Two new articles stress the role of community volunteers, local alternative providers and household members in controlling malaria.
Ajayi and colleagues trained volunteer community medicine distributors (CMDs) to provide arthmether-lumefantrine (AL) in selected villages near Ibadan, Nigeria. They elarned that, “the use of AL at home and community level is feasible with adequate training of community medicine distributors and caregivers. Community members perceived AL to be effective thus fostering acceptability. The negative attitudes of the health workers and issue of incentives to CMDs need to be addressed for successful scaling-up of ACT use at community level.” Parents in these villages had not heard of AL before, but after one year of intervention they were happy with the results of using AL and with the performance of the CMDs. Challenges learned from this field experience included uncertainties of regula medicine supplies, continued supervision of the CMDs, CMD desires for incentives and negative attitudes of formal health workers.
Mbonye et al. have produced another in their series of articles concerning community distribution of intermittent preventive treatment for pregnant women (IPTp) in Uganda. This time they looked at cost and cost effectiveness of community distributors comparent to health facility based provision of IPTp. They had drawn on a variety of existing people to serve as distributors including traditional birth attendants, drug-shop vendors, community health workers and peer mobilizers. Although it cost slightly more to deliver IPTp in the community (due in part to one time training costs), the cost-effectiveness was greater because of reductions in severe anemia and fewer low birth weight babies. The challenges here are common with pilot or experimental programs – that of linking with the formal health system to guarantee ongoing supervision and support, but this can be built into future efforts.
More effort is needed to test the generalizability of these interventions, but the key message is that the community needs to be actively involved in malaria control efforts. Another key factor is that the health system (whether public, private or NGO) needs to ensure that malaria commodity procurement and supply systems reach the community in a sustained way.