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The role of the traditional leader in implementing maternal, newborn and child health policy in Malawi

Walsh, Aisling ORCID: 0000-0002-5312-5101, Matthews, Anne ORCID: 0000-0002-4845-869X, Manda-Taylor, Lucinda ORCID: 0000-0001-8149-0897, Brugha, Ruairi ORCID: 0000-0003-0729-0197, Mwale, Daniel, Phiri, Tamara ORCID: 0000-0002-8758-4648 and Byrne, Elaine ORCID: 0000-0001-7322-277X (2018) The role of the traditional leader in implementing maternal, newborn and child health policy in Malawi. Health Policy and Planning,, 33 (8). pp. 879-887. ISSN 0268-1080

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Abstract

Traditional leaders play a prominent role at the community level in Malawi, yet limited research has been undertaken on their role in relation to policy implementation. This article seeks to analyse the role of traditional leaders in implementing national maternal, newborn and child health (MNCH) policy and programmes at the community level. We consider whether the role of the chief embodies a top-down (utilitarian) or bottom-up (empowerment) approach to MNCH policy implementation. Primary data were collected in 2014/15, through 85 in-depth interviews and 20 focus group discussions in two districts in Malawi. We discovered that traditional leaders play a pivotal role in supporting MNCH service utilization, through mobilization for MNCH campaigns, and encouraging women to give birth at the health facility rather than at home or in the community setting. Women and their families responded to bylaws to deliver in the facility out of respect for the traditional leader, which is ingrained in Malawian culture. Fines were imposed on women for delivering at home, in the form of goats, chickens and money. Fear and coercion were often used by traditional leaders to ensure that women delivered at the health facility. Chiefs who failed to enforce these bylaws were also fined. Although the role of the traditional leader was often positive and encouraging in relation to MNCH service utilization, this was sometimes carried out in a coercive manner. Results show evidence of a utilitarian top-down model of policy implementation, where the goal of health service utilization justified the means, through encouragement, fear, punishment or coercion. Although the bottom-up approach would be associated with a more empowerment approach, it is unlikely that this would have been successful in Malawi, given the hierarchical nature of society. Further research on policy implementation in the context of community participation is needed.

Item Type:Article (Published)
Refereed:Yes
Uncontrolled Keywords:Malawi; traditional leader; maternal; newborn and child health; community health; top-down policy; utilitarian; empowerment; community participation
Subjects:Medical Sciences > Pediatric nursing
DCU Faculties and Centres:DCU Faculties and Schools > Faculty of Science and Health > School of Physical Sciences
Publisher:Oxford University Press
Official URL:https://dx.doi.org/10.1093/heapol/czy059
Copyright Information:© 201 The Authors
Funders:Irish Aid/Higher Education Authority (of Ireland) 2012–2015 (Grant Number: COSYST_MNCH 1513: Irish Aid.), as part of the Programme of Strategic Cooperation
ID Code:27752
Deposited On:14 Sep 2022 16:02 by Thomas Murtagh . Last Modified 14 Sep 2022 16:02

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