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Malar J. 2022 Mar 9;21(1):82. doi: 10.1186/s12936-022-04108-7.
Accurately testing, treating, and tracking all malaria cases is critical to achieving elimination. Ensuring health providers are able and motivated to test, treat, and report cases is a necessary component of elimination programmes, and particularly challenging in low endemic settings where providers may not encounter a large volume of cases. This study aimed to understand provider motivations to test, treat, and report malaria cases to better optimize programme design, adjust incentive schemes, and ultimately improve reporting rates while growing the evidence base around private providers in the Greater Mekong Subregion (GMS).
With funding from the Bill & Melinda Gates Foundation, this study aimed to identify and validate distinctive subtypes of motivation among private sector providers enrolled in the Greater Mekong Subregion Elimination of Malaria through Surveillance (GEMS) programme, implemented by Population Services International. Quantitative questionnaires were administered electronically in person by trained enumerators to various provider groups in Myanmar, Lao PDR, and Vietnam. A three-stage confirmatory factor analysis was then conducted in STATA.
Following this analysis, a two-factor solution that describes motivation in this population of providers was identified, and providers were scored on the two dimensions of motivation. The correlation between the two rotated factors was 0.3889, and the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy was 0.93, indicating an excellent level of suitability. These providers, who are often assumed to only be financially motivated, engaged in malaria elimination activities because of both internal and external motivational factors that are independent of remuneration or financial gain. For all three countries' data, significant covariances between the two latent variables for internal and external motivation were found. The models were found to be of adequate to good fit for the data across all three countries. It was determined that private sector providers, who were previously believed to be primarily financially motivated, were also motivated by personal factors. Motivation was also associated with key outcomes of importance to malaria elimination, such as reporting and stocking of tests and treatments.
Maintaining or increasing provider motivation to test and treat is essential in the fight to eliminate malaria from the GMS, as it helps to ensure that providers continue to pursue this goal, even in a low incidence environment where cases may be rare and in which providers face financial pressure to focus on areas of health service provision. Establishing mechanisms to better motivate providers through intrinsic factors is likely to have a substantive impact on the sustainability of malaria case management activities.
准确地检测、治疗和跟踪所有疟疾病例对于实现消除疟疾至关重要。确保卫生服务提供者有能力并愿意进行检测、治疗和报告病例，是消除疟疾规划的必要组成部分，在疟疾低流行地区尤其具有挑战性，因为那里的提供者可能不会遇到大量病例。本研究旨在了解提供者检测、治疗和报告疟疾病例的动机，以便更好地优化规划设计、调整激励机制，并最终提高报告率，同时在大湄公河次区域（GMS）扩大私营部门提供者的证据基础。
在比尔及梅琳达·盖茨基金会的资助下，本研究旨在确定并验证参与大湄公河次区域消除疟疾监测（GEMS）计划的私营部门提供者的不同动机亚型，该计划由人口服务国际组织实施。定量问卷由经过培训的普查员以电子方式亲自分发给缅甸、老挝人民民主共和国和越南的各种提供者群体。然后在 STATA 中进行了三阶段验证性因素分析。
通过分析，确定了一个描述该人群提供者动机的两因素解决方案，并对提供者在两个动机维度上进行了评分。两个旋转因素之间的相关性为 0.3889，Kaiser-Meyer-Olkin（KMO）抽样充分性测量值为 0.93，表明具有极好的适用性。这些提供者通常被认为只是出于经济动机而参与疟疾消除活动，因为他们受到独立于报酬或经济利益的内部和外部激励因素的激励。对于所有三个国家的数据，都发现内部和外部激励两个潜在变量之间存在显著的协方差。对于所有三个国家的数据，模型都被认为具有足够到良好的拟合度。结果表明，以前被认为主要是出于经济动机的私营部门提供者，也受到个人因素的激励。动机与消除疟疾的重要关键结果有关，如报告和储备检测和治疗。
在大湄公河次区域消除疟疾的斗争中，保持或增加提供者检测和治疗的动机至关重要，因为这有助于确保提供者继续追求这一目标，即使在发病率较低的环境中，病例可能很少，提供者面临着将重点放在卫生服务提供领域的财务压力。建立通过内在因素更好地激励提供者的机制，可能会对疟疾病例管理活动的可持续性产生实质性影响。
