Table 1

Key elements of the household model

	Previous HIV/TB model of CHWs in Neno District	Household model
Role and recruitment
Conditions Addressed	HIV, TB	HIV, TB, NCDs, STIs, family planning, maternal and neonatal health, paediatric malnutrition.
Ratios	1 CHW for ~5 to 8 HIV or patients with TB	1 CHW for 20–40 households
Recruitment	CHWs nominated from community leadership. Must live in catchment area and demonstrate willingness to work as a volunteer.	A mapping exercise to ensure every household was assigned a CHW was added to the process. CHWs identified by HSAs and local leaders then vetted by the community. Then the endorsed candidates undergo literacy test and those who pass become CHWs after being trained.
Training and Mentorship	1 day foundational training with quarterly refreshers.	5- day foundational training with quarterly refreshers Addition 2- day training for senior CHW cadre to perform additional duties of mentorship and quarterly spot-checks
Accreditation	In both models, CHWs who complete their training are given certificates signed by Partners In Health (PIH) and local Ministry of Health (MOH).
Equipment and Supplies	Paper registers	Paper registers, home visit checklists, referral forms, MUAC tape, supplies for collecting sputum; job aids, bicycles for senior CHWs, carrier bags
Supervision	CHW cadre reported to CHW Site Supervisor with ratios up to 100:1	Addition of senior CHW (box 1).
Incentives	Monthly flat stipend plus additional amount per patient assigned.	Monthly flat stipend set, roughly equivalent to Malawi minimum wage, which represented a modest raise for the majority of CHWs
Community involvement	Community groups are highly engaged during the recruitment process. Community leadership attends district meetings for programme and data review
Opportunity for advancement	Ad hoc advancement of exemplary CHWs to positions when open, eg promotion to senior CHW, site supervisor (box 1), or other programmatic roles, but not automatic. New opportunities for collaboration and training available as they arise
Data	CHWs submitted paper-based monthly report on number of patients followed up	CHWs used household registers, home visit checklists, and referral forms. Senior CHWs had forms for data aggregation, sputum collection, default tracking assignments and mentorship. Site supervisors used data aggregation forms, meeting agendas, HSA checklist, and mentorship forms. (not the data used in the analysis)
Linkages to Health Systems	Site Supervisors based at health facility to partner with clinical staff and HSAs.	Site supervisors supported with formal checklists to use with HSAs. Clinic data for missed visits for HIV, NCDs provided directly to CHW programme for default tracking. Senior CHWs collect sputum and use MOH TB registers and forms.

CHW, community health worker; HSAs, health surveillance assistants; MOH, Ministry of Health; MUAC, mid upper arm circumference; NCDs, non-communicable diseases; STIs, sexually transmitted infections.