MANZINI, 7 September 2010 (IRIN) - The scope of Malawi's health assistants - first introduced in the 1960s as part of an initiative to eradicate smallpox - is being broadened to compensate for the lack of available medical skills and to assist in managing the treatment of child malnutrition.

Rudi Thetard of Management Sciences for Health - an NGO working to strengthen public health care - told the recent annual meeting of the Rural Doctors Association of Southern Africa in Manzini, Swaziland, that since 2008 about 1,000 health surveillance assistants (HSAs) had completed the several-week-long training course.

After an additional six days of training on top of their basic module, many were conducting "village clinics", increasing the access of communities to the treatment of a variety of ailments - such as malaria, fevers, pneumonia, and diarrhoeal diseases - by a quarter in the areas in which they were deployed, he said.

The World Health Organization (WHO) estimates there are about two doctors and 59 nurses for every 100,000 people and that in 2006 the vacancy rate for nurses stood at about 65 percent. About 59 percent of Malawi-born physicians were practising outside the country.

Donors contribute about 60 percent of the country's total health expenditure, according to the WHO.

After HSAs' basic training, the low-skilled health practitioners initially work with clinical officers - medical personnel who have completed a three-year course - who are used as substitutes for physicians.

HSAs with additional training travel to remote and isolated communities by bicycle, providing medical services that previously were unavailable.

Thetard told IRIN: "Simple approaches allow for the expansion of services. Even Malawi's scale-up of anti-retrovirals, which has been very successful, is based on very simple approaches and standard treatment regimens. There's been no reliance on lab diagnostics until recently."

About 11.9 percent of Malawians aged 15-49 are infected with HIV.

Thetard said it was found some medicines, especially anti-malarials, were being overused and this could be corrected by equipping HSAs with onsite diagnostic tools, such as rapid malaria testing.

Lessons from the Sahel

Learning from the Sahel droughts of the late 1990s where community management of acute malnutrition was first employed, HSAs were playing a crucial role treating malnutrition among children: Seasonal or cyclical hunger meant about 47 percent of Malawian children were classified as stunted, Thetard said.

A nurse or clinical officer determines the severity of a child's condition and whether the case merits hospitalization or management by HSAs at their homes.

Until recently children requiring nutritional rehabilitation were routinely admitted to hospital for up to three weeks, removing them from the home environment, burdening poor families with additional transport costs to visit their children.

Thetard said the Sahel experience had shown that as many as 80 percent of acutely malnourished children can be treated as outpatients and that through the establishment of community nutritional services, almost double the paediatric malnutrition cases were identified than were previously referred to hospitals for treatment.

"In child survival this kind of simplicity is so important, and moving away from a heavily clinic-based approach is possible," Thetard said.

 Boosting medical services is a welcome development.