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IS A NOVEL COMMUNITY-BASED HEALTH WORKER STRATEGY FOR PROVIDING NEAR AND APPROPRIATE TREATMENT OF MALARIA FEASIBLE AND WORTHWHILE: AN ANALYSIS OF PROCESSES, COSTS AND OUTCOMES. Onwujekwe OE 1,2, Shu EN 2 , Uzochukwu BSC 3 , Okonkwo PO 2 1 Gates Malaria Partnership, LSHTM
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IS A NOVEL COMMUNITY-BASED HEALTH WORKER STRATEGY FOR PROVIDING NEAR AND APPROPRIATE TREATMENT OF MALARIA FEASIBLE AND WORTHWHILE: AN ANALYSIS OF PROCESSES, COSTS AND OUTCOMES
Onwujekwe OE1,2, Shu EN2, Uzochukwu BSC3, Okonkwo PO2
1 Gates Malaria Partnership, LSHTM
2 Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu
3 Department of Community Medicine, College of Medicine, University of Nigeria, Enugu
Problem Statement: People have difficulty accessing proper treatment for malaria. An approach for bringing appropriate and timely treatment of malaria closer to home is through the use of community-based health workers (CBHWs). The processes, costs, and outcomes of the strategy are unknown.
Objectives: To determine the processes, costs, and outcomes of the CBHW strategy.
Design: A prospective study in four villages in Nigeria where holo-endemic malaria is present was used. The CBHW strategy was implemented in two villages (Adu and Ahani), while the other two villages (Amaetiti and Enugu-Akwu) were the controls. The study was conducted in five phases: (1) baseline survey; (2) design; (3) implementation, supervision, and monitoring; (4) evaluation; and (5) handing over of the project to the villages.
Outcome Measures:The key outcome measures were the market share of the CBHWs, acceptability, referrals, morbidity and mortality, the socioeconomic differentials of the consumers, type of drug consumed, and payment strategies. Cost-benefit computations showed that the people found the services of the CBHWs to be worthwhile.
Results:Processes: Discussions at village assemblies with a broad segment of community leaders and an interactive meeting with all the stakeholders were used to fine-tune the design of the CBHW strategy. Selected community members were trained to become CBHWs. The remuneration of the CBHWs was through commissions on their drug sales.
Consumer costs: Nonfinancial costs were the highest contributor to consumer costs. The total cost in Ahani was approximately USD 2,548, while the cost in Adu was USD 1,585.
Provider costs: Financial costs constituted more than 90% of provider costs in the two intervention villages. The total cost in Ahani was approximately USD 4,515, and in Adu it was USD 4,302.
Aggregate costs: The aggregate cost in Ahani was approximately USD 7,062, and it was USD 5,886 in Adu. The unit cost was USD 1.40 in Ahani and USD 1.70 in Adu. The combined data from both villages showed a unit cost of USD 1.50.
Outcomes: The CBHWs in the intervention villages had an increased market share, and no mortality from malaria was reported.
Conclusions: The cost of starting up the CBHW strategy is very reasonable and in line with what malaria control programs and communities can afford. The study shows that the community-based health worker strategy is economically viable and a strong potential source for providing nearby, timely, and appropriate treatment of malaria in rural areas. The requirements now are further studies to fine-tune and scale up the use of the strategy in rural parts of Nigeria and sub-Saharan Africa.
Aim: Analyze the processes, costs and outcomes of the CBHW strategy for providing near and appropriate treatment of malaria.
The study was conducted in five phases:
(1) baseline study in four villages
(2) design in two intervention villages
(3) implementation, supervision, and monitoring in two intervention villages
(4) evaluation in four villages
(5) handing over of the project to the villages in two intervention villages
Note: 125 Naira (local currency) = US$1.00
Train (divided into 2 parts):
Payment to CBHWs:
Community mobilization for the implementation:
Acknowledgements: IDRC for funding the study