#HealthForAll #HealthForAll ichc2017.org ichc2017.org
History and Future of Community Health Workers in Malawi Ministry of Health March 27, 2017 Malawi Ministry of Health 2
Malawi Context Malawi’s population is 17 million 84% 24% Rural Not within 8km of health facility 53% Of deaths caused by top 4 illnesses (HIV/AIDS, LRI, Diarrhoeal, Malaria) 1 61yrs 4% Rural access to Life expectancy power 3 Sources: CIA Factbook 2016; Bowie & Mwase Malawi Burden of Disease data sets, 2011, Malawi Demographic Health Survey 2015-16
Community Health in Malawi Before the nineties Malawi’s community health was delivered by: Volunteers Health Inspectors Primary Health Nurses Malawi Ministry of Health 4
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) Malawi Ministry of Health 5
HSAs are full-time CHWs employed by MOH HSA’s & Senior HSA’s are over half of MoH’s clinical staff Medical / MoH Clinical Staff (thousands) HSAs are meant to reside Clinical Officer; 1,4 Nursing Officer; 1,1 in their catchment area HSA; 8,0 Nurse Midwife The recommended HSA to Technician; 3,5 population ratio is 1 to Medical Assistan 1,000 people t; 1,2 Senior HSA; 1,2 Pharmacy and Lab Technician; 0,6 Malawi Ministry of Health 6
HSAs have a wide range of responsibilities and must work alongside key partners HSA Responsibilities HSA Key Partners Health promotion Community Health Volunteers Prevention HSAs Village Env. Health Health Officers Disease surveillance Committee Basic curative services Community Health Nurses Malawi Ministry of Health 7
Community health activities have contributed to significantly improved health outcomes for Malawi Infant Mortality Rate & Under 5 Mortality Proportion of Households with Rate no toilet facility 234 14% Deaths per 1,000 6% 135 133 2008 2016 76 Malaria Case Fatality Rate 64 42 46% 1992 2004 2016 24% Year Infant Mortality Under 5 Mortality 2011 2014 Sources: HSSP II Situation Analysis October 2016 Malawi Ministry of Health 8
However, Malawi continues to face sub-optimal health coverage and outcomes Children aged 12-23 months % of Children Under 5 years Maternal Mortality Rate per fully immunized sleeping under ITN 100,000 live births 574 81% 71% 55% 45% 155 2010 2016 2010 2016 2015 2016 Target Sources: HSSP Situation Assessment 2016, MDG End Survey 2014 Malawi Ministry of Health 9
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 sub- health services contribute to these sub -optimal outcomes optimal outcomes health services contribute to these sub health services contribute to these sub - - optimal outcomes optimal outcomes 51% 51% 51% 51% 0 0 0 0 +7,000 +7,000 +7,000 +7,000 NO NO NO NO of HSAs not staying in Senior HSAs trained in New HSA’s needed to National Community their Catchment Area supervision reach policy level Health Strategy or Policy Malawi Ministry of Health 10
The MOH is acting quickly to address this The MOH is acting quickly to address this The MOH is acting quickly to address this The 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 Malawi community health coordinator for Malawi community health coordinator for Malawi community health coordinator for Malawi Malawi Ministry of Health 11
Our Vision: To improve the livelihoods of all people all people all people in all people Malawi. Malawi Ministry of Health 12
Our Mission To ensure quality, integrated community health services are affordable, culturally acceptable, scientifically appropriate, and accessible to every every every every household household household household through community participation to reduce deaths and the socio-economic burden of illness in Malawi. Malawi Ministry of Health 13
In 2017 the CHS section has made significant progress through teamwork, partnership, and participation Situation Assessment Developed Partnerships and Consultative Workshops Mobilized Resources Malawi’s first ever National Community Health Strategy Malawi Ministry of Health 14
But we are just getting started… Phase 1 Phase 2 Strengthen the System Implement of the System Clarify roles and teams for CHWs Hire more CHWs Develop Integrated Training Curriculums Train CHWs on integrated service Establish standard CHW supply list Provide all CHWs with critical supplies Establish CHW HR and Residency Policy CHW housing and service structures Integrated community health indicators mHealth and digital data collection Assessing the System Malawi Ministry of Health 15
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 16 Malawi Ministry of Health
#HealthForAll #HealthForAll ichc2017.org ichc2017.org
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