Task-shifting and prioritization: a situational analysis examining the role and experiences of community health workers in Malawi

Human Resources for Health

Alexandra Martiniuk³  Lisa M Puchalski Ritchie¹  Elizabeth Chingaipe⁴  Nwaka Mwambene⁵  Joel Negin²  Joshua Berman⁵  Amber Deveridge²  Sarah Smith² 

[1] University Health Network, Toronto, Canada;School of Public Health, University of Sydney, Sydney, Australia;Sunnybrook Health Sciences Research Institute, University of Toronto, Toronto, Canada;District Health Office, Ministry of Health, Zomba, Malawi;Dignitas International, Zomba, Malawi

关键词: Task- prioritization;    Health promotion;    Task-shifting;    Lay health workers;    Community health workers;   

Others  :  821732
DOI  :  10.1186/1478-4491-12-24

 received in 2013-10-30, accepted in 2014-04-07,  发布年份 2014

【 摘 要 】

Background

As low- and middle-income countries face continued shortages of human resources for health and the double burden of infectious and chronic diseases, there is renewed international interest in the potential for community health workers to assume a growing role in strengthening health systems. A growing list of tasks, some of them complex, is being shifted to community health workers’ job descriptions. Health Surveillance Assistants (HSAs) - as the community health worker cadre in Malawi is known - play a vital role in providing essential health services and connecting the community with the formal health care sector. The objective of this study was to understand the performed versus documented roles of the HSAs, to examine how tasks were prioritized, and to understand HSAs’ perspectives on their roles and responsibilities.

Methods

A situational analysis of the HSA cadre and its contribution to the delivery of health services in Zomba district, Malawi was conducted. Focus groups and interviews were conducted with 70 HSAs. Observations of three HSAs performing duties and work diaries from five HSAs were collected. Lastly, six policy-maker and seven HSA supervisor interviews and a document review were used to further understand the cadre’s role and to triangulate collected data.

Results

HSAs performed a variety of tasks in addition to those outlined in the job description resulting in issues of overloading, specialization and competing demands existing in the context of task-shifting and prioritization. Not all HSAs were resistant to the expansion of their role despite role confusion and HSAs feeling they lacked adequate training, remuneration and supervision. HSAs also said that increasing workload was making completing their primary duties challenging. Considerations for policy-makers include the division of roles of HSAs in prevention versus curative care; community versus centre-based activities; and the potential specialization of HSAs.

Conclusion

This study provides insights into HSAs’ perceptions of their work, their expanding role and their willingness to change the scope of their practice. There are clear decision points for policy-makers regarding future direction in policy and planning in order to maximize the cadre’s effectiveness in addressing the country’s health priorities.

【 授权许可】

   
2014 Smith et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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