A microplanning model to improve door-to-door health service delivery: the case of Seasonal Malaria Chemoprevention in S
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(2020) 20:1128
RESEARCH ARTICLE
Open Access
A microplanning model to improve door-to-door health service delivery: the case of Seasonal Malaria Chemoprevention in Sub-Saharan African villages André Lin Ouédraogo1* , Julie Zhang2,3, Halidou Tinto4, Innocent Valéa4 and Edward A. Wenger1
Abstract Background: Malaria incidence has plateaued in Sub-Saharan Africa despite Seasonal Malaria Chemoprevention’s (SMC) introduction. Community health workers (CHW) use a door-to-door delivery strategy to treat children with SMC drugs, but for SMC to be as effective as in clinical trials, coverage must be high over successive seasons. Methods: We developed and used a microplanning model that utilizes population raster to estimate population size, generates optimal households visit itinerary, and quantifies SMC coverage based on CHWs’ time investment for treatment and walking. CHWs’ performance under current SMC deployment mode was assessed using CHWs’ tracking data and compared to microplanning in villages with varying demographics and geographies. Results: Estimates showed that microplanning significantly reduces CHWs’ walking distance by 25%, increases the number of visited households by 36% (p < 0.001) and increases SMC coverage by 21% from 37.3% under current SMC deployment mode up to 58.3% under microplanning (p < 0.001). Optimal visit itinerary alone increased SMC coverage up to 100% in small villages whereas in larger or hard-to-reach villages, filling the gap additionally needed an optimization of the CHW ratio. Conclusion: We estimate that for a pair of CHWs, the daily optimal number of visited children (assuming 8.5mn spent per child) and walking distance should not exceed 45 (95% CI 27–62) and 5 km (95% CI 3.2–6.2) respectively. Our work contributes to extend SMC coverage by 21–63% and may have broader applicability for other community health programs. Keywords: Malaria, Microplanning, Seasonal malaria chemoprevention, SMC, Door-to-door, Model, Community health worker, CHW, Satellite imagery, Burkina Faso
Background Malaria remains the foremost health challenge in SubSaharan Africa [1]. Recent data showed that globally, progress in reducing malaria burden has stalled, especially in high-burden countries [1] urging the World * Correspondence: [email protected] 1 Institute for Disease Modeling, Bill and Melinda Gates Foundation, 500 5th Ave N, Seattle, WA 98109, USA Full list of author information is available at the end of the article
Health Organization (WHO) to launch the country-led high burden to high impact (HBHI) approach. The goal of the HBHI is to bring the 11 highest burden countries, 10 in Sub-Saharan Africa plus India, back on track to achieve WHO Global Technical Strategy’s milestone which aims to reduce incidence by at least 75% by 2025 [2]; but that is unlikely to succeed unless key burden reduction strategies such as seasonal malaria chemoprevention (SMC) are revisited to maximize impacts.
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 Internati
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