Scotland Chikwawa Health Initiative

Addressing healthy settings in Malawi

“Staying with Strangers” the challenges faced by health workers in rural areas


In February the SCHI team met with the health surveillance assistants, facility health workers (nurses and medical assistant) and supervisory staff from the District Health Office. The meeting had two purposes, (1) to further sensitise the health office team on the project and progress, and most importantly (2) to discuss the challenges facing all the health workers in their every day personal and professional lives when based in Chikhwawa, and specifically the Mfera area. The work of SCHI since 2006 has shown that health improvements at community level can only be achieved with the full buy-in of the health workers and the development of effective working relationships between health workers and communities. In order to achieve this, we need to have a clear understanding of the attitudes of the health workers (and communities), as well as the perceived barriers to success so that we can develop realistic solutions.

The discussion split the cadres into two groups – facility based and community based – and groups discussed not only their professional issues, but also the personal implications of living and working in a remote rural area which is not their original home. In particular facility based personnel felt disempowered and stated that they were “staying with strangers” and that local leaders who are “the custodians and gatekeepers of culture in villages” consider them as “outsiders who cannot question the traditional practices” at community level. This was also an issue with regard to professional supervision an support where they felt they could not question superiors.  Health workers felt that it was hard for them to develop meaningful friendships with community members due to differences in education levels, however they did demonstrated community participation through being active members of churches and football teams on a social level.

Other challenges (both personal and professional) outlined included: access to transportation, access to goods, education opportunities for family members, lack of professional development opportunities, poor supervision and administrative support, etc.

A full report of the assessment process will be published in due course.


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This entry was posted on April 10, 2014 by in Health workers and facilities.

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