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Angwenyi_V_BMJ_Glob_Health_2018.pdf (249.36 KB)

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2018-09

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cc by-nc (c) BMJ Publishing Group Ltd, 2018
Please use this identifier to cite or link to this item: https://hdl.handle.net/2445/134919

Moving to a strong(er) community health system: analysing the role of community health volunteers in the new national community health strategy in Malawi

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http://dx.doi.org/10.1136/bmjgh-2018-000996

Abstract

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 health 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 preexisting 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.

Subject

Voluntaris, Assistència mèdica, Malawi

Subject (English)

Volunteers, Medical care

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Articles publicats en revistes (ISGlobal)

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ANGWENYI, Vibian, et al. Moving to a strong(er) community health system: analysing the
                role of community health volunteers in the new national
                community health strategy in Malawi. BMJ Global Health. 2018. Vol. 3, num. supl 3. ISSN 2059-7908. [consulted: 17 of August of 2026]. Available at: https://hdl.handle.net/2445/134919

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