This article is part of the supplement: Global health research case studies: lessons from partnerships addressing health inequities

Open Access Research article

Evaluating a streamlined clinical tool and educational outreach intervention for health care workers in Malawi: the PALM PLUS case study

Sumeet Sodhi123, Hastings Banda4, Damson Kathyola5, Barry Burciul1, Sandy Thompson1, Martias Joshua56, Eric Bateman7, Lara Fairall7, Alexandra Martiniuk1089, Ruth Cornick7, Gill Faris7, Beverley Draper7, Martha Mondiwa11, Egnat Katengeza1, Lifah Sanudi4, Merrick Zwarenstein1101213 and Michael J Schull1101214*

Author Affiliations

1 Dignitas International, 2 Adelaide Street West, Suite 200, Toronto, M5H 1L6, Canada

2 Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 263 McCaul Street, 5th Floor, Toronto, M5T 1W7

3 Department of Family and Community Medicine, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, M5T 2S8

4 Research for Equity and Community Health (REACH) Trust, POB 1597, Lilongwe, Malawi

5 Malawi, Ministry of Health Malawi, POB 3, Lilongwe, Malawi

6 Zomba Central Hospital, Kamuzu Highway, Zomba, Malawi

7 Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, PO Box 34560, Groote Schuur 7937, South Africa

8 Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, M5T 3M7, Canada

9 George Institute for Global Health; University of Sydney, 341 George Street Sydney, 2000, Australia

10 Sunnybrook Health Sciences Center; 2075 Bayview Ave, Toronto, M4N 3M5 Canada

11 Nurses and Midwives Council of Malawi, POB 30361, Lilongwe, Malawi

12 Department of Health Policy, Management and Evaluation, 155 College Street, Suite 425, Toronto, M5T 3M6, Canada

13 IHCAR, Karolinska Institute, Nobelsveg 9, Stockholm, Sweden

14 Department of Medicine, University of Toronto, 200 Elizabeth Street Toronto, M5G 2C4, Canada

For all author emails, please log on.

BMC International Health and Human Rights 2011, 11(Suppl 2):S11  doi:10.1186/1472-698X-11-S2-S11

Published: 8 November 2011



Nearly 3 million people in resource-poor countries receive antiretrovirals for the treatment of HIV/AIDS, yet millions more require treatment. Key barriers to treatment scale up are shortages of trained health care workers, and challenges integrating HIV/AIDS care with primary care.

The research

PALM PLUS (Practical Approach to Lung Health and HIV/AIDS in Malawi) is an intervention designed to simplify and integrate existing Malawian national guidelines into a single, simple, user-friendly guideline for mid-level health care workers. Training utilizes a peer-to-peer educational outreach approach. Research is being undertaken to evaluate this intervention to generate evidence that will guide future decision-making for consideration of roll out in Malawi. The research consists of a cluster randomized trial in 30 public health centres in Zomba District that measures the effect of the intervention on staff satisfaction and retention, quality of patient care, and costs through quantitative, qualitative and health economics methods.

Results and outcomes

In the first phase of qualitative inquiry respondents from intervention sites demonstrated in-depth knowledge of PALM PLUS compared to those from control sites. Participants in intervention sites felt that the PALM PLUS tool empowered them to provide better health services to patients. Interim staff retention data shows that there were, on average, 3 to 4 staff departing from the control and intervention sites per month. Additional qualitative, quantitative and economic analyses are planned.

The partnership

Dignitas International and the Knowledge Translation Unit at the University of Cape Town Lung Institute have led the adaptation and development of the PALM PLUS intervention, using experience gained through the implementation of the South African precursor, PALSA PLUS. The Malawian partners, REACH Trust and the Research Unit at the Ministry of Health, have led the qualitative and economic evaluations. Dignitas and Ministry of Health have facilitated interaction with implementers and policy-makers.

Challenges and successes

This initiative is an example of South-South knowledge translation between South Africa and Malawi, mediated by a Canadian academic-NGO hybrid. Our success in developing and rolling out PALM PLUS in Malawi suggests that it is possible to adapt and implement this intervention for use in other resource-limited settings.