Rapid Fire Presentation 8th International Conference on Plasmodium vivax Research 2022

Is there a place for community health workers in town? A case study in a rapidly expanding periurban area with high ethnic diversity and population mobility in Papua, Indonesia  (#304)

Annisa Rahmalia 1 2 , Enny Kenangalem 1 , Christel van den Boogaard 3 , Liony Fransisca 1 3 , Faustina Burdam 1 4 , Reynold R Ubra 4 , Jeanne Rini Poespoprodjo 1 5 , Ric Price 3 6 7 , Koen Peeters Grietens 8 9 , Charlotte Gryseels 8
  1. Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
  2. Research, Magnaka Inspirasi Inklusi, Bandung, Indonesia
  3. Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
  4. Mimika District Health Authority, Timika, Papua, Indonesia
  5. Department of Child Health, Faculty of Medicine, University Gadjah Mada, Yogyakarta, Indonesia
  6. Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
  7. Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropial Medicine, Mahidol University, Bangkok, Thailand
  8. Socio-Ecological Health Research Unit (SEHR), Institute of Tropical Medicine, Antwerp, Belgium
  9. School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan

Background: Community health workers (CHWs) can support healthcare delivery, including malaria case detection and treatment adherence.  

 

Methods: This qualitative study in Timika, Papua, triangulated data from participant observation (N=26), in-depth interviews (N=6), and focus group discussions (N=6) with malaria patients, community members, healthcare workers, and CHWs to investigate the challenges of CHW activities. The study site is inhabited by indigenous populations, government-sponsored national migrants working in agriculture, and other migrant workers. Regular movements between short-term rental houses lead to limited social engagement with neighbors. In most neighborhoods, public and private clinics are a short walk or motorcycle ride.  

 

Results: CHWs were recruited in ethnically diverse neighborhoods where sense of community was based on ethnic identity rather than area of residence. In combination with the proximity of clinics to most residences, this challenges the effectiveness of CHW activities. For malaria case detection, most CHW only reached out to their kin or people they shared ethnicity with. Adherence monitoring visits to patients referred from clinics were complicated by difficulties in locating patients’ houses (addresses are nonspecific), patients’ declining interaction, and patient mobility before completing treatment. Incomplete information upon referral and lack of supervision from clinic staff further demotivated CHWs. From a patient perspective, knowing a CHW personally, resulted in preference for engaging a CHW over malaria testing at a health clinic. For adherence monitoring, patients accepted CHWs known through community activities (such as community-based health programs, village council, or local churches) or CHWs with the same ethnicity. Explanation about upcoming CHW visits from clinic staff increased acceptance.  

 

Conclusion: Understanding social relations is key to effective community-based malaria strategies in ethnically diverse areas. Involvement of public and private local health services will be critical for improving case detection and management.