Abstract
BackgroundMyanmar has the highest malaria incidence and attributed mortality in South East Asia with limited healthcare infrastructure to manage this burden. Establishing malaria Community Health Worker (CHW) programmes is one possible strategy to improve access to malaria diagnosis and treatment, particularly in remote areas. Despite considerable donor support for implementing CHW programmes in Myanmar, the cost implications are not well understood.MethodsAn ingredients based micro-costing approach was used to develop a model of the annual implementation cost of malaria CHWs in Myanmar. A cost model was constructed based on activity centres comprising of training, patient malaria services, monitoring and supervision, programme management, overheads and incentives. The model takes a provider perspective. Financial data on CHWs programmes were obtained from the 2013 financial reports of the Three Millennium Development Goal fund implementing partners that have been working on malaria control and elimination in Myanmar. Sensitivity and scenario analyses were undertaken to outline parameter uncertainty and explore changes to programme cost for key assumptions.ResultsThe range of total annual costs for the support of one CHW was US$ 966–2486. The largest driver of CHW cost was monitoring and supervision (31–60 % of annual CHW cost). Other important determinants of cost included programme management (15–28 % of annual CHW cost) and patient services (6–12 % of annual CHW cost). Within patient services, malaria rapid diagnostic tests are the major contributor to cost (64 % of patient service costs).ConclusionThe annual cost of a malaria CHW in Myanmar varies considerably depending on the context and the design of the programme, in particular remoteness and the approach to monitoring and evaluation. The estimates provide information to policy makers and CHW programme planners in Myanmar as well as supporting economic evaluations of their cost-effectiveness.
Highlights
Myanmar has the highest malaria incidence and attributed mortality in South East Asia with limited healthcare infrastructure to manage this burden
A cluster randomized trial conducted in 2012 demonstrated modest improvements to malaria healthcare in Myanmar following the introduction of malaria Community Health Worker (CHW) [6] and a study related to this one has examined cost effectiveness and resource allocation scenarios of insecticide treated bed nets and malaria CHWs in Myanmar [11]
Community health workers for malaria in Myanmar CHWs are supposed to be nominated by village health committee
Summary
Myanmar has the highest malaria incidence and attributed mortality in South East Asia with limited healthcare infrastructure to manage this burden. Establishing malaria Community Health Worker (CHW) programmes is one possible strategy to improve access to malaria diagnosis and treatment, in remote areas. Malaria CHWs are trained to diagnose febrile patients with malaria rapid diagnostic test (RDT) and provide them with anti-malarial medication after parasitological confirmation. This aims to treat patients within 24 h of onset of fever while reducing unnecessary use of anti-malarial medication. This study estimates annual cost of CHWs given different programmatic options and identifies key cost-drivers, with the aim of helping policy makers plan malaria CHWs programmes in Myanmar
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