Moving to a strong(er) community health system: analysing the role of community health volunteers in the new national community health strategy in Malawi

Angwenyi V, Aantjes C, Kondowe K, Mutchiyeni JZ, Kajumi M, Criel B, Lazarus JV, Quinlan T, Bunders-Aelen J

Since the Alma Ata Declaration in 1978, community health volunteers (CHVs) have been at the forefront, providing health services, especially to underserved communities, in low-income countries. However, consolidation of CHVs position within formal health systems has proved to be complex and continues to challenge countries, as they devise strategies to strengthen primary healthcare. Malawi's community health strategy, launched in 2017, is a novel attempt to harmonise the multiple health service structures at the community level and strengthen service delivery through a team-based approach. The core community health team (CHT) consists of health surveillance assistants (HSAs), clinicians, environmental health officers and CHVs. This paper reviews Malawi's strategy, with particular focus on the interface between HSAs, volunteers in community-based programmes and the community health team. Our analysis identified key challenges that may impede the strategy's implementation: (1) inadequate training, imbalance of skill sets within CHTs and unclear job descriptions for CHVs; (2) proposed community-level interventions require expansion of pre-existing roles for most CHT members; and (3) district authorities may face challenges meeting financial obligations and filling community-level positions. For effective implementation, attention and further deliberation is needed on the appropriate forms of CHV support, CHT composition with possibilities of co-opting trained CHVs from existing volunteer programmes into CHTs, review of CHT competencies and workload, strengthening coordination and communication across all community actors, and financing mechanisms. Policy support through the development of an addendum to the strategy, outlining opportunities for task-shifting between CHT members, CHVs' expected duties and interactions with paid CHT personnel is recommended.

December 5, 2018
Year of publication
2018
Resource types
Journal and research articles
Countries
Tags
community health volunteers, underserved communities, health surveillance assistants, community-based interventions, community health systems

Similar Resources

Malawi, like other countries with a generalized HIV epidemic, is striving to reach the ambitious targets set by UNAIDS known as the three 90's for testing, provision of antiretroviral therapy and viral suppression.

South Africa has implemented a community-based HIV programme (CBHP) in its primary healthcare (PHC) re-engineering strategy that aims to improve public healthcare delivery.

Option B+ for prevention of mother-to-child transmission (PMTCT) specifies treating all HIV-positive women with antiretroviral therapy (ART) regardless of CD4 count. This simplified approach enhances countries' capacity to reach national HIV targets and contribute to the global 90-90-90 goals.…

Integrating high-quality nutrition care, support, and treatment (NCST) services into service delivery platforms for HIV and tuberculosis (TB) requires providing healthcare workers with guidelines, job aids, and monitoring tools to facilitate effective prevention and treatment of malnutrition.

The Pediatric-Adolescent Treatment Africa (PATA) and the Positive Action for Children Fund (PACF) have worked across 9 countries and facilitated 36 clinic-community collaborations through their partnership on the three-year Clinic-CBO Collaboration (C3) Programme, which aims to…

Swaziland has one of the highest adult HIV prevalence rates worldwide, 27%; with approximately 200,000 people 15 years and older living with HIV. Swaziland and many other countries in sub-Saharan Africa have adopted universal test-and-treat (UTT) policies.

The ever-growing HIV treatment programs in sub-Saharan Africa (SSA) present local policy makers with complex decision dilemmas, as international guidelines emphasize the need for expanded access to antiretroviral therapy (ART), yet funding has flatlined.

The scale-up of antiretroviral therapy (ART) in Malawi was based on a public health approach adapted to its resource-poor setting, with principles and practices borrowed from the successful tuberculosis control framework.

This study aimed to evaluate the impact of clinic-based prevention of mother-to-child transmission (PMTCT) community support by trained lay health workers in addition to standard clinical care on PMTCT infant outcomes.