Enabling and Hindering Factors of Health Surveillance Assistants’ Roles in the Provision of Contraceptive Services in Mangochi, Malawi

Helena de Kat, Amref Health Africa Tanzania
Maryse Kok, Researcher
Madalitso Tolani, Amref Health Africa in Malawi
Twambilire Mwabungulu, Amref Health Africa Tanzania
Arnold Munthali, Amref Health Africa Tanzania
Benedict Chinsakaso, Amref Health Africa Tanzania

Despite increased contraceptive use over the past decades, unmet need is still high in Malawi. Health surveillance assistants (HSAs) provide an expanded range of contraceptive services at community level. We conducted a qualitative study to explore enabling and hindering factors of HSAs’ roles in the provision of contraceptive services in Mangochi district, Malawi. The study involved HSAs and their supervisors, 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. HSAs were found to be trusted contraceptive service providers. It was found that their ability to ensure male involvement, increase access to services for youth and address misconceptions needs improvement. This requires a thorough understanding of socio-cultural norms and improved behavioral change communication competencies, which need to be incorporated in future training.