Abstract
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 preexisting 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.
Original language | English |
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Article number | e000996 |
Journal | BMJ global health |
Volume | 3 |
DOIs | |
Publication status | Published - 1 Jan 2018 |
Funding
► 2005: national funding through the National AIDS Council to support civil society organisations and CBO/ FBO programmes in HIV/AIDS activities ► 2015: direct funding to CBO/FBOs from the National AIDS Council stopped 1Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands 2Unit of Equity and Health, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium 3Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain 4Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Westville Campus, Durban, South Africa 5Phalombe District Health Office, Ministry of Health, Phalombe, Malawi Acknowledgements We are grateful to the CBO/FBO volunteers, health managers and officials working in Phalombe District for their participation in this research. We wish to thank Dadirai Khambadza, Joseph Chomanika and Vanessa Kumwenda for their support with data collection. We thank Madam Mary Ganiza, Health Secretary, the Archdiocese of Blantyre Catholic Health Commission for supporting implementation of this research.