title: Quantifying and Valuing Community Health Worker Time in Improving Access to Malaria Diagnosis and Treatment.
abstract: BACKGROUND
  Community health workers (CHWs) are members of a community who are chosen by their communities as first-line, volunteer health workers. The time they spend providing healthcare and the value of this time are often not evaluated. Our aim was to quantify the time CHWs spent on providing healthcare before and during the implementation of an integrated program of diagnosis and treatment of febrile illness in 3 African countries.
  
  
  METHODS
  In Burkina Faso, Nigeria, and Uganda, CHWs were trained to assess and manage febrile patients in keeping with Integrated Management of Childhood Illness recommendations to use rapid diagnostic tests, artemisinin-based combination therapy, and rectal artesunate for malaria treatment. All CHWs provided healthcare only to young children usually <5 years of age, and hence daily time allocation of their time to child healthcare was documented for 1 day (in the high malaria season) before the intervention and at several time points following the implementation of the intervention. Time spent in providing child healthcare was valued in earnings of persons with similar experience.
  
  
  RESULTS
  During the high malaria season of the intervention, CHWs spent nearly 50 minutes more in daily healthcare provision (average daily time, 30.2 minutes before the intervention vs 79.5 minutes during the intervention; test for difference in means P < .01). On average, the daily time spent providing healthcare during the intervention was 55.8 minutes (Burkina Faso), 77.4 minutes (Nigeria), and 72.2 minutes (Uganda). Using the country minimum monthly salary, CHWs' time allocated to child healthcare for 1 year was valued at US Dollars (USD) $52 in Burkina Faso, USD $295 in Nigeria, and USD $141 in Uganda.
  
  
  CONCLUSIONS
  CHWs spend up to an hour and a half daily on child healthcare in their communities. These data are informative in designing reward systems to motivate CHWs to continue providing good-quality services.
  
  
  BACKGROUND
  ISRCTN13858170.
authors.affiliation: Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, The Netherlands.
authors.forename: Joëlle
authors.initials: J
authors.lastname: Castellani
authors.affiliation: Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, United Kingdom.
authors.forename: Borislava
authors.initials: B
authors.lastname: Mihaylova
authors.affiliation: Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria.
authors.forename: IkeOluwapo O
authors.initials: IO
authors.lastname: Ajayi
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Mohamadou
authors.initials: M
authors.lastname: Siribié
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Jesca
authors.initials: J
authors.lastname: Nsungwa-Sabiiti
authors.affiliation: Epidemiology and Biostatistics Research Unit, Institute of Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria.
authors.forename: Chinenye
authors.initials: C
authors.lastname: Afonne
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Luc
authors.initials: L
authors.lastname: Sermé
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Andrew
authors.initials: A
authors.lastname: Balyeku
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Kabarungi
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Josephine
authors.initials: J
authors.lastname: Kyaligonza
authors.affiliation: Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, The Netherlands.
authors.forename: Silvia M A A
authors.initials: SM
authors.lastname: Evers
authors.affiliation: Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, The Netherlands.
authors.forename: Aggie T G
authors.initials: AT
authors.lastname: Paulus
authors.affiliation: Centre for Applied Biostatistics, Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Max
authors.initials: M
authors.lastname: Petzold
authors.affiliation: UNICEF/UNDP/World Bank/WHO/Special Programme for Research & Training in Tropical Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Singlovic
authors.affiliation: UNICEF/UNDP/World Bank/WHO/Special Programme for Research & Training in Tropical Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Melba
authors.initials: M
authors.lastname: Gomes
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D037621:Artemisinins / Q000627:therapeutic use; D000077332:Artesunate; D002050:Burkina Faso / Q000453:epidemiology; D003150:Community Health Workers / Q000706:statistics & numerical data*; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D012424:Rural Population / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013997:Time Factors; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D000077332:Artesunate; C031327:artemisinin
keywords: ACTs; CHW; RDTs; opportunity cost; workload