- Community health workers go door-to-door in Neno, Malawi, to test people and to put those who need it on treatment — and stick to it.
- Home visits have worked so well to diagnose HIV early on and to get them on treatment that HIV-positive people in Neno have much higher survival rates than in parts of the country where no such visits are conducted.
- Now, the same programmes are used to diagnose people with conditions such as diabetes, cancer and high blood pressure — to help them live longer and have higher quality lives.
In the afternoons, as people take a rest after doing their chores and working in the fields, Lydia Kabokondo starts knocking on doors. Her rounds take in people who have diseases that can easily go undiagnosed and untreated.
In rural Malawi, where a hospital or clinic is usually far away, illnesses — even serious noncommunicable diseases (NCDs) such as cancer and diabetes or sickle cell anaemia — are often just something that people live with, or die from, with little medical intervention.
Kabokondo describes herself as a bridge between the 20 households on her patch and health facilities far from their homes and villages.
From HIV to diabetes, high blood pressure and cancer
Making sure that patients were taking their medications was a key part of the HIV programme that helped Neno district, in the south-west of Malawi, achieve the highest rates of patient survival, and maintaining their care, in the country.
Now the successful HIV outreach programme is being used as a model to improve treatment for the new major diseases on the block: diabetes, hypertension, cancer.
“Some of these patients were close to losing their lives but through the information I shared with them we were able to visit the hospital and get the help they needed,” says Kabokondo. “It is such a great feeling to know that I’m playing a role in making a difference in people’s lives.”
There are about 1 200 community health workers employed through the integrated chronic-care model in Neno. They connect patients to 12 health facilities and two hospitals, and screen for both HIV and NCDs.
Getting advice from health workers at home reduces how many times people have to make often arduous and expensive journeys.
Find them, treat them — and make sure they take stick to their treatment
Emily Wroe, who was for several years chief medical officer in Malawi for the charity Partners in Health (PIH), which supports the scheme, says the impetus for integrating HIV and NCD care came from staff on the ground, who first saw the need for such an initiative.
“This health system had figured out how to support people with chronic diseases — find them, keep them, ensure they stuck to their treatment,” she says. “We had already built a chronic-care system, so why not expand that to other conditions?”
The pilot project in Neno has reached 5 500 NCD patients in the area and proved highly cost-effective. While $2.1-million [about R39 102 630] a year had been spent on reaching HIV patients, only $300 000 [R5 586 090] was needed for the integrated care of HIV and NCDs, according to research by Wroe. Annual costs for each patient were reduced from $327 [R6 088] to $260 [R4 821] as more and more people were reached.
Wroe says that while HIV has been well funded, there has been less concern about NCDs in developing countries and so combining care for these diseases has been an efficient way of tackling the problem without having to build an entirely new system.
“We think people with type 1 diabetes were just dying at home without being diagnosed,” she says. “But afterwards we saw thousands of patients going from having no care to having care. Most of them were just living with an NCD or didn’t have medication. There was honestly no option before.”
Neno has also been used to pilot the Pen-Plus programme, which was designed by the World Health Organisation to treat severe NCDs. Two new clinics were established after community workers identified patients who could not be treated through existing facilities.
Chiyembekezo Kachimanga, PIH’s current chief medical officer in Malawi, says that Neno district has gone from offering very limited NCD care to treating 5 500 NCD patients and 8 500 HIV patients at an integrated clinic.
The success has led to PIH supporting the government in setting up clinics in 28 districts across the country and training 1 600 health workers to identify and treat NCDs. They now treat 100 000 people across the country for NCDs.
Taking stock: “Now I’m very healthy and happy.”
“I know people who would not have accessed the care; their quality of life would have been lower. They would not have been diagnosed and that means people die,” says Kachimanga.
“If patients are diagnosed earlier that can improve their quality of life and for some you can prevent unnecessary death.”
Noel Gomani, 24, has type 1 diabetes. She spent a month feeling dizzy and constantly needing the toilet.
“I had a friend who fell ill at the time, back in 2019, in my community. When this friend was sick, he was visited by one of the community health workers and he asked them to also check up on me,” says Gomani, who was referred to a hospital for diagnosis and help to manage her condition.
“Now I’m very healthy and happy. Using the information that I obtain from these programmes, I’m very informed and I even get constant reminders on my medications.”
It takes time to earn trust but Kabokondo believes the work is making a difference. “We have cases of people coming to us just to thank us for saving their lives, and some even reminding us when they see that we have not visited them for some time,” she says.
This article was originally published by The Guardian’s global development project — part of Guardian News & Media Ltd.
Kaamil Ahmed is a journalist at The Guardian's Global Development desk. Ahmed is the author of 'I Feel No Peace', on the ongoing violence against and exploitation of Rohingya refugees.
