The Lay Healthcare Worker Tuberculosis Study

 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.

 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.