#HealthForAll

ichc2017.org

#HealthForAll

ichc2017.org

History and Future

of Community

Health Workers

in Malawi

Ministry of Health

March 27, 2017

Malawi Ministry of Health2

Malawi Context

3Sources: CIA Factbook 2016; Bowie & Mwase Malawi Burden of Disease data sets, 2011,

Malawi Demographic Health Survey 2015-16

84%Rural

24%Not within 8km of

health facility

4%Rural access to

power

61yrsLife expectancy

53%Of deaths caused by top 4 illnesses

(HIV/AIDS, LRI, Diarrhoeal, Malaria)1

Malawi’s population is 17 million

Community Health in Malawi

Malawi Ministry of Health 4

Before the nineties Malawi’s community health was delivered by:

Volunteers Health Inspectors Primary Health Nurses

Malawi Ministry of Health 5

Since then until Since then until Since then until Since then until

today community today community today community today community

health has primarily health has primarily health has primarily health has primarily

been delivered by been delivered by been delivered by been delivered by

Health Surveillance Health Surveillance Health Surveillance Health Surveillance

Assistants (HSAs)Assistants (HSAs)Assistants (HSAs)Assistants (HSAs)

HSAs are full-time CHWs employed by MOH

Malawi Ministry of Health 6

HSA’s & Senior HSA’s are over half of MoH’s clinical staff

Medical /

Clinical Officer;

1,4

Nursing Officer; 1,1

Nurse Midwife

Technician; 3,5

Medical

Assistan

t; 1,2

Pharmacy and Lab

Technician; 0,6

Senior

HSA; 1,2

HSA; 8,0

MoH Clinical Staff (thousands)HSAs are meant to reside

in their catchment area

The recommended HSA to

population ratio is 1 to

1,000 people

HSAs have a wide range of responsibilities and must work alongside key partners

Malawi Ministry of Health 7

Health promotion

Prevention

Disease surveillance

Basic curative services

HSAs

Community Health

Volunteers

Village Health

Committee

Community Health

Nurses

Env. Health Officers

HSA Responsibilities HSA Key Partners

Community health activities have contributed to significantly improved health outcomes for Malawi

Malawi Ministry of Health 8

135

76

42

234

133

64

1992 2004 2016

De

ath

s p

er

1,0

00

Year

Infant Mortality Rate & Under 5 Mortality

Rate

Infant Mortality Under 5 Mortality

46%

24%

2011 2014

Malaria Case Fatality Rate

14%

6%

2008 2016

Proportion of Households with

no toilet facility

Sources: HSSP II Situation Analysis October 2016

However, Malawi continues to face sub-optimal health coverage and outcomes

Malawi Ministry of Health 9

81%

71%

2010 2016

Children aged 12-23 months

fully immunized

55%

45%

2010 2016

% of Children Under 5 years

sleeping under ITN

574

155

2015 2016 Target

Maternal Mortality Rate per

100,000 live births

Sources: HSSP Situation Assessment 2016, MDG End Survey 2014

Significant resource constraints and inconsistencies of community Significant resource constraints and inconsistencies of community Significant resource constraints and inconsistencies of community Significant resource constraints and inconsistencies of community health services contribute to these subhealth services contribute to these subhealth services contribute to these subhealth services contribute to these sub----optimal outcomesoptimal outcomesoptimal outcomesoptimal outcomes

Malawi Ministry of Health 10

51% 51% 51% 51% of HSAs not staying in

their Catchment Area

+7,000 +7,000 +7,000 +7,000 New HSA’s needed to

reach policy level

0 0 0 0 Senior HSAs trained in

supervision

NO NO NO NO National Community

Health Strategy or Policy

Malawi Ministry of Health 11

The MOH is acting quickly to address thisThe MOH is acting quickly to address thisThe MOH is acting quickly to address thisThe MOH is acting quickly to address this

The Community Health Services (CHS) The Community Health Services (CHS) The Community Health Services (CHS) The Community Health Services (CHS)

section has been strengthened to section has been strengthened to section has been strengthened to section has been strengthened to

address these challenges as the overall address these challenges as the overall address these challenges as the overall address these challenges as the overall

community health coordinator for Malawicommunity health coordinator for Malawicommunity health coordinator for Malawicommunity health coordinator for Malawi

Malawi Ministry of Health 12

Our Vision:

To improve the livelihoods of all peopleall peopleall peopleall people in

Malawi.

Our Mission

Malawi Ministry of Health 13

To ensure quality, integrated community health services are

affordable, culturally acceptable, scientifically appropriate,

and accessible to everyeveryeveryevery householdhouseholdhouseholdhousehold through community

participation to reduce deaths and the socio-economic

burden of illness in Malawi.

In 2017 the CHS section has made significant progress through teamwork, partnership, and participation

Malawi Ministry of Health 14

Situation Assessment Developed Partnerships and

Mobilized Resources

Consultative Workshops

Malawi’s first ever National Community Health Strategy

But we are just getting started…

Malawi Ministry of Health 15

Phase 1

Strengthen the System

Phase 2

Implement of the System

Assessing the System

Clarify roles and teams for CHWs

Develop Integrated Training Curriculums

Establish standard CHW supply list

Establish CHW HR and Residency Policy

Integrated community health indicators

Hire more CHWs

Train CHWs on integrated service

Provide all CHWs with critical supplies

CHW housing and service structures

mHealth and digital data collection

Malawi Ministry of Health 16

This is more than just a

strategy.

With a stronger

community health system

we can all contribute to

improved livelihoods for

all people in Malawi

#HealthForAll

ichc2017.org

#HealthForAll

ichc2017.org