Community health worker involvement across domains and national infectious disease programmes in rural Madagascar: evidence of fragmentation and determinants of engagement

Authors: Emmanuel Harizaka Andriamasy, Haingotiana Razafimanantsoa, Michel Tiaray Harison, Lydia Raveloarisoa, Onja Gabrielle Ravololohanitra, Sandro Andry Nathia Randrianirisoa, Nadine Muller

This study examined how Community Health Workers (CHWs) in rural Madagascar were involved in different health programmes, with a focus on HIV/AIDS and tuberculosis (TB). Among 408 CHWs surveyed, nearly all were involved in maternal and child health and malaria activities, but only about one in four were involved in TB and about one in five in HIV/AIDS, mainly through community education. CHWs were more likely to be involved in HIV/AIDS and TB when they had clear written guidance and disease-specific training. The findings suggest that stronger training and clearer roles could help CHWs play a greater role in HIV and TB services.