World Health Worker Week: bringing heart failure screening and interventions to communities in Neno, Malawi

Author: Amy McLaughlin, NCD Synergies
April 5, 2019

During the first week of April 2019, WHO and the larger global health community is celebrating the contributions that health workers make in their communities, and their fundamental role in achieving comprehensive Universal Health Coverage.

The NCD Synergies team is fortunate to work alongside incredible care teams at PIH-supported sites in Haiti, Liberia, Malawi and Rwanda, which include nurses, clinical officers, physicians and community health workers (CHWs). These teams of providers work tirelessly to deliver, integrated care for severe, chronic NCDs such as type 1 diabetes, sickle cell anemia, and rheumatic heart disease (RHD) in rural, resource-poor settings. This model of care includes a significant investment in training and task shifting to bring high-quality care closer to communities and the patients and families who need it.

Todd Ruderman / Partners In Health Dr. Brown Khongo, Clinical Officer Wellington Mazengera and Dr. Fred Ochieng conduct an echocardiogram at the Matope Health Care Center.

On March 20th, Abwenzi Pa Za Umoya (APZU), PIH’s sister site in Malawi tested its new strategy for active case-finding  for heart failure in Neno District, a predominantly rural district that serves over 170,000 people. Active case finding is a critical strategy for finding patients with subtle illness early so they can get the treatment they need, before the disease progresses. The team trained over 100 community health workers to screen community members in their homes for symptoms of heart failure and referred them in for further evaluation. Accompanied by Dr. Fred Ochieng, a cardiologist and  fellow in Cardiovascular Disease and Global Health Equity at Brigham and Women’s Hospital, the clinical team of clinical officers, nurses, and physicians evaluated 67 patients who were referred by the community health workers.

This included seven patients visited at home because they were unable to travel, conducting at-home echocardiograms to screen for heart failure and identifying at-risk patients to enroll in follow-up care. The team also worked closely with CHWs to identify symptoms and ask screening questions to diagnose suspected heart failure. Of the 67 patients visited, 28 needed further care and were enrolled in both APZU’s Integrated Chronic Care Clinic (IC3) or the Advanced NCD Clinic for follow-up. Of these 28 patients, 12 were diagnosed with heart failure, including seven with RHD.

In the coming months, the APZU NCD team will continue to work in both clinics and throughout the surrounding communities to strive toward universal access to high-quality care for patients living with RHD, type 1 diabetes and other severe, chronic NCDs.

Partners In Health / The APZU NCD team heading to communities in Neno to identify patients with heart failure and other severe, chronic conditions.

This work represents just one of many great examples of efforts by health workers to support essential care for people living with severe NCDs. On World Health Worker Week, and every week, we celebrate our colleagues, collaborators and partners in rural settings like Neno District, and recognize the key role they play in achieving and delivering high-quality universal health care.