title: Non-use of Formal Health Services in Malawi: Perceptions from Non-users.
abstract: BACKGROUND
  The study upon which this paper is based was undertaken to understand users' and non-users' perceptions concerning facilitators and barriers to equitable and universal access to health care in resource-poor countries such as Malawi. In this study, non-users of health services were defined as people who were not in need of health services or those who had stopped using them due to significant barriers.
  
  
  METHODS
  A total of 80 interviews with non-users of health services were conducted in Rumphi, Ntchisi, Phalombe and Blantyre Districts of Malawi. Interviews focused on why informants were not using formal health services at the time of data collection. In order to identify non-users, snowballing was used health surveillance assistants, village headmen and community members also helped. One focus group discussion was also conducted with non-users of health services who were members of the Zion Church.
  
  
  RESULTS
  Informants described themselves as non-users of health services due to several reasons: cost of health services; long distances to health facilities; poor attitude of health workers; belief in the effectiveness of traditional medicines; old age and their failure to walk. Others were non-users due to their disability; hence they could not walk over long distances or could not communicate effectively with health providers. Some of these non-users were complete non-users, namely members of the Zion Church and those who believed in traditional medicine, and they stated that nothing could be done to transform them into users of health services. Other non-users stated that they could become users if their challenges were addressed e.g. for those who were non-users of health services due to poor attitudes of health workers, they stated that if these health workers were transferred they would be able to access health services.
  
  
  CONCLUSIONS
  Public health education targeting both health workers and non-users, ensuring a functional outreach program and addressing other health system challenges such as shortage of drugs and human resources would assist in transforming non-users into users of health services.
authors.affiliation: Centre for Social Research, Chancellor College, University of Malawi, Zomba, Malawi.
authors.forename: A C
authors.initials: AC
authors.lastname: Munthali
authors.affiliation: Nossal Institute for Global Health, University of Melbourne, Victoria, Australia ; Centre for Global Health & School of Psychology, Trinity College Dublin, Dublin, Ireland.
authors.forename: H
authors.initials: H
authors.lastname: Mannan
authors.affiliation: Centre for Global Health & School of Psychology, Trinity College Dublin, Dublin, Ireland ; Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: M
authors.initials: M
authors.lastname: MacLachlan
authors.affiliation: Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: L
authors.initials: L
authors.lastname: Swartz
authors.affiliation: Department of Population Studies, Chancellor College, University of Malawi, Zomba, Malawi.
authors.forename: C M
authors.initials: CM
authors.lastname: Makupe
authors.affiliation: Department of Sociology, Chancellor College, University of Malawi, Zomba. Malawi.
authors.forename: C
authors.initials: C
authors.lastname: Chilimampunga
mesh_terms: D001291:Attitude of Health Personnel; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006801:Humans; D007407:Interviews as Topic; D008295:Malawi; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D036301:Qualitative Research