Abstract:
Purpose: Improving access to malaria treatment in rural remote areas remains a major challenge
facing innovative strategies, such as Accredited Drug Dispensing Outlets (ADDOs) and
Community Health Workers (CHWs) programs in Tanzania. This study tested the effectiveness
of a financial benefit approach to motivate CHWs to improve prompt access to malaria treatment.
Patients and methods: We applied a quasi-experimental study design in rural-remote areas in
Kilosa district, Tanzania. Febrile children in selected intervention areas were provided access to
malaria diagnostic and treatment at a minimal fee to CHWs and compared with non-intervention
areas. We measured impact using difference in differences (DID) analysis.
Results: At baseline, 870 children <5 years of age were recruited and 1,127 in post-intervention.
The DID in prompt access to malaria diagnostics and treatment was 28.0% in favor of
intervention. A net pre and post decrease (DID=24.1%) in seeking care from public facilities
was observed, signifying decrease in workload. Incidentally, knowledge on malaria treatment
increased in intervention area (DID 11%–21%).
Conclusion: Using the financial benefit approach, CHWs were able to significantly improve
prompt access to malaria diagnostics and treatment in rural remote areas. Scaling up of the
strategy might speed up the pace toward achieving national target of accurate diagnosis and
appropriate treatment by 80% in 2020.
