Providing Services Deep in Malawi’s Hard to Reach Areas

Providing Services Deep in Malawi’s Hard to Reach Areas

Malawi has some of the worst health statistics in the world, ranking 166 out of 177 countries. This is the result of HIV & AIDS, food insecurity, weak governance, and many human resources challenges. Health care vacancies range anywhere from 30-80%, and Malawi only has 252 doctors in the entire country. The health system is regularly plagued with stock outs of key medicines and supplies, as a result of poor procurement and distribution practices. Malawi has one of the highest HIV prevalence rates in the world; the average prevalence for sub-Saharan Africa is 7.5%, Malawi has 12% prevalence in the adult population.

More than 50% of Malawi’s population lives further than 5 km from a health center.  Health care workers in the community, who are capable of providing essential health care services to those living in ‘hard to reach areas,’ are essential.  Meet the HSAs – Health Surveillance Assistants.

Health Surveillance Assistant in Malawi

The HSAs are a generalist cadre of health care workers who provide a range of services from health education and water and sanitation inspection to treatment of childhood illnesses (diarrhea, malaria, and pneumonia) and injections of Depoprovera©.

MSH has supported this cadre of health care workers through two projects, Basic Support for Institutionalizing Child Survival (BASICS) and Community-based Family Planning and HIV & AIDS Services (CFPHS). Through the BASICS project, MSH has provided Integrated Management of Childhood Illness training to 772 HSAs in 12 districts.

CFPHS trains HSAs to provide Depoprovera©, a long term family planning method. CFPHS has trained 1709 HSAs in 8 districts. By providing HSAs different sets of skills, the cardre of health care workers remains diverse and able to provide a range of services to the populations.

I had the opportunity to talk with some of Malawi’s HSAs and better understand their work on a recent field visit. A typical week for an HSA includes two days of Village Clinic, where they see and treat children suffering from diarrhea, pneumonia, and malaria. They are responsible for holding regular health education sessions on varying topics and conducting home visits and public facility inspections. They actively participate in vaccination campaigns, child health days, bed net distribution, and disease surveillance.

Women listening to community health information.

As you meet the HSAs in their communities and see their Village Clinics, you have a great appreciation for the work that they do. These clinics can be as far as 20 or 30 kilometers away from a health center, off secondary dirt roads. As you turn off the secondary road onto the two track road running through corn and tobacco plots, bicycles move off the road, children’s faces appear smiling and waving through the tall grass. Women move gracefully carrying water, fire wood, sugar cane, wash, goods to be sold at the market, or goods that have been bought along the road in their brightly colored chitenje with their sleeping babies tied to their back. When you think about what it must be like for these young mothers to think about the 20 km walk to the health facility to have their child checked and treated for malaria, it seems almost an impossible existence. And then, the road opens up, and the HSA and his Village Clinic appears, and you realize how critical these service delivery points are in these hard to reach areas.

Malawi, April 2011

The cadre of Health Surveillance Assistants is providing critical services to a population that does not often have access to the services that they require. They are committed to their work, and see themselves as valuable contributors to the health system. They operate out of small spaces, often just a single room with a door and a window, a desk to keep their records and medications, and two chairs – one for the patient and one for themselves.

Kate Dilley, MPH is an Administrative Coordinator at Management Sciences for Health.