The Community-based Health System Model Series briefs identify and discuss critical health system inputs and processes that have contributed to the implementation and expansion of community-based se...rvice delivery in different countries.
Countries were selected for their geographic diversity, type of service delivery model, and programmatic scale-up.
This brief reviews Malawi’s community health model to inform future policy, program design, and implementation in other countries.
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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 h...ealth 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.
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The Government of Malawi is committed to improving health and livelihoods in Malawi through community health – the
provision of basic health services in rural and urban communities with the participation of people who live there.
Historically, <...span class="attribute-to-highlight medbox">Community Health has significantly contributed to improvements in Malawi’s health outcomes in particular
attainment of MDG4. However, the community health system faces resource constraints and inconsistencies around quality
of service – which negatively affect health outcomes.
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Background: Community Health Workers (CHWs) have a positive impact on the provision of community-based
primary health care through screening, treatment, referral, psychosocial support, and accompan...iment. With a
broad scope of work, CHW programs must balance the breadth and depth of tasks to maintain CHW motivation for
high-quality care delivery. Few studies have described the CHW perspective on intrinsic and extrinsic motivation to
enhance their programmatic activities.
Methods: We utilized an exploratory qualitative study design with CHWs employed in the household model in Neno
District, Malawi, to explore their perspectives on intrinsic and extrinsic motivators and dissatisfiers in their work. Data
was collected in 8 focus group discussions with 90 CHWs in October 2018 and March–April 2019 in seven purposively
selected catchment areas. All interviews were audiotaped, transcribed verbatim, coded, and analyzed using Dedoose.
Results: Themes of complex intrinsic and extrinsic factors were generated from the perspectives of the CHWs in
the focus group discussions. Study results indicate that enabling factors are primarily intrinsic factors such as positive
patient outcomes, community respect, and recognition by the formal health care system but can lead to the chal-
lenge of increased scope and workload. Extrinsic factors can provide challenges, including an increased scope and
workload from original expectations, lack of resources to utilize in their work, and rugged geography. However, a posi-
tive work environment through supportive relationships between CHWs and supervisors enables the CHWs.
Conclusion: This study demonstrated enabling factors and challenges for CHW performance from their perspec-
tive within the dual-factor theory. We can mitigate challenges through focused efforts to limit geographical distance,
manage workload, and strengthen CHW support to reinforce their recognition and trust. Such programmatic empha-
sis can focus on enhancing motivational factors found in this study to improve the CHWs’ experience in their role. The
engagement of CHWs, the communities, and the formal health care system is critical to improving the care provided
to the patients and communities, along with building supportive systems to recognize the work done by CHWs for
the primary health care systems.
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PLoS Med 16(3): e1002768. https://doi.org/10.1371/journal.pmed.1002768
Home delivery and late and infrequent attendance at antenatal care (ANC) are responsible for substantial avoidable maternal and pediatric morbidity and mortality in sub-Saharan Africa. This cluster-randomized trial aimed to de...termine the impact of a community health worker (CHW) intervention on the proportion of women who visit ANC fewer than 4 times during their pregnancy and deliver at home.
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Suicides take a high toll. Over 800 000 people die by suicide every year and it is the second leading cause of
death in 15-29-year-olds. Most suicides occur in low- and middle-income countries where resources
and services, if they do exist, are often scarce and limited for early identification, tr...eatment and support of
people in need. These striking facts and the lack of implemented timely interventions make suicide a serious
global public health problem that needs to be tackled urgently.
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This manual was designed to support the GRN-UNICEF Youth Health and Development Programme with the aim of sustaining My Future is My Choice graduates and other young people’s peer education activities. It was written and reviewed in a three-day workshop in November 1999 and in the following weeks ...with assistance from participating organizations including AIDS Care Trust, Catholic AIDS Action, Ella Du Plessis High School AIDS Awareness Club, the Namibian Broadcasting Corporation, NACAMA, the National Youth Council of Namibia, PEDI/PECP, Polytechnic of Namibia, the University of Namibia and UNICEF. It was revised by Jennifer Lentfer of the Youth Health and Development Program of UNICEF Namibia in July of 2001.
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This document synthesizes key elements of the World Health Organization (WHO) normative guidance on health policy and system support for community health worker (CHW) programmes and their application for HIV programmes. Building on relevant elements... of HIV guidelines, tools and evidence identified by experts, it provides recommendations on tasks and roles that can be performed by CHWs (including for HIV), identifies the policy and system supports to optimize CHW performance, and gives examples of best practice. Its purpose is to inform the optimal design and delivery of CHW programmes targeting – either specifically or as part of a broader approach – the scale-up and sustainability of HIV services.
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Documentation of Best Practices and Bottlenecks to Program Implementation in Senegal
SUMMARY REPORT
Accessed at March 2014
When Ebola hit Liberia in 2014, an atmosphere of fear and confusion contributed to the spread of the virus by making people unwilling to come forward for testing and treatment. Oxfam trained and equipped community health volunteers to go door-to-doo...r, giving information and advice, encouraging anyone showing symptoms to go for tests, and keeping their family members informed about the progress of their treatment. The approach won the trust of communities and helped to slow the spread of the disease. This case study gives an overview of the programme, including aims, results and a personal story.
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The Humanitarian Pandemic Preparedness (H2P) Initiative and its many partners have developed ready-to-use training curricula for district- and community-level leaders, and community volunteers and w...orkers in order to minimize morbidity and mortality in the event of an influenza pandemic. The time to put these tools into action is now.
The curriculum has separate tracks for district/community leaders and for first responders (community volunteers and workers) at the community level.
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Public Health Fact Sheet
Involving the Community in Responding to TB/HIV: Outcomes of Community-Led Monitoring and Advocacy
Accessed November 2017
This Manual is primarily intended for Local Government, Community Based Organizations and Civil Society Organizations (CSO) supporting or implementing Community Based Disaster Risk Management (CBDRM...) program.
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