they serve as a temporary home for patient guardians while taking care of their relatives admitted to the hospital. Despite GWSs valuable role in healthcare settings, there have been few studies on the specific experiences, infrastructure, and conditions provided at these facilities. The study examines GWS management structures and conditions, as well as guardian satisfaction and perception of health risks related to GWS use. MethodsIn this cross-sectional, mixed-methods study, we assessed 12 GWSs from 12 districts in the southern region of Malawi. Qualitative data included interviews (n=149) and focus group discussions with patient guardians (n=72), as well as interviews with GWS caretakers (n=5), representatives from Hospital Management (n=12) and Hospital Advisory Committees (n=11). Quantitative data included structured assessments (n=12) of infrastructure present and used at GWSs. Descriptive statistics and qualitative thematic analysis were utilized for data analysis, and a problem tree analysis was used to triangulate and summarize the findings. Results249 participants, including 221 being patient guardians, participated across the 12 GWSs. Each GWS had an average of 100 users daily, primarily middle-aged females (71%). There was a lack of clear and consistent management and responsibility for GWS operation and maintenance. GWS infrastructure conditions were poor, with inadequate functional sleeping rooms, insufficient access to water and sanitation facilities, and limited facilities for hygienic food preparation. Notably, 50% of the GWSs lacked water access, and a quarter had non-functional toilets. Overall, guardians felt unsafe and at risk of disease transmission when staying within GWS. ConclusionStudy findings highlight lack of clear, consistent GWS ownership as a root cause of challenges in GWSs. Clear policy and operational standards must be established for effective management and smooth functioning of GWSs in Malawi.