Feasibility of a community health worker strategy for providing near and appropriate treatment of malaria in southeast Nigeria: an analysis of activities, costs and outcomes.
BACKGROUND
Community health workers (CHWs) could be used to bring appropriate and timely treatment of malaria closer to home and there is the need to increase the body of knowledge about the feasibility of implementing the strategy.


OBJECTIVE
To determine the processes, costs and outcomes of design and implementation of a strategy based on use of CHWs for near and appropriate treatment of malaria.


METHODS
The CHW strategy was implemented in two villages (Adu and Ahani) in Enugu state, southeast Nigeria. Adu and Ahani have a population of approximately 3500 and 5000 residents, respectively. The study was conducted in four phases: (1) baseline survey; (2) design; (3) implementation, supervision and monitoring; and (4) evaluation. Interactive meeting with all the stakeholders were used to fine-tune the design of the CHW strategy. Community members that were selected by the project team with the help of community leaders were trained to become CHWs and their remuneration was through commissions on their drug sales. Community and provider's financial and non-financial costs of the startegy were computed.


RESULTS
Non-financial costs were the highest contributor to consumer costs, while financial costs constituted more than 90% of provider costs. The total consumer cost in Ahani was US$2548, while the consumer cost in Adu was US$1585. The total provider cost in Ahani was US$4515, while in Adu it was US$4302. The unit cost cost per villager was US$1.40 in Ahani and US$1.70 in Adu, while the unit financial consumer cost per treated patient was $0.05 in both villages, respectively. The CHWs were acceptable to the people and had an increased market share out of existing malaria treatment provision strategies.


CONCLUSIONS
The cost of starting up the CHW strategy is low and should be affordable to malaria control programs and communities. The CHW strategy is also economically viable and a potential cost-effective source for providing timely, and appropriate treatment of malaria in rural areas. It should be fine-tuned and added to malaria control armamenterium in Nigeria and other parts of sub-Saharan Africa.
Onwujekwe
Obinna
O
Gates Malaria Partnership, London School of Hygiene and Tropical Medicine, London, UK. onwujekwe@yahoo.co.uk
Uzochukwu
Benjamin
B
Ojukwu
Juliana
J
Dike
Nkem
N
Shu
Elvis
E
D000962:Antimalarials / Q000191:economics / Q000627:therapeutic use; D003153:Community Health Services / Q000191:economics* / Q000379:methods*; D003150:Community Health Workers; D003365:Costs and Cost Analysis; D004359:Drug Therapy, Combination; D005240:Feasibility Studies; D019538:Health Care Surveys; D006801:Humans; D008288:Malaria / Q000517:prevention & control*; D009549:Nigeria; D010043:Outcome and Process Assessment, Health Care; D012424:Rural Population; D011795:Surveys and Questionnaires
D000962:Antimalarials