The Difference in Clinical Knowledge Between Staff Employed at Faith-based and Public Facilities in Malawi




healthcare ownership, non-profit faith-based providers, clinical knowledge, quality of care, low-income country, Malawi


Empirical evidence concerning differences in the quality of service offered by faith-based and public healthcare facilities in low- and middle-income countries is limited. This study contributes by examining the difference in clinical knowledge of staff based at faith-based and government facilities in Malawi.  Using vignette data for individual healthcare workers from the 2018/2019 Malawi Harmonised Health Facility Assessment we undertake regression analysis of the relationship between ownership and the probability of respondents making the correct diagnosis, treatment and management choices for eight childhood, adult and pregnancy-related cases after accounting for differences across healthcare workers, facilities and geography. Staff employed at faith-based facilities, compared to staff at public facilities, are found to be less likely to correctly diagnose and treat children presenting with diarrhoea with severe dehydration but are better at diagnosing and treating adults presenting with diabetes.  We do not find any differences in the diagnosis and treatment of the remaining six cases. Hence, we do not find compelling evidence of an overall difference in clinical knowledge across staff at faith-based compared to public facilities in Malawi.


Author Biographies

Wiktoria Tafesse, University of York

PhD, Centre for Health Economics, University of York 

Martin Chalkley, University of York

PhD, Professor, Centre for Health Economics, University of York


Das J, Hammer J. Quality of primary care in low-income countries: facts and economics. Annu Rev Econ. 2014;6(1):525–53.

Sloan F. Not-for-profit ownership and hospital behavior. In: Anthony C, Joseph N, editors. Handbook of health economics. 2000. pp. 1141–74. 1B.

Herrera C, Rada G, Kuhn-Barrientos L, Barrios X. Does ownership matter? An overview of systematic reviews of the performance of private for-profit, private not-for-profit and public healthcare providers. PLoS ONE. 2014 9(12): e93456.

Olivier J, Tsimpo C, Gemignani R, Shojo M, Coulombe H, Dimmock F, et al. Understanding the roles of faith-based health-care providers in Africa: review of the evidence with a focus on magnitude, reach, cost, and satisfaction. Lancet. 2015; 386 (10005): 1765–75.

Olivier J, Wodon Q, Tsimpo C. Satisfaction with faith-inspired health care services in Africa: review and evidence from household surveys. In: Olivier J, Wodon Q, editors. The comparative nature of faith-inspired health care providers in Sub-Saharan Africa. Washington, DC; HNP Discussion Paper, World Bank: 2012. pp. 6-28.

Whyle E, Olivier J. Models of engagement between the state and the faith sector in sub-Saharan Africa – a systematic review. Dev Pract. 2017; 27(5): 684-97.

Kamugumya D, Olivier J. Health system’s barriers hindering implementation of public-private partnership at the district level: a case study of partnership for improved reproductive and child health services provision in Tanzania. BMC Health Serv Res. 2016; 16(1): 596–609.

Di Giorgio L, Evans DK, Lindelow M, Nguyen SN, Svensson J, Wane W, et al. Analysis of clinical knowledge, absenteeism and availability of resources for maternal and child health: a cross-sectional quality of care study in 10 African countries. BMJ Glob Health. 2020 Dec;5(12):e003377. bmjgh-2020-003377

Leonard KL, Masatu MC. The use of direct clinician observation and vignettes for health services quality evaluation in developing countries. Soc Sci Med. 2005 Nov;61(9):1944-51.

Das J, Hammer J. Money for nothing: the dire straits of medical practice in Delhi, India. J Dev Econ. 2007;83(1):1-36.

Donabedian A. Evaluating the quality of medical care. Milbank Q. 2005;83(4):691-729.

Levin A, Dmytraczenko T, McEuen M, Ssengooba F, Mangani R, Van Dyck G. Costs of maternal health care services in three anglophone African countries. Int J Health Plann Manage. 2003 Jan-Mar;18(1):3-22.

Widmer M, Betran AP, Merialdi M, Requejo J, Karpf T. The role of faith-based organizations in maternal and newborn health care in Africa. Int J Gynaecol Obstet. 2011 Sep;114(3):218-22.

Banuri S, de Walque D, Keefer P, Haidara OD, Robyn PJ, Ye M. The use of video vignettes to measure health worker knowledge. Evidence from Burkina Faso. Soc Sci Med. 2018 Sep;213:173 180.

Peabody JW, Luck J, Glassman P, Dresselhaus TR, Lee M. Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality. JAMA. 2000 Apr 5;283(13):1715-22.

Leonard KL, Masatu MC. Variations in the quality of care accessible to rural communities in Tanzania. Health Aff (Millwood). 2007 May-Jun;26(3):w380-92.

Das J, Hammer J, Leonard K. The quality of medical advice in low-income countries. J Econ Perspect. 2008 Spring;22(2):93-114.

Government of Malawi, Ministry of Health and Population, Malawi Harmonized Health Facility Assessment, 2019.

Christian Health Association of Malawi, 2016, Christian Health Association of Malawi, CHAM 2016 Annual Report.

Fort A. The quantitative and qualitative contributions of faith based organizations to healthcare: the Kenya case. Christ J Global Health. 2017; 4(3); 60-71.

Khuluza F, Kigera S, Heide L. Low prevalence of substandard and falsified antimalarial and antibiotic medicines in public and faith-based health facilities of Southern Malawi. Am J Trop Med Hyg. 2017 May;96(5):1124-35.

Barden-O’Fallon J. Availability of family planning services and quality of counseling by faith-based organizations: a three country comparative analysis. Reprod Health. 2017. May 8;14(1):57.

Tafesse W, Chalkley M. Faith-based provision of sexual and reproductive healthcare in Malawi. Soc Sci Med. 2021 Aug;282.113997.

Serneels P, Montalvo JG, Pettersson G, Lievens T, Butera JD, Kidanu A. Who wants to work in a rural health post? The role of intrinsic motivation, rural background and faith-based institutions in Ethiopia and Rwanda. Bull WHO. 2010 May;88(5):342-9.

Tumlinson K, Speizer IS, Curtis SL, Pence BW. Accuracy of standard measures of family planning service quality: findings from the simulated client method. Studies in Family Planning. 2014;45(4):443-70.




How to Cite

Tafesse, W., & Chalkley, M. (2024). The Difference in Clinical Knowledge Between Staff Employed at Faith-based and Public Facilities in Malawi. Christian Journal for Global Health, 11(1), 46–63.