Challenges of achieving sustainable community health services for community case management of malaria

Background: Community Case Management of malaria (CCMm) using Community Health Workers (CHWs) is an approach to improve access to timely and effective malaria case management in malaria endemic countries. So far the programme has been shown to be effective in many communities in sub-Saharan Africa. However, questions remain on the sustainability of this programme due to the high dropout cases of CHWs given their modest remuneration. The aim of the study was to identify challenges of achieving sustainable community health services for CCMm. Methods: A community based qualitative study was conducted in five districts in western Kenya where CCMm was being undertaken. In-depth interviews and focus group discussions were conducted with the CHWs, mothers of children under-five years and key informants such as public health officers and clinicians involved in the CCMm. The interviews were audio recorded and conducted in English, Swahili and the local language. Recorded interviews were transcribed. Analysis was conducted using NVivo version 7 software, where transcripts were coded after which themes related to the objectives of the study were identified. Results: The community members, the CHWs and stakeholders perceived CCMm as an important approach for reducing the burden of malaria. Key informants perceived lack of basic supplies (RDTs, gloves), drugs, inadequate remuneration of CHWs and lack of basic working equipment as challenges for CCM. CHWs highlighted that lack of drugs and basic supplies such as gloves at the health facilities, inadequate community sensitization by health workers, inadequate stipend to meet basic needs, as challenges of achieving sustainable CCMm. Some clinicians perceived that CHWs should not be given Artemisinin-based combination therapy (ACT) as part of the CCMm since they might misuse them. Conclusion: This study shows that for CCMm to be sustainable, concerted efforts from stakeholders are needed to boost the programme. Commodities needed for implementation of the programme need to be readily available and the morale of the CHWs who undertake CCMm needs boosting.