The Role of Heath Surveillance Assistants (HSAs) in the Delivery of Health Services and Immunization in Malawi

In June 2001, the Centre for Social Research (Malawi) was approach by UNICEF to undertake a study that would provide answers to the apparent low immunization coverage rates that have been thought of as arising out of Health Surveillance Assistants (HSAs) taking on almost everything at community level. A study concept paper was developed and circulated to other stakeholders including the Ministry of Health, who also made their suggestions to the overall design and approach. This resulted in shifting the focus of the study from looking at whether immunization coverage rates have been declining as a result of HSAs taking on almost everything at community level to assessing their contribution in the delivery of health services in general and their working conditions.

The general picture arising out from this survey is that HSAs, who were formerly recruited as temporary `Smallpox Vaccinators’ in the 1960’s and as `Cholera Assistants’ in mid-1970’s have contributed greatly to the delivery of preventive health services in rural areas of Malawi.

The overall recommendation being made by this report calls for increased support towards preventive health services and reorientation of priorities in budgetary allocation towards training and technical support in the Ministry of Health and Population so that infection and exposure rates are reduced. Specific recommendations include:

• more HSAs must be recruited, trained and deployed to rural areas to reduce the workload among those currently in service
• HSAs must be served with clear Terms of References (ToRs) at the time of their recruitment and whenever new tasks are being introduced to the old ToRs
• there are some tasks in which the sampled HSAs said they lacked skills and knowledge. These areas of need should be properly addressed during HSA training and refresher courses
• HSAs could also be utilised to provide meat inspection services at community level if trained and oriented to do so
• transport and mobility problems be reduced by provision of push bikes to HSAs and motor cycles to their supervisors on an ownership scheme.