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 continue...s 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 pre-existing 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.
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The Community-based Health System Model Series briefs identify and discuss critical health system inputs and processes that have contributed to the implementation and expansion of community-based service delivery in different countries.
Countries were selected for their geographic diversity, type o...f service delivery model, and programmatic scale-up.
This brief reviews Malawi’s community health model to inform future policy, program design, and implementation in other countries.
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The Government of Malawi is committed to improving health and livelihoods in Malawi through community health – the
provision of basic health services in rural and urban communities with the participation of people who live there.
Historically, Community Health has significantly contributed to im...provements in Malawi’s health outcomes in particular
attainment of MDG4. However, the community health system faces resource constraints and inconsistencies around quality
of service – which negatively affect health outcomes.
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The document "J-esyon ak bon manipilasyon manje yo" focuses on proper food handling and hygiene practices to prevent contamination and foodborne illnesses. It provides comprehensive guidelines for individuals and communities, emphasizing the importance of food safety. Key recommendations include kee...ping raw and cooked foods separate, ensuring thorough cooking of perishable items like meat and fish, and checking canned goods for damage or expiration before use. It stresses the need to use treated or boiled water for cooking, drinking, and washing food, as contaminated water can lead to diseases such as diarrhea, typhoid, and skin infections.
The document also highlights critical hygiene practices, such as washing hands with soap and treated water before handling food or eating, and thoroughly cleaning food preparation areas. Proper storage of food at suitable temperatures to prevent spoilage is another key focus, along with protecting food from animals, insects, and other sources of contamination. Overall, the manual emphasizes that maintaining proper hygiene and safe food handling practices is vital for preventing illnesses and promoting public health, making it a valuable resource for educating communities on food safety.
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The document "Prevansyon kont Diare" provides guidance on preventing and managing diarrhea. It explains that diarrhea, caused by pathogens like viruses, bacteria, and parasites, can lead to severe dehydration if untreated. Symptoms include vomiting, fever, and loss of appetite, with severe cases req...uiring urgent medical care.
To prevent diarrhea, the document emphasizes using treated or boiled water, washing hands with soap, cooking food thoroughly, and cleaning fruits and vegetables with safe water. It also provides a recipe for Oral Rehydration Solution (ORS) to combat dehydration: mix 1 liter of boiled or treated water with 8 teaspoons of sugar, 1 teaspoon of salt, and a pinch of baking soda. This solution should be consumed while seeking medical attention.
The document serves as an educational resource to promote hygiene and provide simple, effective solutions for preventing and managing diarrhea.
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The document "Classification and Referral Algorithm – iCCM Uganda" (2013) by Malaria Consortium provides a practical guide for community health workers to assess, classify, and manage common childhood illnesses in Uganda. It focuses on key symptoms such as fever, cough, diarrhoea, and danger signs... like convulsions or inability to drink. Based on these assessments, the guide helps determine whether a child needs urgent referral to a health facility or can be treated at home. It includes detailed treatment protocols using medicines like amoxicillin, ORS, zinc, Coartem, and rectal artesunate. The goal is to strengthen integrated community case management (iCCM) to reduce child mortality through early detection, appropriate treatment, and timely referral.
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The document titled "Classification and Referral Algorithm – iCCM South Sudan", published by Malaria Consortium in 2012, provides a practical tool for community health workers to assess, classify, and manage common childhood illnesses in South Sudan. It outlines step-by-step procedures for identif...ying danger signs and symptoms related to malaria, pneumonia, diarrhoea, and severe acute malnutrition. Based on clinical findings, the algorithm guides health workers in making decisions about immediate treatment, referral to higher-level health facilities, and caregiver counseling. The aim is to support timely and appropriate care at the community level through the Integrated Community Case Management (iCCM) strategy.
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