“The Health Facility In-Charge Cannot Go into the Community as We Do": Healthcare Workers’ Perceptions of Task-Sharing for Community-Based Psychosis Screening and Referral in Malawi.

Background Tasksharing is increasingly seen as a practical way to address the shortage of qualified mental health specialists in low-resource settings. In Malawi, involving general healthcare workers, such as health surveillance assistants (HSAs), in psychosis screening and referrals could help expand mental health services to underserved communities. However, little is known about healthcare workers’ perceptions of tasksharing for community-based psychosis screening and referral. This formative qualitative study investigated the factors that support or hinder tasksharing among HSAs and assessed how feasible it is to implement this approach from the perspective of healthcare workers. Methods A qualitative formative study was conducted in the Chiradzulu and Salima districts as part of the Psychosis Recovery Orientation in Malawi by Improving Services and Engagement (PROMISE) project. Data were collected through in-depth interviews and focus group discussions with members of the district mental health team, primary healthcare providers, and HSAs. Thematic analysis guided the data analysis and interpretation. Results The findings revealed variations in the understanding of psychosis across healthcare cadres. District mental health professionals were confident in their biomedical knowledge, whereas most HSAs reported a limited understanding of psychosis. Despite this, district and primary healthcare workers expressed confidence in HSAs’ potential to support community-based screening and referrals, citing their close ties to communities and experience in health promotion. Key barriers to tasksharing included inadequate training, medication shortages, limited supervision, and divergent cultural beliefs about psychosis. These systemic and contextual challenges must be addressed for tasksharing to be effective. Conclusions Task-sharing with HSAs offers a promising strategy to enhance psychosis screening and referral at the community level in Malawi. For successful implementation, comprehensive policy support, adequate resourcing, and targeted training are essential.