title: 'Whose failure counts?' A critical reflection on definitions of failure for community health volunteers providing HIV self-testing in a community-based HIV/TB intervention study in urban Malawi.
abstract: The category of community health worker applied within the context of health intervention trials has been promoted as a cost-effective approach to meeting study objectives across large populations, relying on the promotion of the concept of 'community belonging' to encourage altruistic volunteerism from community members to promote health. This community-based category of individuals is recruited to facilitate externally driven priorities defined by large research teams, outside of the target research environment. An externally defined intervention is then 'brought to' the community through locally recruited community volunteers who form a bridge between the researchers and participants. The specific role of these workers is context-driven and responsive to the needs of the intervention. This paper is based on the findings from an annual evaluation of community health worker performance employed as community counsellors to deliver semi-supervised HIV self-testing (HIVST) at community level of a large HIV/TB intervention trial conducted in urban Blantyre, Malawi. A performance evaluation was conducted to appraise individual service delivery and assess achievements in meeting pre-defined targets for uptake of HIVST with the aim of improving overall uptake of HIVST. Through an empirical 'evaluation of the evaluation' this paper critically reflects on the position of the community volunteer through the analytical lens of 'failure', exploring the tensions in communication and interpretation of intervention delivery between researchers and community volunteers and the differing perspectives on defining failure. It is concluded that community interventions should be developed in collaboration with the population and that information guiding success should be clearly defined.
authors.affiliation: a Malawi Liverpool Wellcome Trust Clinical Research Programme , Science Communication , PO Box 30096 , Chichiri , Blantyre , Malawi.
authors.forename: Rodrick
authors.initials: R
authors.lastname: Sambakunsi
authors.affiliation: b College of Medicine , University of Malawi , Blantyre , Malawi.|c Malawi Liverpool Wellcome Trust Clinical Research Programme , Blantyre , Malawi.
authors.forename: Moses
authors.initials: M
authors.lastname: Kumwenda
authors.affiliation: c Malawi Liverpool Wellcome Trust Clinical Research Programme , Blantyre , Malawi.|d London School of Hygiene & Tropical Medicine , London , UK.
authors.forename: Augustine
authors.initials: A
authors.lastname: Choko
authors.affiliation: c Malawi Liverpool Wellcome Trust Clinical Research Programme , Blantyre , Malawi.|d London School of Hygiene & Tropical Medicine , London , UK.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Corbett
authors.affiliation: c Malawi Liverpool Wellcome Trust Clinical Research Programme , Blantyre , Malawi.|e Liverpool School of Tropical Medicine , Liverpool , UK.
authors.forename: Nicola Ann
authors.initials: NA
authors.lastname: Desmond
mesh_terms: D003150:Community Health Workers / Q000523:psychology / Q000592:standards; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000208:ethnology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008295:Malawi / Q000208:ethnology; D008297:Male; D015397:Program Evaluation; D019037:Urban Health Services / Q000592:standards*; D014838:Volunteers
keywords: HIV self-testing; community counsellor; community health worker; failure; volunteerism