Abstract
BackgroundAs low- and middle-income countries face continued shortages of human resources for health and the double burden of infectious and chronic diseases, there is renewed international interest in the potential for community health workers to assume a growing role in strengthening health systems. A growing list of tasks, some of them complex, is being shifted to community health workers’ job descriptions. Health Surveillance Assistants (HSAs) - as the community health worker cadre in Malawi is known - play a vital role in providing essential health services and connecting the community with the formal health care sector. The objective of this study was to understand the performed versus documented roles of the HSAs, to examine how tasks were prioritized, and to understand HSAs’ perspectives on their roles and responsibilities.MethodsA situational analysis of the HSA cadre and its contribution to the delivery of health services in Zomba district, Malawi was conducted. Focus groups and interviews were conducted with 70 HSAs. Observations of three HSAs performing duties and work diaries from five HSAs were collected. Lastly, six policy-maker and seven HSA supervisor interviews and a document review were used to further understand the cadre’s role and to triangulate collected data.ResultsHSAs performed a variety of tasks in addition to those outlined in the job description resulting in issues of overloading, specialization and competing demands existing in the context of task-shifting and prioritization. Not all HSAs were resistant to the expansion of their role despite role confusion and HSAs feeling they lacked adequate training, remuneration and supervision. HSAs also said that increasing workload was making completing their primary duties challenging. Considerations for policy-makers include the division of roles of HSAs in prevention versus curative care; community versus centre-based activities; and the potential specialization of HSAs.ConclusionThis study provides insights into HSAs’ perceptions of their work, their expanding role and their willingness to change the scope of their practice. There are clear decision points for policy-makers regarding future direction in policy and planning in order to maximize the cadre’s effectiveness in addressing the country’s health priorities.
Highlights
As low- and middle-income countries face continued shortages of human resources for health and the double burden of infectious and chronic diseases, there is renewed international interest in the potential for community health workers to assume a growing role in strengthening health systems
Globally, 57 countries face critical heath workforce shortages and more than four million health workers are needed to fill this gap [1]. Such shortages of human resources for health combined with the double burden of infectious and chronic diseases contribute to increased mortality and morbidity, impede the achievement of the health-related Millennium Development Goals, and hinder economic growth in low- and middle-income countries
The role of the Health Surveillance Assistant (HSA) has continued to expand beyond prevention to include tasks that are curative in order to respond to disease priorities
Summary
As low- and middle-income countries face continued shortages of human resources for health and the double burden of infectious and chronic diseases, there is renewed international interest in the potential for community health workers to assume a growing role in strengthening health systems. 57 countries face critical heath workforce shortages and more than four million health workers are needed to fill this gap [1] Such shortages of human resources for health combined with the double burden of infectious and chronic diseases contribute to increased mortality and morbidity, impede the achievement of the health-related Millennium Development Goals, and hinder economic growth in low- and middle-income countries. Given this human resource gap, in rural areas, there is renewed interest globally in the potential for community health workers (CHWs) to take on an expanded role in strengthening health systems [1]. Typical roles include: nutrition, maternal and child health promotion, childhood immunization, infectious disease control and implementation of noncommunicable disease interventions [1]
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