HSAs: The unsung heroes driving Malawi’s health


Every week Chimwemwe, a Health Surveillance Assistant (HSA), has to find a means to get to outreach clinic sites which are ten to 15 kilometres apart.

He works in the catchment area of Nambazo Health Centre, which borders with Mozambique and a two hour drive from Phalombe boma.

Even though government has the responsibility to provide him with a bicycle to help with his movements, this is not the case.


Chimwemwe last had an official bicycle in year 2008 which is no longer in a usable state.

“The distance is long so I hire a bicycle taxi which costs me about K2, 500. At times I think of giving up but I can’t considering that there are many people who may be waiting for my assistance among them under five children so I just have to sacrifice,” she laments.

As if this is not enough, Chimwemwe says he lives in a grass thatched house since his duty station catchment area is in a remote area.


“The house I live in is so pathetic. You can’t even think of visiting my toilet to answer a call of nature let alone to take a bath in my open roof bathroom,” he says.

In the course of his duties, he administers immunisations for various diseases.

He is also expected to go in villages for community assessments and distribute Chlorine especially during rainy season.

On average an HAS is supposed to be attached to one village with an average population of 1,000 but due to shortage of staff, he serves a population of 5,000 people.

“We are the last to be considered during child health days. We get only K800 per day which is very little as compared to the 12 hours we work. Other people may just sit in a room for less than an hour and get K5, 000 or more,” Chimwemwe explains.

It is even hard for him to communicate with family and friends since there is no reliable mobile network in the area.

Chimwemwe is one of the 10 020 HSAs across the country many of whom may share her story.

Parliamentarian for Zomba Lisanjala, Enock Luka, who once worked as an HSA for eight years says the job goes with one’s passion otherwise there are many demotivating factors.

“In my catchment area where I was supposed to live, schools were very far, there was no electricity and entertainment; so I found a house at Ntcheu Town. But I made sure that my living there shouldn’t affect my duties because I was passionate about my job,” he elaborates.

Maternal, Newborn and Child Health Project Manager for Save the Children International, Reuben Ligowe says HSAs assist patents where there is no immediate health service.

“They have been of much help in our Community Based Maternal and Newborn care project. They do home assessments when a woman has been discharged from the hospital after delivery,” he says, adding that the country has managed to achieve high immunisation coverage because of HSAs.

Ligowe also said it is important to motivate HSAs because they also help in noting symptoms of diseases in under-five children and seek treatment on time there by saving lives of under five children.

Vice Chairperson for Parliamentary Committee on Health, Victor Musuwa, says majority of Malawians live in rural areas and HSAs play a great role in assisting these people there by assisting in the reduction of maternal and under five deaths.

“But these people seem to be ignored. In my area, there are 20 HSAs but I hardly see them because they don’t live in their catchment areas due to lack of housing, entertainment and schools for their children among others,” he notes, adding that only six reside in his area.

Executive Director for Health and Rights Education Programme (Hrep), Maziko Matemba, says HSAs are regarded as non-professional health workforce whose original role to the public health sector was to help the health sector in hard to reach areas in disease survey and report to nearest public health facilities and health professionals for action.

“The situation on the ground is that because of huge shortages of professional workforce, the HSAs are tasked to do more roles than originally designed. They are tasked to provide immunisation, provide family planning services and many more,” he says.

The World Health Organization (WHO) advises its member countries to always strive to use professional workforce in health care delivery.

However, Matemba says even though WHO has these standards, it is tricky for Malawi health sector since HSAs have helped the country to achieve high immunisation coverage for many years now.

“I support the idea of reviewing the use of HSAs on roles, trainings and their supervision where they are providing medical services because it is a known fact that for Malawi to have adequate numbers for professional health workforce it might take a while,” he observes.

He notes that most HSAs do not live in their areas of designation the reasons are many but some of them are; proper housing, mobility including incentives.

Matemba also says HSAs are finding it hard to work in hard to reach areas because local governance structures are not supporting their roles saying district councils, chiefs and community members need to support HSAs through improving road network and structures, for example, other than waiting for MoH.

Ministry of Health Spokesperson, Henry Chimbali, says the ministry has been working with them for a long time saying they were originally known as Cholera assistants but due to high demand for services at community level, their role has significantly changed including the name.

He said transport challenges they are facing is a cross cutting issue at all levels in the ministry adding: “We are working towards this and we hope things will improve at all levels. We are aware of how crucial HSAs are in delivering health care especially at community level.”

Chimbali reveals that the Ministry of Health is supposed to buy bicycles for HSAs at a standard interval of three years but this has not been the case due to financial constraints. He however said other funding agencies and implementing partners have been able to fill this gap by buying bicycles for HSAs.

He also disclosed that MoH is currently recruiting 1,350 HSAs that were employed under the Global Fund support into mainstream health sector after the expiry of the support.

“All these HSAs were on temporary basis and we are now in a process to recruit them into the mainstream health sector,” he said.

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