Sustaining village malaria worker programmes with expanded roles and primary care integration: Evidence from the Greater Mekong Subregion and with Thailand as a case study

Thesis

Despite decade-long progress, malaria remains a public health threat in remote rural areas in the Greater Mekong Subregion (GMS). As malaria declines, there will be an increase in the proportion of non-malarial febrile illnesses, and consequently a growing inability of the village malaria workers (VMWs), who currently can only test, and sometimes treat, for malaria, to manage the bulk of fever cases that present to them. Evidence has shown that VMWs are essential to malaria elimination strategies by providing accessible care to the highest risk populations of forest goers and mobile and migrant populations and are a valuable resource to address other illnesses. However, gaining political and financial support to maintain their services is challenging as malaria declines as a health priority. This could undermine malaria elimination efforts. Identifying new roles that allow VMWs to address a wider range of local health needs will keep them relevant, active, and motivated. It should also increase the number of people with fevers who attend VMWs and thus ensure a high proportion of malaria cases are reached.

This social science research examines these public health issues at three interrelated levels. First, it explores the landscape of role expansion among malaria community health workers in the Asia Pacific, focusing on the enabling factors of, and entry points to, programme sustainability. Second, it aims to understand how VMW role expansion could be designed and implemented in Thailand which is facing a changing primary care landscape and a malaria resurgence along the western border. Particular attention is paid to the roles and perceptions of multi-level stakeholders directly engaged with malaria interventions including policymakers, programme implementers, health workers, and members of endemic communities. The third part of the thesis explores a policy window to integrate VMWs into primary care and discusses approaches to sustain malaria services until and beyond elimination as well as improve access to care more broadly. Throughout the research, its implications for policy and practice in Thailand, and other GMS countries, are discussed.

Authors: Jongdeepaisal, M

• DOI: 10.5287/ora-9e9baywv9
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: Thai, English
• Keywords: malaria; Southeast Asia; Asia Pacific; village malaria worker; Thailand; community health worker; Greater Mekong Subregion
• Subjects: Public health