Jongdeepaisal Monnaphat, Sirimatayanant Massaya, Khonputsa Panarasri, Hein Phone Si, Buback Laura, Beyeler Naomi, Chebbi Amita, Maude Richard J
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
PLOS Glob Public Health. 2024 Aug 14;4(8):e0003597. doi: 10.1371/journal.pgph.0003597. eCollection 2024.
Malaria Community Health Workers (CHWs) in the Greater Mekong Subregion (GMS) are an important component of malaria elimination efforts. As malaria declines with intensified efforts to eliminate by 2030, expanding their roles beyond malaria could help to sustain funding and provision of malaria services at the community level. Evidence of how programmes have implemented and managed CHWs performing both malaria and non-malaria roles across the Asia-Pacific region can provide insight into the viability of this strategy. A short survey was distributed to national malaria programmes and implementing organizations in the Asia-Pacific region in 2021-2022. The survey identified CHW programmes in the region, and collected information on malaria and non-malarial services provided by CHWs, characteristics of each identified programme, and the impact of COVID-19 on these programmes. 35 survey responses identified 28 programmes in 14 countries. The most frequently reported services provided by malaria CHWs were health promotion and education for malaria (13/14 countries) and other diseases (11/14); and COVID-19 related activities (10/14). Most programmes were financed wholly through donor funding (18/28 programmes), or donor plus government funding (6/28). Of 21 programmes which performed programme evaluation, only 2 evaluated their impacts on diseases beyond malaria. Declining donor funding, and COVID-19 related travel and activity restrictions were identified as implementation challenges. CHWs across the Asia Pacific provide a range of health services with malaria and are resilient under changing public health landscapes such as the COVID-19 pandemic. Further investigation into the impact of additional roles on malaria CHW performance and targeted health outcomes is needed to verify the benefits and feasibility of role expansion. As the GMS approaches elimination, and funding declines, verifying the cost effectiveness of malaria CHW programmes will be vital to persuade donors and countries to invest in malaria CHWs to sustain malaria services, and strengthen community-based health care.
大湄公河次区域（GMS）的疟疾社区卫生工作者（CHW）是疟疾消除工作的重要组成部分。随着通过强化努力到2030年消除疟疾，扩大他们在疟疾之外的作用有助于维持社区层面疟疾服务的资金和提供。关于亚太地区各项目如何实施和管理同时履行疟疾和非疟疾职责的社区卫生工作者的证据，可以为该战略的可行性提供见解。2021 - 2022年向亚太地区的国家疟疾项目和实施组织分发了一份简短调查问卷。该调查确定了该地区的社区卫生工作者项目，并收集了关于社区卫生工作者提供的疟疾和非疟疾服务、每个确定项目的特征以及新冠疫情对这些项目影响的信息。35份调查回复确定了14个国家的28个项目。疟疾社区卫生工作者最常报告提供的服务是疟疾（14个国家中的13个）以及其他疾病（14个国家中的11个）的健康促进和教育；以及与新冠疫情相关的活动（14个国家中的10个）。大多数项目完全通过捐助资金（28个项目中的18个）或捐助加政府资金（28个项目中的6个）提供资金。在进行项目评估的21个项目中，只有2个评估了其对疟疾以外疾病的影响。捐助资金减少以及与新冠疫情相关的旅行和活动限制被确定为实施挑战。亚太地区的社区卫生工作者提供一系列疟疾相关的卫生服务，并且在新冠疫情等不断变化的公共卫生形势下具有韧性。需要进一步调查额外职责对疟疾社区卫生工作者表现和目标健康结果的影响，以验证角色扩展的益处和可行性。随着大湄公河次区域接近消除疟疾目标且资金减少，验证疟疾社区卫生工作者项目的成本效益对于说服捐助方和各国投资于疟疾社区卫生工作者以维持疟疾服务并加强基于社区的医疗保健至关重要。
