Practical Approach to Lung Health and HIV/AIDS in Malawi
In 2008, the Knowledge Translation Unit led the guideline adaptation process in Malawi in partnership with NGO Dignitas International, engaging a wide array of Malawi Ministry of Health personnel and representatives of Malawian professional associations. The PALSA PLUS guideline was used as starting point and was substantially revised and adapted to comply with Malawi national disease-specific guidelines to become PALM PLUS. A content review was carried out, with some primary care conditions of relevance to Malawi (e.g. malaria) and key symptom pages (e.g. approach to fever) added.
The Knowledge Translation Unit led the facility trainers’ workshops. On-site training targeted clinical officers, nurses, and medical assistants and was piloted in a cluster randomised trial in health centres in the Zomba District. Clinic staff received the training with enthusiasm, in some instances reorganising the delivery of care in their facility and resolving medication supply issues. The pilot aimed to ease the integration of HIV/AIDS care with existing primary care, thereby improving healthcare worker satisfaction and the quality of care. Further implementation was initially well supported, especially by the Dignitas International appointment of a programme coordinator and a total of 455 staff were trained in 32 facilities over a 2 year period. On-site training sessions also involved other health cadres like laboratory technicians, pharmacy assistants, lay health workers and patient attendants, encouraging multidisciplinary interaction around patient care. However, attempts to embed this in the training structures of the district’s health system later faltered in the wake of local political unrest and the global economic crisis in 2012.