Ownership and Quality of Primary Care: A Comparative Analysis of Public and Faith-Based Providers in Malawi

Non-profit, faith-based providers (FBPs) play a major role in primary care delivery across Sub-Saharan Africa and are increasingly integrated into national health systems, yet evidence on how the quality of faith-based primary care compares to that of public providers remains limited. Using healthcare worker observations, patient exit interviews, and patient follow-up data from Malawi, we compare consul-tation duration, clinical content, and patient-reported outcomes across faith-based and government facilities. Ordinary least squares estimates controlling for facility-, provider-, and shift-level characteristics, as well as patient health conditions, indicate that FBPs conduct significantly longer consultations, by around 1.9 minutes (75% of the sample mean), and perform a greater number of key clinical processes, including physical examinations and diagnostic tests. Patient-reported data corroborate these findings. Patients attending FBPs report receiving more tests and examinations and, at follow-up, are more likely to state that their treatment is working. These findings provide new evidence that publicly supported FBPs de-liver higher-quality primary care on both process measures and patient-reported outcomes, underscoring the importance of accounting for provider ownership when examining variation in access to quality primary care in Sub-Saharan Africa.