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

# metadata.dc.description.abstract[].value
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.

# metadata.dc.rights[].value
cc by-nc (c) BMJ Publishing Group Ltd, 2018

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Moving to a strong(er) community health system: analysing the
                role of community health volunteers in the new national
                community health strategy in Malawi