Malawi integrated community case management

Malawi introduced integrated community case management (iCCM) of childhood illness nationwide in 2007 to ensure that children under five years have access to early diagnosis and treatment of malaria and other childhood illnesses.  Health Surveillance Assistants (HSAs) are salaried community health workers who provide disease prevention and health promotion services; the programme is intended to serve communities more than five kilometers from a health facility.   

In addition to these core duties they also provide ICCM services including testing, treatment, and referral of malaria cases at the community level as appropriate. HSAs perform a variety of activities, including integrated community case management (iCCM) and malaria case management, for children under five years of age at the community level; approximately 54 percent of HSAs are trained in iCCM. The Government of Malawi intends to reach a target of 1 HSA per 1,000 population by 2022. As of 2021, the ratio was 1 HSA per 2,095 population; HSAs receive a stipend of approximately US$150 per month but there is not a retention policy specific for HSAs. 

Equipped with a three-lock drug box, HSAs are regularly supplied with mRDTs for malaria parasitological testing, artemether-lumefantrine (AL) for treatment of confirmed uncomplicated malaria and rectal artesunate (RA) as pre-referral intervention of severe malaria at community level.