Oops!!!! Disaster in training HSA’s in Mangochi

Are you involved in training Health Surveillance assistants (HSA’s) in health projects in Malawi? Do you have evidence based facts of their success in implementation after training?

I have just returned Mangochi where we trained a group of 30 HSA’s from Mangochi Zone and another group of 30 volunteers from Chilipa Zone where I faced major challenges with the HSA’s .Relax and I will share my experiences with you.

Having trained HSA’s in Mulanje and Zomba (a total of over 300) I thought with my vat experience, the training in Mangochi would be smooth. I had overlooked a number of issues which I would advise any one willing to train HSAs in Mangochi to seriously consider before rushing doing anything. Mangochi district ,in Southern Malawi is 190 km from Blantyre and has the beautiful Lake Malawi on one part of it and lake Malombe on the other. Lake Malawi has various tourist resorts and Hotel and the environment is very friendly .I stayed at the mini Martins Lodge
The district though very rural has various health research projects including the College of Medicine department of community Health and the Malawi Liverpool Welcome Trust. Most of the community projects involve training and using HSA’s

HSA’s take the invitations to attend the trainings as a privilege and look forward to the financial incentives that are associated with the training.
Some HSA’s claim from Mangochi that in order to win to win their favours and loyalty some NGOs pay them an allowance of up to USD 50 per day despite the government lunch allowance being USD 7.

We thought we had done our assignment well ;had talked to the responsible officers and agreed we would give an allowance of USD 7 for the one day training but in addition we would provide drinks and snacks .As a background in 2007 I had done a situation analysis in Mangochi on why HSA’s despite working in the community were not involved in identifying children with eye problems .I spoke to a group of representative HSAs (20 in total) and they all indicated what they lacked was the skill and if trained they would be willing to do such a job. So this training was organised as part of my study and in response to the findings .We conducted the first training to a group of 30 Volunteers from a different area on day one ,gave them the allowances and snacks. During day 2 we arrived at a different place to train HSA’s ;started the training but noted that the participants were not attentive. In probing why ,we learnt that they wanted to know how much money they would get at the end of training ,and whether we had brought t-shirts and other incentives for them. After explaining that we would only give USD 7 as per what volunteers got the previous day, the whole workshop turned into chaos with the HSA’s threatening to boycott the training and forfeit the highly needed skills if they did not get all their monies .

So how did it all went at the end ? Not very well – I sustained a few emotional bruises .I would like to write a whole blog about this –when I am better.
For now you can gues!!!!


Have you experienced difficulties in conducting training? What did you do? Or are you just interested to comment.

Email me!

Primary Health Workers for Malawi

If you are an NGO or an individual interested in community health issues, you probably be wondering how much impact the role of community health workers have in improving the health of Malawians. In particular to this cadre are the so called Health surveillance assistants (HSA), who are said to be the backbone of the health system in Malawi .HSAs are employed and paid by the Ministry of Health. But what skills do HSA’s have to implement health care; and if trained do they actually do their work.
There are currently an approximately 12,000 HSA’s in the Malawi public service ,as a result of the recent scale up (2007) with almost half employed by the ministry of Health under the Global fund and other funding parteners and the rest through normal employment. HSA’s are responsible for implemented most of the health initiatives in the community, and for disease surveillance .By education ,the newer HSA’s have reached at least high school (Form 4) ,while the order groups may have not been very educated .HSA’s only undergo a 3 months training in Preventive, Diagnostic and Curative measures and upon completion they become experts in all community diseases .
With all the community interventions in Malawi relying on HSA’s ;is there evidence that HSA’s have contributed to the reduction in morbidity and mortality of the common Malawians .What are the implications and limitations of using HSA’s in health programmes ?

A look at the maternal, mortality figures in Malawi indicates that Malawi has the highest mortality rates (1120deaths per 100,000 mothers delivery) despite the many health promotion messages being spread by HSA’s. Many causes of these deaths are attributed to low levels of maternal care.

Unicef States of the world children 2009 that over a period of 16 years (1990 and 2006) of intensive community programme interventions, Malawi has only managed to reduce under five mortality by 40% and that the main causes of deaths still remain preventable at the community level. HSA’s are taught the integrated management of childhood infections (IMCI).
Since 2007 I have been involved in training HSA’s in identifying blind and visual impaired children in rural communities in Malawi; and have been comparing their performance with a matched group of trained volunteers .
I have very interesting results –which will be published later ,but certain issues desrve to be mentioned at this stage.

I have noted that most NGO’s and government institutions assess the outcomes of HSA’s training through reports submitted to the interested parties ,and that rarely do the trainers observe and access the skills attained by HSA’s after the training. I have also noted that most HSA’s rate the trainings based on the amount of subsistence allowance received during the training, and not on the skills attained. The mismatch in expectations between the trainers and the HSA’s has more than often resulted in not having proper measures to measure the outcomes of trainings .
In my next blog I would like write about what incentives HSA’s have mentioned to be being necessary for them to do the work ; and whether when given such incentives they have successfully accomplished the desired tasks. I will also be introducing the tracking tools that we have developed to assess whether HSA’s are doing their work and the incentives that we give. In the picture I am listening to a group discussion by HSA’s from Zomba. The forms we have devised can be used for any time of training and I will be more than willing to share with you.

Are you involved in training HSA’s in health projects in Malawi? Do you have evidence based facts of their success in implementation after training?

Or do you want me to share our results with you? Or are you just interested or want to comment.

Email me!