Malaria Journal
Volume 15, Issue 1, 2016

Village malaria worker performance key to the elimination of artemisinin-resistant malaria: A Western Cambodia health system assessment (Article) (Open Access)

Canavati S.E.* , Lawpoolsri S. , Quintero C.E. , Nguon C. , Ly P. , Pukrittayakamee S. , Sintasath D. , Singhasivanon P. , Peeters Grietens K. , Whittaker M.A.
  • a Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand, Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
  • b Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand
  • c Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
  • d National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Corner Street 92, Trapaing Svay Village, Sankat Phnom Penh Thmey, Khan Sensok, Phnom Penh, Cambodia
  • e National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Corner Street 92, Trapaing Svay Village, Sankat Phnom Penh Thmey, Khan Sensok, Phnom Penh, Cambodia
  • f Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand
  • g Malaria Consortium Asia, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajavidhi Road, Bangkok, 10400, Thailand
  • h Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand
  • i Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan, Partners for Applied Social Sciences (PASS) International, Tessenderlo, Belgium
  • j Division of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia, University of Queensland, School of Public Health, Herston, QLD 4006, Australia

Abstract

Background: Village malaria workers (VMWs) and mobile malaria workers (MMWs) are a critical component of Cambodia's national strategy to eliminate Plasmodium falciparum malaria by 2025. Since 2004, VMWs have been providing malaria diagnosis through the use of rapid diagnostic tests and free-of-charge artemisinin-based combination therapy in villages more than 5 km away from the closest health facility. They have also played a key role in the delivery of behaviour change communication interventions to this target population. This study aimed to assess the job performance of VMWs/MMWs, and identify challenges they face, which may impede elimination efforts. Methods: A mixed-methods assessment was conducted in five provinces of western Cambodia. One hundred and eighty five VMW/MMW participants were surveyed using a structured questionnaire. Qualitative data was gathered through a total of 60 focus group discussions and 65 in-depth interviews. Data triangulation of the qualitative and quantitative data was used during analysis. Results: Overall, VMWs/MMWs met or exceeded the expected performance levels (80 %). Nevertheless, some performance gaps were identified. Misconceptions regarding malaria transmission and prevention were found among workers. The recommended approach for malaria treatment, directly-observed treatment (DOT), had low implementation rates. Stock-outs, difficulties in reaching out to migrant and mobile populations, insufficient means of transportation and dwindling worker satisfaction also affected job performance. Discussion: VMW/MMW job performance must be increased from 80 to 100 % in order to achieve elimination. In order to do this, it is recommended for the national malaria programme to eliminate worker malaria knowledge gaps. Barriers to DOT implementation and health system failures also need to be addressed. The VMW programme should be expanded on several fronts in order to tackle remaining performance gaps. Findings from this evaluation are useful to inform the planning of future activities of the programme and to improve the effectiveness of interventions in a context where artemisinin drug resistance is a significant public health issue. © 2016 The Author(s).

Author Keywords

Malaria elimination Cambodia Community malaria worker Health system strengthening Artemisinin resistance

Index Keywords

Community Health Workers mobile malaria worker village malaria worker health care survey Cambodia health care personnel human middle aged protocol compliance Malaria Job Satisfaction health auxiliary program effectiveness Cross-Sectional Studies Surveys and Questionnaires health program cross-sectional study Humans health services research Antimalarials male antimalarial agent female qualitative analysis questionnaire medical education Article health care utilization adult health education disease elimination artemisinin health care access Malaria, Falciparum malaria falciparum Plasmodium falciparum Disease Management antibiotic resistance drug resistance health care system quantitative analysis artemisinin derivative Artemisinins practice guideline job performance health care delivery
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84974678550&doi=10.1186%2fs12936-016-1322-6&partnerID=40&md5=ff0510b9697233f182ab4cf98d73c3b6
DOI: 10.1186/s12936-016-1322-6
ISSN: 14752875
Cited by: 20
Original Language: English