Jongdeepaisal Monnaphat, Khonputsa Panarasri, Prasert Orathai, Maneenate Supitsara, Sirimatayanant Massaya, Sopa Paradorn, Saisong Arisa, Charoensup Ittisak, Kamsri Tanong, Tipmontree Rungrawee, Sudathip Prayuth, Liverani Marco, Maude Richard J, Pell Christopher
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 Sep 17;4(9):e0003670. doi: 10.1371/journal.pgph.0003670. eCollection 2024.
In Thailand, since the 2000s, malaria post (MP) workers have been tasked with promptly detecting and treating all malaria cases to prevent onward transmission in the communities. Expanding their roles to provide health services beyond malaria has been proposed as a strategy to sustain their activities until elimination is reached. This article examines the perspectives of stakeholders on community-based malaria care to assess prospects for expanding the role of MPs. The study incorporated in-depth interviews (IDIs) and focus group discussions (FGDs). In forested communities and local health facilities in northeast Thailand bordering Lao PDR and Cambodia, where malaria transmission is low, IDIs were conducted with 13 MPs and 23 community members. An additional 14 policymakers and implementers across the health sector in Thailand were interviewed. The respondents highlighted how in these border areas population groups most at risk of malaria, namely forest goers and migrants, are reluctant to visit public health facilities. In these areas, MP workers are well integrated in their communities and remain relevant although the communities no longer see malaria as spriority. Common conditions such as dengue, diabetes, insect bites, diarrhea, mental illness and substance abuse, were identified as local health concerns needing potential add-on services from MP workers. Although challenges in terms of training, supervision, and financing were raised, opportunities included additional funds from local administrative offices to maintain and integrate malaria activities with other health programmes. Changes to the roles of MPs should be adapted to changing local needs, some of which were identified in this study, should avoid duplication and potential tensions with other local health programmes, and need to build on the capacity of the community and primary care system. These enabling factors are worthy of consideration by any malaria programmes looking into maintaining their village malaria workers in the Greater Mekong Subregion.
在泰国，自21世纪以来，疟疾病后（MP）工作人员的任务是及时发现和治疗所有疟疾病例，以防止疾病在社区内进一步传播。有人提议扩大他们的职责范围，提供疟疾以外的卫生服务，作为一项战略，以维持他们的活动，直至实现疟疾消除。本文探讨了利益相关者对社区疟疾护理的看法，以评估扩大MP角色的前景。该研究纳入了深入访谈（IDI）和焦点小组讨论（FGD）。在泰国东北部与老挝和柬埔寨接壤的森林社区和当地卫生设施中，疟疾传播率较低，对13名MP工作人员和23名社区成员进行了深入访谈。另外还采访了泰国卫生部门的14名政策制定者和实施者。受访者强调，在这些边境地区，疟疾风险最高的人群，即森林居民和移民，不愿前往公共卫生设施。在这些地区，MP工作人员与他们所在的社区融合良好，仍然发挥着作用，尽管社区不再将疟疾视为优先事项。登革热、糖尿病、昆虫叮咬、腹泻、精神疾病和药物滥用等常见病症，被确定为当地需要关注的健康问题，MP工作人员可能需要提供额外服务。尽管提出了培训、监督和资金方面的挑战，但机会包括当地行政办公室提供的额外资金，以维持疟疾活动并将其与其他卫生项目整合。MP角色的转变应适应不断变化的当地需求，其中一些需求在本研究中已得到确认，应避免与其他当地卫生项目重复和产生潜在冲突，并且需要建立在社区和初级保健系统的能力基础之上。任何希望在大湄公河次区域维持其村庄疟疾防治工作人员的疟疾项目，都值得考虑这些有利因素。
