IFGH 2012: ‘Create CBOs or no Funding for HIV Work’: The Case of External Funding on Community HIV Response in Malawi

January 29, 2012

Authors:Kadzandira JM.

Author Affiliations:University of Malawi, Dept. of Epidemiology & Public Health Medicine, Royal College of Surgeons in Ireland

Option 1– Scientific / Empirical Research Findings Presented as – Oral Poster


The study is being conducted to assess the impact of task shifting on the quality and coverage of HIV and primary health care services in Malawi.


Trend data was collected for immunisation, PHC, HIV and AIDS and health workers for the period 2006-2010 from seven health facilities in two districts in Malawi. One-on-one in-depth interviews were also held with health service managers at the district and facility levels to discuss the trends and to get their views on task shifting.


With the exception of Health Surveillance Assistants (HSAs) whose numbers doubled, nurse and clinician numbers remained fairly stable. HTC services more than trebled between 2006 and 2009 but there have been either declines or level for immunisation and family planning (FP) services. Findings from interviews with district and facility staff suggest that the declining HIV and immunisation trends are due to stock-outs of drugs.

There are mixed views on the use of HSAs to scale up HIV services in addition to surveillance and provision of other PHC services in the communities. Proponents are arguing that task shifting is reducing workload for nurses and clinicians while at the same time bringing services to the remote areas. Opponents doubt quality of care and biased time allocation against non-office community surveillance work amid low supervision and absence of incentives for the HSAs to do more community-based work.

Discussion/conclusions/ implications:

Task shifting has increased HIV service coverage but this may be leading to declining PHC services as HSAs take-on more facility based HIV work. There is therefore need to strengthen the training and mentorship of the HSAs to ensure service quality and for HSAs to balance time allocation against competing demands so as to improve the image of their contribution to health service delivery. Causes of drug stock-outs should be properly analysed and addressed.


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