title: Supporting middle-cadre health care workers in Malawi: lessons learned during implementation of the PALM PLUS package.
abstract: BACKGROUND
  The government of Malawi is committed to the broad rollout of antiretroviral treatment in Malawi in the public health sector; however one of the primary challenges has been the shortage of trained health care workers. The Practical Approach to Lung Health Plus HIV/AIDS in Malawi (PALM PLUS) package is an innovative guideline and training intervention that supports primary care middle-cadre health care workers to provide front-line integrated primary care. The purpose of this paper is to describe the lessons learned in implementing the PALM PLUS package.
  
  
  METHODS
  A clinical tool, based on algorithm- and symptom-based guidelines was adapted to the Malawian context. An accompanying training program based on educational outreach principles was developed and a cascade training approach was used for implementation of the PALM PLUS package in 30 health centres, targeting clinical officers, medical assistants, and nurses. Lessons learned were identified during program implementation through engagement with collaborating partners and program participants and review of program evaluation findings.
  
  
  RESULTS
  Key lessons learned for successful program implementation of the PALM PLUS package include the importance of building networks for peer-based support, ensuring adequate training capacity, making linkages with continuing professional development accreditation and providing modest in-service training budgets. The main limiting factors to implementation were turnover of staff and desire for financial training allowances.
  
  
  CONCLUSIONS
  The PALM PLUS approach is a potential model for supporting mid-level health care workers to provide front-line integrated primary care in low and middle income countries, and may be useful for future task-shifting initiatives.
authors: Sumeet
authors: S
authors: Sodhi
authors: Hastings
authors: H
authors: Banda
authors: Damson
authors: D
authors: Kathyola
authors: Martias
authors: M
authors: Joshua
authors: Faye
authors: F
authors: Richardson
authors: Emmay
authors: E
authors: Mah
authors: Hayley
authors: H
authors: MacGregor
authors: Emmanuel
authors: E
authors: Kanike
authors: Sandy
authors: S
authors: Thompson
authors: Lara
authors: L
authors: Fairall
authors: Eric
authors: E
authors: Bateman
authors: Merrick
authors: M
authors: Zwarenstein
authors: Michael J
authors: MJ
authors: Schull
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003150:Community Health Workers / Q000193:education*; D003299:Cooperative Behavior; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006302:Health Services Research; D006801:Humans; D007318:Inservice Training; D007407:Interviews as Topic; D008295:Malawi / Q000453:epidemiology; D008297:Male; D010379:Peer Group; D011320:Primary Health Care; D015397:Program Evaluation; D012944:Social Support; D000078329:Workforce
chemical_list: D019380:Anti-HIV Agents