Village malaria worker performance key to the elimination of artemisinin-resistant malaria: a Western Cambodia health system assessment

Abstract

BackgroundVillage 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.MethodsA 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.ResultsOverall, 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.DiscussionVMW/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.

High mobility, low access thwarts interventions among seasonal workers in the Greater Mekong Sub-region: lessons from the malaria containment project

“…Of concern was the fact that a large proportion of seasonal workers sought treatment in the private sector, despite evidence that the private sector often treats malaria with counterfeit or sub-standard drugs that are a major driver of evolving multidrug-resistance in the area [36]. It has also been documented that stock-outs, as reported by MMWs in this study, are a major driver of private sector health-seeking among MMPs [17]. It is critical to resolve supply chain inefficiencies.…”

“…After the broadcast, the audience was engaged in a discussion and question and answer session [13, 14]; (3) an insecticide-treated net (ITN) lending scheme was implemented in farms where MMPs tended to work [15], as seasonal workers do not have access to the same free net-distribution scheme that villagers have. It empowered farm owners to lend ITNs to their employees and educate them on the benefits of using them; (4) taxi drivers in Palin Province were trained to provide malaria education and materials to MMPs and divert symptomatic passengers to a health facility upon obtaining their consent, due to the fact that 75 % of seasonal workers use taxis as their primary means of transportation [16]; and, (5) Mobile Malaria Workers (MMWs) were introduced in 2009 to provide health services to MMPs, as detailed elsewhere [17]. MMWs are a critical component of the national strategy to eliminate and contain drug-resistant malaria among MMPs in Cambodia.…”

The challenge of safe anesthesia in developing countries: defining the problems in a medical center in Cambodia

“…According to the records from the Cambodian Society of Anesthesia Critical Care and Emergency Medicine [30], anesthesiologists at Preah Ket Mealea Hospital tend to have better education and training experience than anesthesiologists in other hospitals, and the patient population they serve is larger than that of other hospitals. Second, we should also recognize that Cambodia still faces a critical shortage of medical resources and has a huge gap between urban and rural medical services [31]; therefore, the results of this study can only reflect the level of anesthesia services in the cities. Third, the sample size was too small to make firm conclusions on the safety of anesthesia practice for rare events such as death [4].…”

Tools to accelerate falciparum malaria elimination in Cambodia: a meeting report

“…Recent evidence for the success of this strategy comes from the roll out of malaria posts in Karen State, Myanmar which played an important part in the dramatic reduction of malaria transmission [21]. In 2009, Cambodia successfully introduced village malaria worker (VMW) programmes which have now been expanded country wide [22][23][24][25][26]. The main challenges in the ongoing case management of malaria are the continued provision and support of competent health care providers e.g.…”