Comparing the roles of community health workers for malaria control and elimination in Cambodia and Tanzania

Abstract

The reduction of deaths from malaria in sub-Saharan Africa (SSA) is stalling, whereas many countries in Southeast Asia are approaching malaria elimination. We reviewed the role of community health worker (CHW) programmes in malaria control and elimination between regions, with a more detailed description of the programmes in Tanzania and Cambodia. Compared with Tanzania, Cambodia has a much more developed CHW network, which has been pivotal in the near elimination of malaria. In Tanzania, the malaria burden has remained similar over the last decade and treatment continues to rely on healthcare facilities, which provide more limited access to early diagnosis and treatment. Overall, the proportion of malaria cases treated by CHWs is substantially lower in SSA than in Southeast Asia. Even though networks of CHWs are resource intensive and malaria epidemiology differs substantially between countries, there is a strong case for expanding CHW networks in rural SSA to improve early access to effective malaria treatment and reduce the malaria burden.

Expanding the roles of community health workers to sustain programmes during malaria elimination: a meeting report on operational research in Southeast Asia

“…It is difficult to imagine that VMWs could continue to deliver increasingly complex roles without adequate remuneration or better integration within the formal health system. A systematic review on how community health workers could take on integrated roles for community case management of malaria also identified challenges related to the need for sustainable financing, tailoring the training to address the identified gaps, and improving supply chain management [ 9 , 52 ]. Integrated community case management (iCCM) of malaria, pneumonia and diarrhoea have been shown to be successful in the past and could possibly add optimism to Cambodia’s plan for adding roles related to vector-borne diseases (VBDs) [ 53 , 54 ].…”

“…Approximately 3500 VMWs have been deployed in rural areas of Cambodia where malaria is endemic. The VMW programme has been linked to a significant decrease in malaria cases in recent years [ 9 ]. This decline was first noticeable among Plasmodium falciparum infections and later vivax malaria as well [ 7 , 10 , 11 ].…”

Impact of targeted drug administration and intermittent preventive treatment for forest goers using artesunate–pyronaridine to control malaria outbreaks in Cambodia

“…These results are important for CNM as they are the first to demonstrate the feasibility of malaria chemoprevention response strategies in an elimination setting. Provided adequate preparations are in place, programmatic roll out can be conducted with the resources available within the operational budget of the health system utilizing community-based network of VMWs and MMWs as opposed to conducting large scale research studies that require additional resources [ 17 ]. The fact that the study was conducted in the malaria endemic villages by the community based VMWs and MMWs also demonstrates the value of these locally available resources and the feasibility of their effectiveness during outbreaks [ 18 ].…”

Proactive home-based malaria management in rural communities of Bassar Health District in northern Togo from 2014 to 2017: PECADOM + , a pilot experiment

“…Regarding malaria, CHWs help reduce the disease burden‒transmission, morbidity, and mortality by means of: (i) case management; i.e., diagnosis with rapid diagnostic tests (RDTs), treatment of fever and uncomplicated malaria cases, and referral of complicated cases to health facilities; (ii) prevention; i.e., education about malaria and its complications, intermittent preventive treatment for pregnant women or children, and supply of insecticide-treated bed nets; and, (iii) collection of key epidemiological data needed for surveillance and control. The actions of CHWs proved successful, provided sufficient funding and remuneration, adequate training, clear role definitions and guidelines, regular supervision, constant support, motivating incentives, and better recognition by the healthcare system (and thus the community itself) [ 11 ].…”