Malawi is among the five sub-sahara Africa presenting with very high maternal mortality rates, 984 per 100,000 live. Inadequate access to and under-utilisation of quality maternal health care services was identified as a major reasons for poor health of the women in Malawi. As a response to this situation, the Malawi government initiated the implementation of skilled attendance approach to delivery of maternal health care in 2006.
The main objectives of the study was to identify the patterns and determinants of utilisation of skilled attendace for maternal health care services in the catchment areas of two rural health centres in the northern part of Malawi. This study used methodological triangulation methods, quantitative study using a descriptive cross sectional survey and qualitative; semistructured interviews and observations.
Results shows that, utilisation of maternal health care services at the study sites has improved compared to the 2004 demographic health survey reports on maternal health care service utilisation in Malawi. Utilisation of skilled care for child birth was much higher than of the other components of maternal health care services. Maternal health services at Bolero health centre seemed to be more accessible and available than at kande. Hence utilisation of most components of care were high at Bolero health centre. Higher odds for utilisation of skilled care at birth was associated with women who made atleast 4 antenatal care visit, who lived within 5km from the health centre. Low utilisation of maternal health care was associated with womens’ low autonomy; women with lower levels of education, younger, married, had lower rates of utilisation of most components of maternal health care.
The malawian strategy of implementing skilled attendance achieved is unique as it aims apromoting total utilisation of skilled care, some lessons can be learnt on how the implementation is done at Bolero health centre . However, provision of quality of care remains a challenge for Malawi. There is need for strengthening supportive supervision and human resource management systems.