This PSI report examines the state of community health workers (CHWs) in Malawi and Zambia, focusing on their crucial role in delivering healthcare services, the challenges they face and the need for increased unionisation.
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The study was conducted by Public Services International in collaboration with the Trade Union Solidarity Centre of Finland SASK.
The report highlights the critical importance of CHWs in delivering universal healthcare in both countries, while emphasizing the need for better working conditions, formal recognition, and stronger representation to improve healthcare outcomes in these regions.
Key Findings:
Both countries heavily rely on CHWs to deliver essential healthcare services, particularly in rural areas, due to severe shortages of medical personnel.
While both nations face similar challenges in healthcare delivery, their approaches to CHW employment differ significantly:
Malawi:
CHWs are formally employed by the government
They comprise over half of all medical professionals
Face challenges with poor remuneration, supervision, and resource access
Have some trade union representation, though primarily focused on community nurses
Zambia:
Most CHWs are considered volunteers
Limited employment protection
Mainly work with NGOs rather than direct government employment
Lack trade union representation
Key Recommendations:
Strengthen solidarity among organizations representing CHWs
Increase participation in government policy development
Engage with international organizations and funders who influence government decisions