malawi ichc presentation v3.25.2017 - shayanne martin...malawi context sources: cia factbook 2016;...
TRANSCRIPT
#HealthForAll
ichc2017.org
#HealthForAll
ichc2017.org
History and Future
of Community
Health Workers
in Malawi
Ministry of Health
March 27, 2017
Malawi Ministry of Health2
Malawi Context
3Sources: CIA Factbook 2016; Bowie & Mwase Malawi Burden of Disease data sets, 2011,
Malawi Demographic Health Survey 2015-16
84%Rural
24%Not within 8km of
health facility
4%Rural access to
power
61yrsLife expectancy
53%Of deaths caused by top 4 illnesses
(HIV/AIDS, LRI, Diarrhoeal, Malaria)1
Malawi’s population is 17 million
Community Health in Malawi
Malawi Ministry of Health 4
Before the nineties Malawi’s community health was delivered by:
Volunteers Health Inspectors Primary Health Nurses
Malawi Ministry of Health 5
Since then until Since then until Since then until Since then until
today community today community today community today community
health has primarily health has primarily health has primarily health has primarily
been delivered by been delivered by been delivered by been delivered by
Health Surveillance Health Surveillance Health Surveillance Health Surveillance
Assistants (HSAs)Assistants (HSAs)Assistants (HSAs)Assistants (HSAs)
HSAs are full-time CHWs employed by MOH
Malawi Ministry of Health 6
HSA’s & Senior HSA’s are over half of MoH’s clinical staff
Medical /
Clinical Officer;
1,4
Nursing Officer; 1,1
Nurse Midwife
Technician; 3,5
Medical
Assistan
t; 1,2
Pharmacy and Lab
Technician; 0,6
Senior
HSA; 1,2
HSA; 8,0
MoH Clinical Staff (thousands)HSAs are meant to reside
in their catchment area
The recommended HSA to
population ratio is 1 to
1,000 people
HSAs have a wide range of responsibilities and must work alongside key partners
Malawi Ministry of Health 7
Health promotion
Prevention
Disease surveillance
Basic curative services
HSAs
Community Health
Volunteers
Village Health
Committee
Community Health
Nurses
Env. Health Officers
HSA Responsibilities HSA Key Partners
Community health activities have contributed to significantly improved health outcomes for Malawi
Malawi Ministry of Health 8
135
76
42
234
133
64
1992 2004 2016
De
ath
s p
er
1,0
00
Year
Infant Mortality Rate & Under 5 Mortality
Rate
Infant Mortality Under 5 Mortality
46%
24%
2011 2014
Malaria Case Fatality Rate
14%
6%
2008 2016
Proportion of Households with
no toilet facility
Sources: HSSP II Situation Analysis October 2016
However, Malawi continues to face sub-optimal health coverage and outcomes
Malawi Ministry of Health 9
81%
71%
2010 2016
Children aged 12-23 months
fully immunized
55%
45%
2010 2016
% of Children Under 5 years
sleeping under ITN
574
155
2015 2016 Target
Maternal Mortality Rate per
100,000 live births
Sources: HSSP Situation Assessment 2016, MDG End Survey 2014
Significant resource constraints and inconsistencies of community Significant resource constraints and inconsistencies of community Significant resource constraints and inconsistencies of community Significant resource constraints and inconsistencies of community health services contribute to these subhealth services contribute to these subhealth services contribute to these subhealth services contribute to these sub----optimal outcomesoptimal outcomesoptimal outcomesoptimal outcomes
Malawi Ministry of Health 10
51% 51% 51% 51% of HSAs not staying in
their Catchment Area
+7,000 +7,000 +7,000 +7,000 New HSA’s needed to
reach policy level
0 0 0 0 Senior HSAs trained in
supervision
NO NO NO NO National Community
Health Strategy or Policy
Malawi Ministry of Health 11
The MOH is acting quickly to address thisThe MOH is acting quickly to address thisThe MOH is acting quickly to address thisThe MOH is acting quickly to address this
The Community Health Services (CHS) The Community Health Services (CHS) The Community Health Services (CHS) The Community Health Services (CHS)
section has been strengthened to section has been strengthened to section has been strengthened to section has been strengthened to
address these challenges as the overall address these challenges as the overall address these challenges as the overall address these challenges as the overall
community health coordinator for Malawicommunity health coordinator for Malawicommunity health coordinator for Malawicommunity health coordinator for Malawi
Malawi Ministry of Health 12
Our Vision:
To improve the livelihoods of all peopleall peopleall peopleall people in
Malawi.
Our Mission
Malawi Ministry of Health 13
To ensure quality, integrated community health services are
affordable, culturally acceptable, scientifically appropriate,
and accessible to everyeveryeveryevery householdhouseholdhouseholdhousehold through community
participation to reduce deaths and the socio-economic
burden of illness in Malawi.
In 2017 the CHS section has made significant progress through teamwork, partnership, and participation
Malawi Ministry of Health 14
Situation Assessment Developed Partnerships and
Mobilized Resources
Consultative Workshops
Malawi’s first ever National Community Health Strategy
But we are just getting started…
Malawi Ministry of Health 15
Phase 1
Strengthen the System
Phase 2
Implement of the System
Assessing the System
Clarify roles and teams for CHWs
Develop Integrated Training Curriculums
Establish standard CHW supply list
Establish CHW HR and Residency Policy
Integrated community health indicators
Hire more CHWs
Train CHWs on integrated service
Provide all CHWs with critical supplies
CHW housing and service structures
mHealth and digital data collection
Malawi Ministry of Health 16
This is more than just a
strategy.
With a stronger
community health system
we can all contribute to
improved livelihoods for
all people in Malawi
#HealthForAll
ichc2017.org
#HealthForAll
ichc2017.org