Malawi’s Community Health Worker Program

By: Abigail Simkoko and Frank Gondwe

Prompted by supply chain and health quality constraints, in 2017 Malawi launched the National Community Health Strategy to develop a workforce capable of providing lifesaving interventions for serious childhood illnesses and educating about disease prevention. Health Surveillance Assistants receive 12 weeks of training to provide comprehensive services, including services such as growth monitoring and water source protection. Health Surveillance Assistants contributed to the successful achievement of the Millennium Development Goals for child health.

Background

Malawi’s community health system has faced chronic resource constraints and deficiencies in quality of services. In view of these challenges, in 2017 Malawi launched the first National Community Health Strategy (2017-2022) in which the government has committed to improve basic community health services throughout the country in collaboration with rural and urban communities.

In Malawi the term Community Health Workers (CHWs) refers to all community health team members working at rural Health Centers such as Community Health Nurses, Midwives, Medical Assistants, Environmental Health Assistants, and Health Surveillance Assistants (HSAs). This chapter focuses on HSAs. HSAs are at the top of the Malawi’s CHW Program structure.

Implementation

HSAs are trained to implement lifesaving interventions through primary health care services such as management of serious childhood illnesses (diarrhea, pneumonia and malaria). CHWs also equip families with the knowledge and skills to prevent disease. They promote good nutrition, sanitation, and hygiene, and link families to essential services.

Roles/responsibilities

The roles of HSAs are very comprehensive and have continued to change over the years as new interventions are introduced into the health sector. Currently, HSA tasks at community level include: child (and mother) vaccination, growth monitoring, sanitation, water source protection and water treatment, disease surveillance, health and nutrition talks, provision of contraceptives and supervising traditional birth attendants and village health and water committees. Other tasks include providing family planning methods, following up on TB patients and other health-related tasks as advised by the government or NGOs. Therefore, HSAs carry essential health knowledge, skills, and tools into communities and homes, and these are essential for saving lives, preventing disease, and helping children, mothers, fathers, and communities to reach their full potential and flourish.

Training

HSAs receive 12 weeks of training (8 weeks classroom-based and 4 weeks practical) followed by a final exam. Most of them have also received supplementary trainings like Integrated Community Case Management (iCCM). They also receive refresher trainings but not regularly.

Supervision

HSAs are supervised on a quarterly basis by an Assistant Environment Health Officer (AEHO), an Environment Health Officer (EHO) or a Community Health Nurse. HSAs themselves supervise other community-level cadres such as traditional birth attendants, village health and water committees.

Incentives and remuneration

HSAs receive a salary of approximately US$ 63 per month, along with per diems (payments for attending trainings and other special activities) and non-financial incentives (such as uniforms, T-shirts, bags, a bicycle, and public recognition).

Impact

HSAs have played a critical role in extending access to health services, especially in underserved, hard-to-reach areas. They are an important part of the frontline Primary Health Care team. HSAs have made notable contributions to improvements in Malawi’s health outcomes, particularly in the attainment of Millennium Development Goal for child health.