Using community health workers for malaria control: experience in Zaire
Delacollette, C.; Van der Stuyft, P.; Molima, K.
Bulletin of the World Health Organization 74(4): 423-430
1996
ISSN/ISBN: 0042-9686 PMID: 8823965 Document Number: 299875
Along the western shore of Lake Kivu in eastern Zaire, Katana health zone's primary health care (PHC) development plan established a pilot community trial in 1987 in 12 villages. It concerned community health workers (CHW) who provide chloroquine phosphate (25 mg/kg) treatment over 3 days for episodes of fever (i.e., presumed malaria attacks). A socioeconomically comparable area about 30 km south of the intervention area with the same malarial ecology and malariometric indices served as the control area. Malaria treatment continued to be offered at the health center only in the control area. Both areas were peninsulas. Villagers selected a literate volunteer to serve as the malaria CHW. CHWs received 2 weeks of in-service training in the area's health center. They charged no consultation fees. Malaria prevalence and incidence fell 50% in the intervention area, a significant decline. The crude parasitological index and high parasitemia index declined by 5- and 6-fold, respectively, in the intervention area compared to 2-fold in the control area. Even though mortality rates fluctuated in both areas, they remained essentially the same in both areas. The population in the intervention area had adopted important health care behavior. For example, the number of malaria episodes that remained untreated decreased 7%, while it increased 8% in the control area. In the intervention area, the number of cases treated at home and by the CHW increased 16% and use of the informal private sector fell markedly (-23%). Thus, more than 65% of malaria episodes were treated at the community level. There were problems revolving around the non-comprehensiveness of CHWs' care and their unclear position in the health care system. The major problems concerned the lack of a long-term commitment to CHWs on the part of the health care system and the failure to achieve real community participation. Even though malaria morbidity and parasitological indices were reduced and health care behavior improved, the problems compromised the sustainability of the intervention.