ArticleReproductive health2020
Enabling and hindering factors of health surveillance assistants' roles in the provision of contraceptive services in Mangochi, Malawi.
Article in Reproductive health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Stock-outs of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs): a systematic literature review of the extent, reasons, and consequences.Human resources for health · 2022Pooled it
- Effect of healthcare worker vs. non-health worker delivered health education on modern contraceptive uptake among women in Malawi: a quasi-experimental study.BMC health services research · 2025Article
- Perspectives of health workers engaging in task shifting to deliver health care in low-and-middle-income countries: a qualitative evidence synthesis.Global health action · 2023Review
- Male Involvement in Family Planning Decisions in Malawi and Tanzania: What Are the Determinants?International journal of environmental research and public health · 2023Article
- Predictors of cessation of exclusive breastfeeding according to the Cox regression model: survey of mothers of children aged 6-12 months, Thiès, Senegal.The Pan African medical journal · 2023Article
- Task shifting and task sharing in the health sector in sub-Saharan Africa: evidence, success indicators, challenges, and opportunities.The Pan African medical journal · 2023Review
- Perceptions of Partners' Fertility Preferences and Women's Covert Contraceptive Use in Eight Sub-Saharan African Countries.Studies in family planning · 2022Article
- Integrated delivery of family planning and childhood immunization services: a qualitative study of factors influencing service responsiveness in Malawi.Health policy and planning · 2022Article
- Integrated delivery of family planning and childhood immunisation services: a mixed methods assessment of service responsiveness.BMC health services research · 2022Article
- Prevalence and characteristics of covert contraceptive use in the Performance Monitoring for Action multi-country study.Contraception: X · 2022Article
- Article
- Slowing progress: the US Global Gag Rule undermines access to contraception in Madagascar.Sexual and reproductive health matters · 2020Article
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Authors and funding
8 authors.
Funding
Abstract
backgroundContraceptive services are essential for promoting people's health, and economic and social well-being. Despite increased contraceptive use over the past decades, unmet need is still high in Malawi. As a result of task shifting, health surveillance assistants (HSAs), Malawi's paid community health worker cadre, provide an expanded range of contraceptive services, aimed at increasing access at community level. We conducted a qualitative study to explore enabling and hindering factors of HSAs' roles in the provision of modern contraceptive services in Mangochi district, Malawi.
methodsThe study involved HSAs and their supervisors, a variety of community members, health workers and policy makers using 34 interviews and 12 focus group discussions. Data were recorded, transcribed, translated, coded and thematically analysed according to a framework that included community-, HSA- and health system-related factors.
resultsHSAs were found to be trusted providers of contraceptive services. At community level, gender norms, decision-making and beliefs about contraceptives were intertwined. They resulted in women using contraceptive services, including those offered by HSAs, in secret. There were misconceptions about contraceptives among both men and women, which were insufficiently addressed by HSAs. Residence and age of HSAs influenced their role in the provision of contraceptive services to (young) community members, whereas sex was not regarded as an enabling or hindering factor. While most community members reported to be satisfied with the quality of HSAs' services, quality was compromised by a lack of contraceptive supplies and other resources, and limited supportive supervision and training.
conclusionsHSAs in Mangochi are important contraceptive service providers. Their ability to ensure male involvement, increase access to services for youth and address misconceptions about contraceptives needs improvement. This requires a thorough understanding of socio-cultural norms and improved behavioural change communication competencies, which need to be incorporated in future training under Malawi's Community Health Strategy. .
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