Longitudinal analysis of the capacities of community health workers mobilized for seasonal malaria chemoprevention in Burkina Faso

Abstract

Background: 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. Methods: 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. Results: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. Conclusion: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.

Optimizing the role of ‘lead mothers’ in seasonal malaria chemoprevention (SMC) campaigns: formative research in Kano State, northern Nigeria

“…For example, the annual recruitment process causes disruption and poses risks to sustainability of the strategy. Concerns about annual recruitment of LMs are similar to those raised in a study of retention of community-based SMC staff in Burkina Faso [ 15 ]. It is recognized that when staff are retained and able to work in successive campaigns, they have a better understanding of their role and this is something future SMC campaigns in Kano state and other areas where SMC campaigns are implemented should aim for.…”

“…As argued by others, there should be a careful consideration of the practical implications of introducing additional roles for community health workers and volunteers, including concerns about workload, costs and training requirements [ 22 ]. Programme planners and policy makers need to discuss with key stakeholders about the feasibility and best modalities for introducing these new roles for LMs within SMC campaigns, especially since previous research cautions against adding new roles for community level SMC staff [ 15 ].…”

Extending Delivery of Seasonal Malaria Chemoprevention to Children Aged 5–10 Years in Chad: A Mixed-Methods Study

“…Regarding training, a longitudinal study in Burkina Faso found that capacities of community distributors grew from round to round and campaign to campaign, after most had undergone training and been supervised. 42 However, in the context of Chad, retaining community distributors is a challenge since as many of them are students; at cycle 3, most of them leave villages for school or become preoccupied with their studies. Therefore, health centers need to reconsider the timing of training.…”

A quasi-experimental study to estimate effectiveness of Seasonal Malaria Chemoprevention in Aweil South County in Northern Bahr El Ghazal, South Sudan.

“…3 Since the WHO recommendation was made, implementation studies have been conducted in Sahelian and sub-Sahelian regions such as The Gambia, Chad, Burkina Faso, Mali and Senegal, which con rmed the effectiveness and cost-effectiveness of SMC in real-world conditions. [3][4][5][6][7][8][9] For those reasons, the scale-up of SMC in West and Central Africa is often seen as a success story. East and Southern African regions were not prioritized for SMC scale-up due to high levels of SP resistance.…”