Malawi's primary health care through community participation

Malawi promotes the implementation of its Primary Health Care through Community Participation at community-based health services level. This is mostly carried out by the Health Surveillance Assistants (HSAs), who are the community based health workers. HSAs are guided by a scheme of service and are liable to promotion to senior HSA. They work in the communities through a chain of various support groups like the Village Health Committees (VHCs). The VHC is a component of another higher body called the village development committee (VDC). The VDC is comprised of several Villages and looks at the development on a wider scale. Members of the VHC and VDC at times work as volunteers and report to the HSAs any events happening in their villages/communities whenever they require their support. They undergo 12 weeks initial training and then they also go for refresher courses in different fields that have service provision at community level. The HSAs are provided with bicycles, drug kits and are given an opportunity to further their studies in areas including nursing, environmental health and clinical medicine as clinical officers or medical assistants.

HSAs are the frontline health workers at the community level and each health programme that has community component has its services delivered by HSAs.

Historically, HSAs have a wide background dating from the early 70s when they were volunteers, then Primary Health Care works/ volunteers, cholera assistants and now HSAs. They are institutionalized and are paid through the government payroll.