Perspectives of community and facility stakeholders on community health workers in rural Malawi

Background: Community health workers (CHWs) bridge the primary health care (PHC) system and communities by providing care in the household. In Malawi, few studies have examined the perspective of users of household-level CHW services, in remote areas, to understand CHW's role in community-based PHC. Aim: To explore perspectives of community and facility stakeholders on the enablers and challenges of the CHW role in community-based PHC in Neno District. Setting: The study was conducted in the Neno District health facilities, namely, Ligowe, Dambe, Chifunga, and Zalewa. Methods: We conducted eight focus group discussions (FGDs) with purposively sampled community members and conveniently sampled facility stakeholders. Data were transcribed and analysed thematically through an adapted COM-B model of behaviour change. Results: Three main themes of perceived behaviour change within the CHW role were identified: (1) capacity – the CHW programme aids health education and promotion within the community; (2) opportunity – the CHW programme facilitates community-based PHC and linkage to the facility; and (3) motivation – the CHW programme enablers and challenges in providing community-based PHC. Conclusion: Community health workers enrich community-based PHC delivery through health education, timely access to care, and linking communities to the facility. Optimising workload and programme support is critical for the help of CHWs. Further studies are required to address programme and cultural challenges to enhance positive health-seeking behaviours. Contribution: This study provides contextual knowledge for further research on bringing together spiritual and formal health practices and considering the cultural background when planning for health interventions in remote areas.