Community directed distributors’ views on their work in community case management of malaria, pneumonia and diarrhoea

Below is the abstract for a another poster being presented by a team from Jhpiego at the upcoming 62nd annual meeting of the American Society for Tropical Medicine and Hygiene November 13-17 2013 at the Marriott Wardman Park in Washington DC.  If you are at the conference, stop by poster number LB-2290 on Friday and discuss with Bright Orji.

CDDs smJhpiego adapted the community directed interventions approach pioneered by the African Program for Onchocerciasis Control and the Tropical Disease Research program of WHO and collaborating agencies to deliver a combination of health interventions in 108 kin groups surrounding six primary health care facilities in Akwa Ibom State, Nigeria.

Volunteer community directed distributors (CDDs) who were selecte dby their co-villagers provided insecticide treated bednets, intermittent preventing treatment of malaria in pregnancy, and integrated community case management (iCCM) of malaria, pneumonia and diarrhoea. Communities selected 1-2 CDDs depending on their size using their own selection criteria.

Experience with volunteer community health workers like CDDs has shown that there are often serious logistical and motivational problems in maintaining a core group of volunteers. The community-selected mainly female CDDs and all had a minimum of secondary school education.

The CDDs were trained by health workers and the nearest primary health care facility. Three nurses who supervised the CDDs asked about their views and experiences as part of the supervisory process. Overall they obtained input from 152 CDDs serving the 108 kin groups. Key reasons why CDDs liked their included rendering service to neighbors (42.6%); reducing malaria (19.5%); reducing death (16.1%); improving Antenatal Care attendance (11.6%) and learning more about malaria (10.2%).

They also voiced discouragements such as working in the heavy rainy season (36.4%); lack of commodities (21.9%); lack of incentives (15.7%); farming season (11.6%); lack of respect from community members (7.2%) and poor road network (0.2%). When the CDDs were asked to identify reasons that they could opt out of the service, lack of commodities topped the list (73.3%). This was followed by lack of incentive (14.4%); and lack of appreciation by the community (9.8%).

The importance of intrinsic perceived benefits as possible motivators augurs well for program continuance. Fortunately few mentioned unsustainable financial incentives. Many of the logistical challenges they face can be tackled by better program management. These views can be incorporated into planning when the CDI approach is expanded into health service areas.

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