Mangochi-ICEIDA-Partnership-in-Public-Health-2012-2016-Part-II ...

MANGOCHI ICEIDA PARTNERSHIP IN PUBLIC HEALTH – PROGRAMME DOCUMENT 2012-2016
acute and complex. Staffing level norms for almost all trained health personnel are nowhere nearly
met in Malawi. The human resources situation is even worse in Mangochi and human resources is
not equally distributed within the district. As is common in low-income countries, community health
workers (CHWs) still play an important role in the health services, particularly in rural areas. Even in
this respect Mangochi is understaffed and its CHWs insufficiently trained.
To improve retention of health care workers the MoH plans extension of housing schemes for health
professionals and provision of appropriate working conditions (staff facilities, accommodation,
incentive packages) for health workers in remote areas. Furthermore, it is important to ensure that
health personnel with administrative and management responsibilities are appropriately equipped
with information technology, hardware and software, including regularly updated anti-virus
software, reliable internet and continuous power supply, and that computer training is provided for
those who need it.
2.2.1. Health Surveillance Assistants
The post of Health Surveillance Assistant developed from the post of Cholera Surveillance Assistant
which was created during a cholera epidemic in the 1970s. Since then the nature and scope of their
activities has changed substantially.
HSAs are under the District Environmental Health Officer. Staffing level norms for HSAs are 1 per
1,000 population but these norms have not been fulfilled in Mangochi. The current ratio is 1 per
1,500 according to HMIS, best in Monkey Bay zone (1 per 1,300) and worst in Makanjira (1 per
1,900). Moreover, according to a survey conducted in May 2011, three out of ten active HSAs in
primary health facilities had not received proper training (Monkey Bay zone 23%, Chilipa zone 40%,
Makanjira zone 70%).
Training of HSAs consists of a 12 weeks certified course in primary health care. The curriculum has
recently been updated. Each HSA is responsible for 2 to 15 villages, visiting each village once a
month. They are badly equipped and their work is physically demanding in that they travel on bicycle
or even on foot from village to village sometimes for up to three hours. HSAs refer patients to a
health centre when necessary. They are supervised by environmental health officers.
In addition to the original role of a cholera worker—demographic surveillance, village inspection and
chlorination of drinking water—HSAs perform a variety of other chores including growth monitoring,
immunisation, and distribution of contraceptives. They also play a role in the prevention of child
malnutrition and even treat common illnesses. They provide health education and encourage
expectant mothers to attend antenatal care services and to give birth at health facilities. Recently
HSAs have also been requested to collect sputum samples from adults with persistent cough
(suspected tuberculosis) and to perform late-patient tracing for anti-tuberculosis and anti-retroviral
treatment programmes.
HSAs are responsible for a village health register, where each and every household is registered—up
to 200 households per register. The register contains on the one hand detailed demographic
information by household and also—at the back—line listings by subject for the following activities:
immunisations, growth monitoring, nutrition supplements and de-worming, antenatal care and
births, and water and sanitation. The last section is updated when facilities, such as boreholes and
latrines, are installed. The HSAs report quarterly to HMIS via health centres.
Many projects and initiatives target HSAs to perform all kinds of chores including supervision of
community based “volunteers” and HSAs are frequently invited to short training courses for a variety
of ad hoc initiatives while many of them have not received the basic 12 weeks’ training (see above).
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