Malawi has made incredible strides over the past few years to reduce morbidity and mortality, specifically among women and children under 5 years old. Key to this success has been a focus on using community health workers, known in Malawi as Health Surveillance Assistants (HSAs), to push direct healthcare services throughout the most rural, hard-to-reach, quintessential last mile communities. As a result, people who otherwise may not have reached a health facility can now access basic services from their HSA—sometimes even in their own homes. At the same time, however, more HSAs work in isolation or as the only person from their cadre within their area, with little interaction with colleagues, supervisors or other healthcare providers.
HSAs are typically responsible for areas of around 1,000 people each, often from two to three neighboring villages. HSAs live and work in these areas to better serve their clients, but this limits their access to information and advice from colleagues and supervisors. Similarly, rural health centers are run by medical assistants who have two years of post-secondary school education and are typically the only medical assistant or clinical officer at their site. Better communication and coordination between healthcare providers—doctors, nurses, midwives etc.— undoubtedly helps improve patient care and health outcomes.
Not unlike healthcare constraints in the United States, providers in Malawi have limited time with patients that is insufficient to adequately meet a patient’s health education needs. Results from a time-motion study VillageReach participated in at health centers in Malawi indicated that providers spend an average of only one minute with a patient. Conversely, users of Chipatala Cha Pa Foni’s toll-free service experience little to no time constraints on the phone with a hotline worker; the average call lasts about 11 minutes. Chipatala cha pa Foni (CCPF) or “Health Center by Phone” improves access to timely, relevant and reliable health information and has been proven to change callers’ health behaviors, equipping them with tailored, actionable advice to manage minor health issues at home. CCPF hotline workers also provide facility referrals—guiding callers on when and where to get the in-person care they need. Closing the loop, more referrals from community and facility-based health workers to CCPF help facility-based health workers support their patients beyond their face-to-face time.
As CCPF grows, the platform can be leveraged to more broadly support the health system. CCPF is currently designed to provide a direct service to clients with health questions, but can have even greater impact by providing direct support to health workers at the last mile.
With the continued support of Johnson & Johnson Corporate Contributions, VillageReach is exploring ways CCPF can better meet the needs of health workers.
VillageReach will study the potential for CCPF to enhance communication and coordination between healthcare providers and the impact this would have on patient health. Taking CCPF’s impact further, we will also explore appropriate protocols to provide aggregated feedback to the Malawi Ministry of Health about gaps in capacity and priority areas for health worker training based on CCPF’s existing database of client inquiries, symptoms and outcomes.
CCPF has grown tremendously since its 2011 pilot, further integrating with Malawi’s health system overall. With partners like Johnson & Johnson Corporate Contributions, VillageReach has been able to continually enhance CCPF’s services to support the health-care needs in Malawi. Working directly with the Ministry of Health, VillageReach is also developing a plan to scale CCPF nationally. These partnerships and innovations allow CCPF to reach more and increase access to quality health services in the most underserved communities.