This dissertation explored the spatial pattern of user satisfaction with health services and factors, including policies that potentially explain the variation in the district-level of user satisfaction with health services. Nationwide secondary data was extracted from the 2002 Core Social Welfare Indicators Survey and the National Health Services Statistics databases obtained from National Statistics of Malawi. The National Health Facilities inventory obtained from the Malawi diffusion project was also geocoded to display the distribution of health care facilities in the country. Spatial autocorrelation and regression modeling techniques were applied on the national representative data set.

The spatial autocorrelation test revealed that districts in the southern region indicated higher than the mean level of user satisfaction with health services than districts in the northern and part of the central region of Malawi (Moran’s I = 0.40 at p < .05). The mean percentage level of household satisfaction with health services was 11.56 percent.

Two models were specified to investigate factors contributing to spatial variation of user satisfaction with health services. One was Ordinary Least Squares (OLS) regression and the second was Spatial Lag regression, which was a modified version of the conventional model. Spatial Regression model included a spatial lag term to take into account of spatial dependency in the data.

The OLS regression model explained 46% of variance and specified the district level determinants: proximity to health facilities, clinical officers’ availability and proportion of poor people who travel more than an hour to the nearest facility. The compared Spatial Lag regression model explained 55% of the variance highlighting an improvement in explanatory power by 9%. The improvement demonstrates the importance of the inclusion of spatial effect in regression analysis when using geographic based data in social research.

In addition, a qualitative study on policy implication on quality and equity of health services delivery system reveals that policies about allocation of health services are not efficiently applied, hence promoting spatial variations in the level of satisfaction with health care services. The study recommends that health care policies need to incorporate principles of social justice and distributive justice in order to provide a more equitable health care delivery system.

LLU Discipline

Social Policy and Research


Social Policy and Research


School of Science and Technology

First Advisor

Robert E. Ford

Second Advisor

Ron Mataya

Third Advisor

Sam Soret

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Medical geography -- Malawi; Geographic information systems; Multivariate analysis; Health -- Social aspects -- Malawi; Health promotion -- Malawi; Equality -- Health aspects -- Malawi; Medical economics -- Malawi; Health Policy -- Malawi; Delivery of Health Care -- Malawi; Health Services Accessibility -- Malawi; Health Care Quality Assessment -- Malawi; Medically Underserved Area -- Malawi; Socioeconomic Factors -- Malawi; Program Evaluation -- methods; Qualitative Research.



Page Count

xii; 125

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


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Loma Linda University. Del E. Webb Memorial Library. University Archives