Living library project on AIDS Memorial Day where the ‘books’ were real people with stories of their own to share © 2008 Alliance Ukraine Participants in the Photovioce project, India © 2006 Jenny Mathews / Alliance / Photovoice

Linking formal health systems and community systems in Malawi


© the Alliance
In Malawi, where AIDS remains the leading cause of death, the Alliance has been supporting a pioneering programme where volunteers refer people in their community to formal health services and community based organizations (CBOs) for support. 


Part of a five-year USAID funded programme known as BRIDGE II, the programme is also promoting behaviour change using mass media approaches, in particular radio, and other community level activities to prevent HIV.  Five local partners are involved as well as Save The Children, Pact Malawi and the Alliance. 

Over the last three years the Alliance has trained 520 volunteers in four districts - Chiradzulu, Thyolo, Mulanje and Phalombe - in the southern region of the country where, according to UNAIDS, HIV prevalence remains highest at 14.5%.

The one to one service offered by the volunteers, or community referral agents (CRAs), has paid huge dividends with more than 40,000 people acting on a referral last year - 42% went for HIV counselling and testing, 25 % for family planning and 12 % sought condoms.  There was a 94% success rate for referrals for prevention of mother to child transmission (PMTCT) with more than 1800 women taking up this service. 

It’s not just individuals who have benefited; the referral approach has also proved to be a successful way of reaching couples with some 2,500 couples referred on for testing and family planning services as well as antiretroviral therapy adherence, and the prevention and treatment of sexually transmitted infections.  Self-help groups for people living with HIV are another important component of the programme, illustrating the importance of linking formal health services to informal services based in the community.

Earlier this month Malawi’s President, Joyce Banda, commended BRIDGE II for its work promoting Option B+, where all pregnant women living with HIV are offered life-long ART, regardless of their CD4 count.  The referrals programme supports the important work to raise community awareness around PMTCT.
The Alliance /BRIDGE II referral model is unique in that it places the volunteers in the community and not just at the health centre, which broadens their reach as other models often focus on those who have already sought healthcare.  Making sure that the volunteers come from existing structures which already focus on HIV, and are therefore known and trusted by the community, is essential to the model’s success. 

In order to ensure sustainability and strengthen community systems, the BRIDGE partners plan to continue strengthening capacity of CBO networks by providing further training in supervision, leadership, and group dynamics.  This is the last year of the programme and the Alliance will focus on documenting the model as well as working with other NGOs to advocate for a package of services to influence the Ministry of Health’s approach on referrals.

BRIDGE II is implemented by the Johns Hopkins Bloomberg School of Public Health Centre for Communication Programs (JHU.CCP) in partnership with Save the Children International, PACT Malawi, International HIV/AIDS Alliance and local partners.

Read more about BRIDGE II.