Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso.
Centre de Recherche du Centre Hospitalier Universitaire de l'Université Laval, Quebec, Canada.
Malar J. 2020 Mar 19;19(1):118. doi: 10.1186/s12936-020-03191-y.
Seasonal malaria chemoprevention (SMC) relies on community health workers to distribute drugs. This study assessed: (1) the capacity of community-based distributors (CBDs) at the start and end of a campaign and from one campaign to another after training or refresher courses before each round; (2) to what extent CBDs' experience over several campaigns contributed to measurable increase in their capacities; and (3) to what extent the training and experience of committed CBDs helped the less productive to catch up.
A longitudinal analysis was conducted in one Burkina Faso health district during the 2017 and 2018 campaigns. A panel including all CBDs was created. Their capacities were observed after: (1) initial training for the 2017 season; (2) refresher training for that year's fourth round; and (3) initial training for the 2018 season. All were invited to complete a questionnaire at the end of training with 27 multiple-choice questions on their main tasks. Observers noted content coverage and conditions under which training sessions were conducted.
The 612 CBDs showed, on average, high understanding of their tasks from the start of the annual campaigns. Tasks related to communicating with parents and reporting were best mastered. Their capacities grew from round to round and campaign to campaign, after most had undergone training and been supervised by head nurses. The greatest progress was in the technical components, considered more complex, which involved selecting eligible children, choosing the correct drug packet, and referring children to health professionals. Retaining CBDs from one round to the next benefited everyone, whatever their starting level. Groups that initially obtained the lowest scores (women, illiterates, youngest/oldest) progressed the most.
These results confirm the potential of using CBDs under routine programme implementation. Mandating CBDs with targeted tasks is a functional model, as they achieve mastery in this context where investments are made in training and supervision. Losing this specificity by extending CBDs' mandates beyond SMC could have undesirable consequences. The added value of retaining committed CBDs is high. It is suggested that motivation and commitment be considered in recruitment, and that a supportive climate be created to foster retention.
季节性疟疾化学预防（SMC）依赖社区卫生工作者分发药物。本研究评估了：（1）在每次活动前的培训或复习课程后，以及在一个活动结束到另一个活动开始时，社区基础分销商（CBD）的能力；（2）CBD 在多个活动中的经验在多大程度上有助于其能力的可衡量提高；以及（3）经验丰富的 CBD 的培训和经验在多大程度上帮助生产力较低的 CBD 迎头赶上。
在布基纳法索的一个卫生区，在 2017 年和 2018 年的活动期间进行了一项纵向分析。创建了一个包括所有 CBD 的小组。在以下情况下观察了他们的能力：（1）2017 年季节的初始培训；（2）当年第四轮的复习培训；（3）2018 年的初始培训。所有 CBD 都被邀请在培训结束时完成一份包含 27 个多项选择题的问卷，内容涉及他们的主要任务。观察员记录了培训内容的涵盖范围以及培训课程的进行条件。
612 名 CBD 的平均表现表明，他们在年度活动开始时对自己的任务有很高的理解。与与父母沟通和报告相关的任务掌握得最好。他们的能力从一轮到一轮，从一个活动到另一个活动都有所提高，大多数 CBD 都接受了培训并由护士长监督。最大的进步是在技术组成部分，这些部分被认为更复杂，涉及选择符合条件的儿童、选择正确的药包以及将儿童转介给卫生专业人员。从一轮活动保留 CBD 到下一轮活动对所有人都有益，无论他们的起点水平如何。最初得分最低的小组（女性、文盲、最年轻/最年长）进步最大。
这些结果证实了在常规方案实施下使用 CBD 的潜力。授权 CBD 完成有针对性的任务是一种有效的模式，因为在这种情况下，培训和监督方面的投资使他们掌握了技能。通过将 CBD 的任务范围扩大到 SMC 以外，从而失去这种特殊性可能会产生不良后果。保留有承诺的 CBD 的附加值很高。建议在招聘时考虑激励和承诺，并营造支持性氛围以促进保留。
