Community Health Workers: Key Drivers in Malaria Community Case Management in Zambia
Abstract:
For over a decade, the Zambia
Ministry of Health has been implementing programs aimed at reducing malaria
prevalence in the Nchelenge district of Luapula Province. High-impact malaria
control interventions implemented include indoor residual spraying, long-lasting
insecticide net distribution and community case management. Despite this, malaria
prevalence remains high. Community health workers (CHWs) are the drivers of
community case management (CCM), a strategy promoting early recognition, prompt
diagnosis, and treatment of preventable illnesses such as malaria. This
systematic desk review aimed to assess the impact of community health workers
on Malaria CCM and prevention in the Nchelenge district. Thirty-four (34)
studies were reviewed which reported indicators of CHW performance and their
roles in community health. The study concluded that CHWs had important
preventive, case management and promotive roles in malaria interventions. The
review revealed that CHWs can provide good quality malaria care, including
performing procedures such as rapid diagnostic tests. The factors perceived to
influence CHWs' performance were community support, training, availability of
drugs and supplies, incentives, and recognition from formal health workers. Though
CHWs are recognized, they are not fully integrated into the health system. To
enable their effective integration, the following should be considered:
introduce sustainable financing of CCM programs; tailor CHW training to address
gaps; and improve sustainable supply chain management of malaria drugs and
diagnostics. By expanding CHWs, the number of malaria diagnosis and treatment
service points per population is expected to decrease treatment-seeking delays
and the percentage of people who progress from mild to severe malaria.
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