Malaria surveillance and case management in remote and indigenous communities of Panama: results from a community-based health worker pilot

Abstract

Background Panama is one of eight countries in Mesoamerica that aims to eliminate malaria by 2022. Malaria is concentrated in indigenous and remote regions like Guna Yala, a politically autonomous region where access to health services is limited and cases are predominately detected through intermittent active surveillance. To improve routine access to care, a joint effort was made by Guna Yala authorities and the Ministry of Health to pilot a network of community health workers (CHWs) equipped with rapid diagnostic tests and treatment. The impact of this pilot is described. Methods Access to care was measured using the proportion of villages targeted by the effort with active CHWs. Epidemiological impact was evaluated through standard surveillance and case management measures. Tests for differences in proportions or rates were used to compare measures prior to (October 2014-September 2016) and during the pilot (October 2016-September 2018). Results An active CHW was placed in 39 (95%) of 41 target communities. During the pilot, CHWs detected 61% of all reported cases from the region. Test positivity in the population tested by CHWs (22%) was higher than in those tested through active surveillance, both before (3.8%) and during the pilot (2.9%). From the pre-pilot to the pilot period, annual blood examination rates decreased (9.8 per 100 vs. 8.0 per 100), test positivity increased (4.2% to 8.5%, Χ2 = 126.3, p < 0.001) and reported incidence increased (4.1 cases per 1000 to 6.9 cases per 1000 [Incidence Rate Ratio = 1.83, 95% CI 1.52, 2.21]). The percent of cases tested on the day of symptom onset increased from 8 to 27% and those treated on the day of their test increased from 26 to 84%. Conclusions The CHW network allowed for replacement of routine active surveillance with strong passive case detection leading to more targeted and timely testing and treatment. The higher test positivity among those tested by CHWs compared to active surveillance suggests that they detected cases in a high-risk population that had not previously benefited from access to diagnosis and treatment. Surveillance data acquired through this CHW network can be used to better target active case detection to populations at highest risk.

Public health surveillance through community health workers: a scoping review of evidence from 25 low-income and middle-income countries

“…The studies adopted quantitative, qualitative and mixed methodologies with some studies specifically describing interventions to train CHWs. 11 12 Studies were from 25 LMICs across the world including Africa, 11–26 Asia, 27–36 Latin America 37 38 and the Caribbean. 39 Although most studies focused on specific infectious diseases including HIV/AIDS, 20 malaria, 15 18 37–39 tuberculosis (TB), 16 19 Ebola, 12 neglected tropical diseases (NTDs) 13 24 26 and COVID-19, 34 others focused on maternal and child health, 14 25 29–32 35 general health/overall mortality 17 21 23 33 and specific outcomes such a suicide.…”

“… 25 In most cases, where CHWs play a role in identifying and testing for conditions, they also often play a role in providing treatment for patients and community members. Bhavnani et al 37 note that Panamanian CHWs, after identifying malaria cases, provide treatment for community members. This treatment could be in the form of giving available medications or accompanying patients in their treatment journey to ensure that patients access the medicines they need.…”

Genomic surveillance of malaria parasites in an indigenous community in the Peruvian Amazon

“…MINSA has implemented the training of community health agents (CHAs), people chosen by their community to develop disease prevention actions and support for the diagnosis and treatment, into the current NMEP 1 . Similar approaches have been used to control malaria in the mobile population in Myanmar 56 and in an indigenous area in Panama 57 , showing promising results in each case. In Peru, CHAs better understand the dynamics of human mobilization, facilitating the work with the population.…”

Strengthening community health worker program in Belize

“…41,42 The incentives for the CHWs in Zimbabwe, Sierra Leone, Guatemala, Panama, Mexico is funded mostly by NGO partners and donors. 39,[42][43][44][45][46] The monthly incentives in these countries ranged from 42USD to 280 USD. [40][41][42][43][44][45][46] Funding from government has important advantages, most notably job security for the individual CHWs.…”

“…39,[42][43][44][45][46] The monthly incentives in these countries ranged from 42USD to 280 USD. [40][41][42][43][44][45][46] Funding from government has important advantages, most notably job security for the individual CHWs. However, one of the inherent problems with government funding is the lack of strong political support to continue funding levels for CHW programs in the face of competing demands which causes cutbacks in funding when government shortfalls.…”