An enormous burden rests on Africa’s few health care workers. In the midst of the emergence of HIV/AIDS, the resurgence of tuberculosis and malaria, the increase in diarrheal diseases, and the rise in chronic disease, sub-Saharan Africa is 4.3 million health care workers short of the number needed to manage the health situation. While the country of Malawi illustrates the challenges of providing health care with too few workers, it also provides many examples of the success of community-based initiatives in the alleviation this burden.
The Gross National Income per capita in Malawi is US$280, making it one of the poorest countries in the world. A majority of mortality is a result of communicable or preventable diseases such as malnutrition, pneumonia, anemia, or diarrheal disease. Malawi currently has only 266 physicians and 7,264 nurses and midwives for a population of 15 million. These hospital health care workers alone are not able to provide for the extensive health care needs of the country.
Malawi’s government, as well as many non-governmental organizations, is in support of a community-based health care approach, and has trained over 11,000 paid community health workers, known as Health Surveillance Officers (HSA’s). This group of trained, paid community health workers is on the frontline of the battle against many preventable diseases, and serves as a bridge between communities and health care institutions. The main goals of the HSA’s are immunization, growth monitoring, disease investigation, water and sanitation, and health education. The global shift from hospital care to community care is driving an initiative to provide communities with the workers and tools they needed to help improve health indicators. As a result, community health workers such as HSA’s are becoming the primary deliverers of community health care in many rural an underserved areas.
These HSA’s are directly observing the administration of tuberculosis and HIV medication, are vaccinating children and pregnant mothers, they are providing home-based treatment of malaria and diarrhea, and are administering antenatal care and prevention of mother to child transmission programs. The services provided by these HSA’s match with the country’s goals to provide for local health care needs, are less expensive and more sustainable, and provide a more accessible form of health care at the community level. Despite the success of community-based approaches, the lack of appropriate diagnostic, treatment, and prevention tools remains a major obstacle in the delivery of community health care. Often, the necessary tools are not available, are too expensive, or require extensive training for use. In response to this need, the purpose of the HSA Backpack is to equip this army of paid, trained HSA community health workers with the tools they need to provide basic diagnostics, first aid treatment, and prevention to their communities in a way that is portable, sustainable, and effective. Because HSA’s receive the most standardized and high-level training of any community health workers, they are potentially the best end-users for the backpack.
Twelve of the second-generation HSA backpacks are being used by teams of trained community health workers spread through the entire 100 mile catchment area of St. Gabriel’s Hospital. A team of 15-20 community health workers, who visit approximately 10 patients per week, is using each backpack. The backpacks are mostly being used for home-based palliative care. With the tools in the backpacks, community health workers are able to take vital signs, dress wounds, monitor infant growth, and distribute medications.
These community health workers need at least twenty-five more backpacks, so that they can travel in teams of five, rather than teams of twenty. There are thousands of other trained HSAs throughout the country who could (and hopefully will) benefit from the kit as well. With partnerships with organizations such as Save the Children, GAIA, UNICEF, Concern Worldwide, and the Ministry of Health, every HSA in the country could have the tools they need to fight preventable and curable diseases in their communities.
These community health workers are able to restock their backpacks during their monthly visits to St. Gabriel’s Hospital, and the backpacks are stored in the chief’s house for safekeeping. These backpacks provide the community health workers with everything they need to provide care for their communities. They are honored and recognized in their communities as legitimate health care workers.
There are several limitations of the backpack. First, there are several items in the backpack – such as the wound dressing materials, the first aid supplies, and the antiseptic – that must be replenished when the backpack’s supplies run out. The community health workers associated with St. Gabriel’s Hospital return to the hospital every month to pick up their own medications. During this time, they are able to restock their backpacks according to the availability of the supplies at the hospital. This limitation is one of the reasons that HSA’s were chosen as the end-user community health workers for the backpacks. They are highly affiliated with their nearest district hospital, and will likely have access to supply replenishment. However, even in programs where HSA’s are well supported by their health centers, supplies are often limited.
A second limitation of the backpack is the need for user training. Currently, the backpack is designed for use by trained community health workers. This is a second reason that HSA community health workers were chosen as the end-users for the backpack. They have already received standardized training in the use of all of the tools in the backpack. The HSA backpack provides a way for community health workers with specific training to expand health care, diagnostics, treatment, and prevention to rural communities in a way that they would not otherwise be able to. With the HSA backpacks, community health workers are being recognized and honored in their communities as legitimate health care workers, and are receiving the support and tools they need to provide health care at the community level.