The Lay Healthcare Worker Tuberculosis Study

Improving the tuberculosis healthcare provided by lay health workers in Malawi to improve TB outcomes.

research-context Context

The global shortage of skilled health care workers is estimated at 4.2 million with 1.5 million health care workers needed in Africa alone. Task shifting of less complex tasks to lay health care workers (LHWs) has been increasingly employed to address this shortage. Malawi has among the lowest health care worker to population ratios in the world with 2 physicians and 34 nurses/midwives per 100,000 people.  In response, Malawi has greatly scaled up its LHW cadre to over 10,000 LHWs nationally.

Out-patient tuberculosis (TB) care is commonly shifted to LHWs. Despite the availability of effective treatment, TB remains a top cause of mortality with 1.3 million lives lost due to TB in 2012. As the primary providers of out-patient TB care, LHWs have a pivotal role in addressing the high TB burden in Malawi, with over 20,000 new TB notifications in 2010. Despite ongoing efforts, poor treatment adherence remains an important contributor to the high TB burden in Malawi with treatment completion rates ranging from 58% to 70% in our recent study.  LHWs identified a lack of disease and job-specific training as the key barrier to their role as TB care providers. Evidence from randomized trials shows LHWs improve access to basic health services and TB treatment outcomes. However, insufficient training and supervision are widely recognized barriers to their effectiveness.

research-aim Aim

To improve TB care provided by LHWs by refining, implementing and evaluating a knowledge translation strategy consisting of a point of care reminder tool, an educational outreach program led by peer trainers and a peer mentorship network designed to incorporate evidence into LHW practice.


research-timeline Timeline

2015 – 2017

research-partnerships Partnerships

Funder: Canadian Institutes of Health Research
Study Lead: Li Ka Shing Knowledge Institute, St. Michael’s Hospital
Partners: Malawi Ministry of Health, Li Ka Shing Knowledge Institute

research-team Study Team

Dr. Sharon Straus
Principal Investigator, Li ka Shing Knowledge Institute

Lisa Puchalski Ritchie
Co-Principal Investigator,
Li Ka Shing Knowledge Institute,
University Health Network, Dignitas International

Harry Kawonga
Knowledge User, Dignitas International

Austine Makwakwa
Knowledge User, Malawi Ministry of Health

Vanessa van Schoor
Knowledge User, Dignitas International

Adrienne Chan
Co-Investigator, Dignitas International

Monique van Lettow
Co-Investigator, Dignitas International

Jamila Hamid
Co-Investigator, Li ka Shing Knowledge Institute

research-info Contact

For more info, please email Lisa Puchalski Ritchie at

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