Reflections on the Salima Quality Improvement team experience
20 November 2017
Towards a Community Health Worker Gender Action Framework
09 November 2017
Find more resources relating to Malawi
In Malawi there are two main categories of community health workers: health surveillance assistants and community volunteers. The government of Malawi has a target of one health surveillance assistant for every 1,000 people. Health surveillance assistants receive eight to ten weeks’ training, are salaried and employed by the Ministry of Health, and there are currently 11,000 of them. This group constitutes a formal link between communities and health facilities. They also supervise all community-based health initiatives and volunteers within their communities. Community volunteers comprise mainly home-based care volunteers, health promoters, village health committees, and expert patients. Many programmes are turning to health surveillance assistants in efforts to improve access, coverage, and basic health outcomes.
HIV, malaria, and TB are major national health priorities. About 86,000 deaths annually are attributable to HIV-related illnesses. HIV is a significant driver of TB; malaria is endemic in Malawi and remains the leading cause of morbidity and mortality in pregnant women and children under five. The Malawi health sector is heavily under-funded, accessibility of health services is poor, only an estimated 57% of the necessary costs are covered, and there are shortages of staff and drug supplies. The public health system does not charge user fees but patients struggle to access HIV, malaria, and TB services because of the costs associated with seeking treatment. The critical shortage of health workers has resulted in increasing demand for the role of health surveillance assistants.
At the provider level health surveillance assistants are in strong demand from multiple programmes with competing priorities. Health surveillance assistants face high workloads, ill-defined job descriptions, inadequate training, and multiple responsibilities. There is a need to understand how they balance their multiple roles and to develop appropriate and responsive supervision, support, training, and human resource mechanisms.
In Malawi policy making is not always based on evidence. This is caused by lack of technical capacity among policy makers, poor packaging of research results, and research that is not locally driven or responsive to local needs. To respond to these challenges the Ministry of Health, in collaboration with the Health Research Capacity Strengthening Initiative, has developed a national health research agenda to help minimise the research gaps within Malawi. The Principal Secretary for Health chairs this collaboration and it is hoped that this will result in policy makers having much more influence on the research, which in turn will strengthen evidence based policy making. The research agenda highlights the importance of supporting community health workers. The government has also recently established a National Commission for Science and Technology as another attempt to increase national research capacity.
In Malawi REACHOUT will focus on the human resource management issues that contribute to successful close-to-community services delivery, including supervision, training, and motivation. REACHOUT will assess the extent to which the pressure of multiple responsibilities prevents health surveillance assistants from delivering equitable, effective, and efficient services, and causes inadequate referral of patients. Improvement cycles will be used to help develop evidence of the best ways to support health surveillance assistants from community and health systems perspectives. REACHOUT will respond to gaps in the national health research agenda. It will also strengthen the technical capacity of policy makers to understand research results and use evidence in policy making. REACHOUT will also work to understand how the National Commission for Science and Technology coordinates research in response to the needs of policy makers. The capacity for health economics research in Malawi is weak so this will be strengthened along with the capacity to use mixed research methodologies.
This project is funded by the European Union.