Ethical and legal issues related to health surveillance assistants’ job description in Malawi

Abstract

The study critically analyzes the ethical and legal issues related to Health Surveillance Assistants (HSAs) job description in Malawi. HSAs are community health workers employed by the Ministry of Health and comprise 30% of the health workforce. Historically, the HSAs cadre evolved from Smallpox Vaccinators in 1960s, to Cholera Assistants in 1973 and HSAs in 1995. Due to the shortage of qualified health workers, the Ministry of Health delegated clinical tasks to HSAs to provide curative care in rural areas in addition to their traditional basic environmental health roles to improve health care access. However, the delegation of clinical tasks to HSAs attracts ethical and legal issues which are the basis of this research. I argue that the benefits of using HSAs include reducing disparity and inequality in accessing quality health care between urban and rural population. However, I claim that HSAs clinical practice exposes patients to risks of harm and conflicts with ethical and legal principles. I recommend that HSAs upon completion of accredited training should be regulated using the Reservation of the Title Only and Grandfathering for experienced HSAs by a health regulatory body. Furthermore, I recommend that the Ministry of Health, regulatory bodies and stakeholders should review the policy frameworks which will guide on supervision, liability standards, and training of HSAs.