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

Canavati, Sara E., Lawpoolsri, Saranath, Quintero, Cesia E., Nguon, Chea, Ly, Po, Pukrittayakamee, Sasithon, Sintasath, David, Singhasivanon, Pratap, Grietens, Koen Peeters and Whittaker, Maxine Anne (2016) Village malaria worker performance key to the elimination of artemisinin-resistant malaria: a Western Cambodia health system assessment. Malaria Journal, 15 282: 1-15. doi:10.1186/s12936-016-1322-6


Author Canavati, Sara E.
Lawpoolsri, Saranath
Quintero, Cesia E.
Nguon, Chea
Ly, Po
Pukrittayakamee, Sasithon
Sintasath, David
Singhasivanon, Pratap
Grietens, Koen Peeters
Whittaker, Maxine Anne
Title Village malaria worker performance key to the elimination of artemisinin-resistant malaria: a Western Cambodia health system assessment
Journal name Malaria Journal   Check publisher's open access policy
ISSN 1475-2875
Publication date 2016-05-20
Year available 2016
Sub-type Article (original research)
DOI 10.1186/s12936-016-1322-6
Open Access Status DOI
Volume 15
Issue 282
Start page 1
End page 15
Total pages 15
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2017
Language eng
Formatted 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.
Keyword Community malaria worker
Artemisinin resistance
Cambodia
Malaria elimination
Health system strengthening
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
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