Abstract
BackgroundMalaria control has been scaled up in many developing countries in their efforts to achieve the Millennium Development Goals. Cambodia recently scaled up their Village Malaria Worker (VMW) project by substantially increasing the number of VMWs and expanding the project's health services to include treatment of fever, diarrhoea, and Acute Respiratory Infections (ARI) in children under five. This study examined if the scale-up interfered with VMWs' service quality, actions, and knowledge of malaria control, and analysed VMWs' overall achievements and perceptions of the newly added health services.MethodsStructured interviews were conducted pre scale-up in February-March 2008 with 251 VMWs and post scale-up in July-August 2010 with 252 VMWs. Comparing the pre and post scale-up survey results (n = 195), changes were examined in terms of VMWs' 1) service quality, 2) malaria prevention and vector control actions, and 3) knowledge of malaria epidemiology and vector ecology. In addition, VMWs' newly added health services were descriptively analysed based on the post scale-up survey (n = 252).ResultsVMWs' service quality and actions significantly improved overall during the scale-up of the VMW project (mean index score: +0.805, p < 0.001; +2.923, p < 0.001; respectively). Although most of knowledge areas also showed significant improvement (between +0.256 and +0.499, p < 0.001), less than half (10.3%-47.7%) of the VMWs correctly answered a set of questions on malaria epidemiology and vector ecology, even in the post scale-up survey. About 70% of the respondents reported that their health services to control malaria remained the same or that they were more active after the scale-up. Two-thirds (66.3%) had become more enthusiastic about serving as a VMW since the scale-up, and all but one respondent reported being willing to continue the new services.ConclusionsThe Cambodian experience clearly demonstrated that a nationwide scale-up of community-based malaria control can be achieved without degrading community health workers' service quality. The government's strategy to expand VMWs' health services, while providing sufficient training to maintain the quality of their original malaria control services, could have contributed to the improvement of VMW's service quality, actions, and knowledge in spite of the rapid scale-up of the project.
Highlights
Malaria control has been scaled up in many developing countries in their efforts to achieve the Millennium Development Goals
At pre scale-up, respondents had served as Village Malaria Worker (VMW) for about 3 years, and most of them attended the VMW training or refresher training on malaria control between 1 and 1.5 years ago
At post scale-up, respondents had served as VMWs for about 6 years, and all of them had attended trainings for malaria control as well as fever, diarrhoea, and Acute Respiratory Infections (ARI) treatment 7 or 8 months ago
Summary
Malaria control has been scaled up in many developing countries in their efforts to achieve the Millennium Development Goals. Since 2005, the concept of ScaleUp for Impact (SUFI) has been endorsed by the Roll Back Malaria Partnership It aims at achieving widespread coverage of a set of preventive and treatment interventions that will lead to a dramatic reduction in the global disease burden that malaria poses [2,3]. Malaria control has been scaled up in a number of lowand middle-income countries during the last several years [4,5,6,7,8], and its effectiveness of reducing malaria mortality and morbidity has been demonstrated in several studies [3,5]. According to a study that explored the relationship between allcause child mortality and malaria mortality in sub-Saharan Africa, if malaria control interventions were scaled up to achieve 70% coverage, malaria mortality could be reduced by 50% [2]
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