Feasibility of Using Appreciative Inquiry to Improve Maternity Services in District Hospitals of Malawi

Friday, 28 July 2017

Zione Dembo, MSc, BSc
Technical department, Parent and Child Health Initiative (PACHI), Lilongwe, Malawi
Abi Merriel, MD, BSc
Institute of applied health research, University of Birmingham, Birmingham, United Kingdom


In Malawi as demand for maternity services continues to surpass supply and overstretch frontline healthcare providers, it is important to improve the quality of maternity care to address the burden of maternal mortality and morbidity. Appreciative Inquiry (AI) is a method through which healthcare providers can make organisational change to improve clinical care and their working lives. It harnesses the energy and ideas of staff through a four-stage cycle: Discover (how it is now), Dream (of what it could be), Design (concrete plans) and Destiny (implement plans).

The purpose of the study was to assess the feasibility of implementing Appreciative Inquiry in three district level facilities in Malawi using participatory aproach.


Between April 2015 and January, 2016 we adapted and implemented AI through participatory action cycle sessions.


We have successfully implemented AI with contributions from the entire ward team (patient attendants, nurses, clinical officers and clerks). Each team chose a different focus for their activities including ‘team spirit’ and ‘infection prevention ’. In two hospitals there have been some steps towards change, driven largely by key midwives team leaders. In one hospital the team have lobbied the management to have security guards to support their ‘traffic control’ policies in addition to successfully implementing the removal of shoes before entering the nursery and kangaroo wards. Another team has reduced the number of incidences of overfull sharps bins and waste in the incorrect bins on the ward. The main challenges faced were from constantly changing teams and the lack of time and resources to dedicate to the change process.


It is feasible to implement AI in maternity settings in Malawi when the care providers stay positive. However, the presence of committed champions seems important and health system challenges necessitate realistic goal setting; further study is needed to understand the effectiveness of the intervention