Malawi Health Surveillance Assistant Programme

Malawi's cadre of government community health workers, known as Health Surveillance Assistants, whose origins trace to the 1950s, when workers performing the same community role were called public vaccinators and later smallpox vaccinators, and who have operated under the Health Surveillance Assistant title since the 1960s as part of Malawi's community-based health care delivery platform. Their responsibilities evolved over decades from disease surveillance toward health promotion and prevention, and in 2008 Health Surveillance Assistants took on curative duties for the first time when Malawi adopted integrated community case management, expanding the workforce to help reach universal coverage of key child health interventions; by 2011 Malawi employed some 12,000 Health Surveillance Assistants nationwide. The programme is credited as a major contributor to Malawi's sharp reduction in child mortality, which fell from 222 deaths per 1,000 live births in 1990 to 92 per 1,000 by 2010, and in 2017 the government built on the cadre by launching a National Community Health Strategy aimed at expanding the workforce's capacity to deliver lifesaving care and prevention education.