RT Journal Article
SR Electronic
T1 Evaluating Vertical Malaria Community Health Worker Programs as Malaria Declines: Learning From Program Evaluations in Honduras and Lao PDR
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP S98
OP S110
DO 10.9745/GHSP-D-20-00379
VO 9
IS Supplement 1
A1 Harriet G. Napier
A1 Madeline Baird
A1 Evelyn Wong
A1 Eliza Walwyn-Jones
A1 Manuel Espinoza Garcia
A1 Lizeth Cartagena
A1 Nontokozo Mngadi
A1 Viengxay Vanisaveth
A1 Viengphone Sengsavath
A1 Phoutnalong Vilay
A1 Kenesay Thongpiou
A1 Theodoor Visser
A1 Justin M. Cohen
YR 2021
UL http://www.ghspjournal.org/content/9/Supplement_1/S98.abstract
AB Key FindingsCommunity health workers (CHWs) detect nearly 30% of all malaria cases in remaining hotspots in Lao PDR and more than 50% of all reported malaria cases in select regions of Honduras.Despite having dedicated funding, both countries face challenges supervising, equipping, and supporting CHWs.As malaria test positivity declines, expanding CHWs' responsibilities may encourage individuals to seek care and enable CHWs to more promptly detect and treat remaining cases.Key ImplicationsNational malaria programs should assess vertical CHW network design, management, and financing to identify opportunities to promote care seeking for febrile illness.As likelihood of malaria as the primary cause of fever decreases, providing an integrated package of services will become more critical in ensuring that patients' needs are met.CHWs are a major source of malaria testing, treatment, and disease intelligence. Information systems capable of tracking their performance and progress to guide remedial action and attribute impact are essential.Background:Across the Greater Mekong Subregion (GMS) and Central America, governments commonly employ community health workers (CHWs) to improve access to and uptake of malaria services. Many of these networks are vertical in design, organized to extend malaria-only services to those remaining communities in which malaria persists.Methods:Between 2019 and 2020, national ministries of health (MOH) and Clinton Health Access Initiative conducted mixed-methods CHW program evaluations across the GMS and Central America. Routine surveillance and programmatic data were analyzed to quantify CHW contributions to malaria elimination objectives and identify gaps and challenges. Semistructured interviews were conducted with governmental and nongovernmental stakeholders from central to community level. This article draws comparisons between the Lao People's Democratic Republic (PDR) and Honduras CHW program evaluation results to distill broader hypotheses about how vertical CHW programs might evolve as their primary mission nears its end.Results:CHWs contribute substantially to malaria case detection and surveillance, diagnosing and treating 27% of malaria cases in Lao PDR and 55% in the department of Gracias a Dios, Honduras in 2019. In the same year, malaria test positivity neared less than 1% in both countries. In 2019, 80% of CHWs in Lao PDR and 74% in Gracias a Dios, Honduras did not report a single malaria case. From inception, both programs were organized as vertical (malaria-only) CHW programs reliant upon Global Fund financing for malaria commodities, training, supervision and, where applicable, remuneration.Conclusions:Although community case management by CHWs has been highly impactful in reducing malaria cases to near zero, new challenges of acceptability and effectiveness of malaria-only service delivery, feasibility of continued vertical program management, and sustainable financing have emerged. To achieve and sustain reductions in malaria, surveillance and delivery platforms must be redesigned to encourage (and reward) care seeking based on experience of symptoms and not on a patient or caregiver's presumptive diagnosis of disease. By expanding the roles and responsibilities of currently vertical malaria CHWs, malarial interventions can be optimized and sustained. Such a shift will also position existing community-based platforms to be resilient and responsive as epidemiology of disease and community need shift.