Motivation To Test, Treat, and Report Malaria Cases: A Quantitative Assessment Among Private Sector Providers in The Greater Mekong Subregion

Abstract

Accurately testing, treating, and tracking all malaria cases is critical to achieving elimination. Ensuring health providers are able and motivated to test, treat, and report cases is a necessary component of elimination programs, and particularly challenging in low endemic settings where providers may not encounter a large volume of cases. With funding from the Bill & Melinda Gates Foundation, this study aimed to identify and validate distinctive subtypes of motivation among private sector providers enrolled in the Greater Mekong Subregion Elimination of Malaria through Surveillance (GEMS) program, implemented by Population Services International. Quantitative questionnaires were administered electronically in person by trained enumerators to various provider groups in Myanmar, Lao PDR, and Vietnam. A three-stage confirmatory factor analysis was then conducted in STATA. Following this analysis, a two-factor solution that describes motivation in this population of providers was identified, and providers were scored on the two dimensions of motivation. Provider motivations were analyzed by provider characteristics, and associations with intentions and outcomes related to malaria service provision were explored. These providers, who are often assumed to only be financially motivated, engaged in malaria elimination activities because of both internal and external motivational factors that are independent of remuneration or financial gain. Motivation varied by provider characteristics and was associated with outcomes of importance to malaria elimination. Understanding components of provider motivation to test, treat, and report malaria cases in elimination settings will ensure that malaria programs can establish mechanisms to encourage lasting engagement by providers in pursuit of elimination goals.

Private Sector Contributions to National Malaria Surveillance Systems in Elimination Settings: Lessons Learned from Cambodia, Lao PDR, Myanmar, and Vietnam

“…19 In settings where the public sector alone cannot adequately cover the population at risk and where high-risk populations face barriers to accessing care at public facilities or from VMWs, the private sector may be a crucial partner in the malaria elimination end game. 20 Among some populations in malaria endemic areas of the GMS, fever care is sought primarily through the private sector. 2,12 Although case detection through the private sector gradually declined in Cambodia, Lao PDR, and Myanmar, in Vietnam, the private sector's case detection and contribution to national caseload increased year-over-year from 2017 to 2019.…”

“…However, a recent study demonstrates that private sector providers are motivated by a complex range of internal and external factors such as commitment to serving their community, boosting their reputation, having access to professional development opportunities, and receiving commodities. 20 These factors along with the lessons from the PSI experience in the GMS can be leveraged to refine context-specific strategies for incorporating the private sector into national surveillance systems in elimination settings.…”