title: Bringing care to the community: expanding access to health care in rural Malawi through mobile health clinics.
abstract: METHODS
  Malawi has chronic shortages of health workers, high burdens of human immunodeficiency virus (HIV) infection and malaria and a predominately rural population. Mobile health clinics (MHCs) could provide primary health care for adults and children in hard-to-reach areas.
  
  
  OBJECTIVE
  To determine the feasibility, volume, and types of services provided by three MHCs from 2011 to 2013 in Mulanje District, Malawi.
  
  
  METHODS
  Cross-sectional retrospective study.
  
  
  RESULTS
  The MHCs conducted 309 492 visits for primary health care, and in 2013 services operated on 99% of planned days. Despite an improvement in service provision, overall patient visits declined over the study period. Malaria and respiratory and gastro-intestinal conditions constituted 60% of visits. Females (n = 11 543) significantly outnumbered males (n = 2481) tested for HIV, yet males tested HIV-positive (27%) more often than females (14%). Malaria accounted for 26 421 (35%) visits for children aged <5 years, with a significant increase in the rainy season. Implementation of rapid diagnostic testing was associated with a decline in numbers treated for malaria. Antibiotic stockouts at government clinics were associated with increased MHC visits.
  
  
  CONCLUSIONS
  MHCs can routinely provide primary health care for adults and children living in rural Malawi and complement fixed clinics. Moving from a complementary role to integration within the government health system remains a challenge.
authors.affiliation: Global AIDS Interfaith Alliance, San Francisco, California, USA, and Limbe, Malawi.
authors.forename: E
authors.initials: E
authors.lastname: Geoffroy
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: K
authors.initials: K
authors.lastname: Bissell
authors.affiliation: Global AIDS Interfaith Alliance, San Francisco, California, USA, and Limbe, Malawi.
authors.forename: E
authors.initials: E
authors.lastname: Schell
authors.affiliation: Global AIDS Interfaith Alliance, San Francisco, California, USA, and Limbe, Malawi.
authors.forename: A
authors.initials: A
authors.lastname: Bvumbwe
authors.affiliation: Médecins Sans Frontières, Medical Department, Operational Centre Brussels, MSF-Luxembourg, Luxembourg.
authors.forename: K
authors.initials: K
authors.lastname: Tayler-Smith
authors.affiliation: Médecins Sans Frontières, Medical Department, Operational Centre Brussels, MSF-Luxembourg, Luxembourg.
authors.forename: W
authors.initials: W
authors.lastname: Kizito
keywords: HIV testing; SORT IT; malaria; operational research; primary health care