Community Health Workers (CHWs) serve as the bedrock of our program and have significantly expanded the local healthcare force.

Since home treatment is so prevalent, it is urgent that we make it more effective. Since 2004, the World Health Organization has advocated home-based management of malaria by training community members in effective pediatric malaria treatment, and aims to scale-up this delivery approach. 

Mobile CHWs make home-based care much more effective because they have a unique capacity to:

• Communicate with patients—they understand the community’s values, perspectives, geography, and resources;
• Build trusting relationships that promote lasting behavior change–they live in the communities they serve and can cultivate ongoing relationships with their patients;
• Relieve overburdened clinical staff by taking on tasks of simple diagnosis and treatment, outreach, education, case management, and patient counseling—particularly relevant in a country like Mali that has only one physician for every 13,478 people;
• Ensure early treatment by proactively searching for new malaria cases—crucial since most children killed by malaria die within two days of their first symptom before seeing a doctor;
• Monitor and support treatment adherence, which is crucial to curing malaria infections and preventing drug resistance; and,
• Make a dramatic difference on health outcomes at a much lower cost than traditional clinical care.

Based on best practices models, Project Muso has trained 20 Community Health Workers and four Community Health Worker Assistants in malaria prevention, diagnosis and treatment. These CHWs are critical in facilitating early detection and treatment of malaria and other illnesses. As neighbors, they are trusted and respected women who each now spend at least two hours a day conduction door-to-door outreach in their communities, finding, diagnosing, and treating cases of simple pediatric malaria, bringing patients with severe malaria and other illness into the CSCOM, and educating families on malaria prevention and basic health and hygiene practices. They have been trained to use Malaria Rapid Diagnostic Testing to identify plasmodium falciparum malaria in children younger than five and to administer home treatment with ACT.

Our CHWs provide counseling, malaria treatment, or referral to an average of 1,683 patients per month. The vast majority, according to our CHW’s assessments, would not have accessed clinic care on their own. In the past three months, CHWs have tested 931 children, treated 192 positive cases for malaria in the home, and brought 3,971 severely ill children into the Yirimadjo CSCOM or Commune VI CSREF for care. Since the CBMP’s inception, Community Health Workers have been essential to removing financial barriers to care by accompanying more than 12,359 patients to the CSCOM, where they are seen and treated through Project Muso’s healthcare financing system. Their roll will be central to achieving and maintaining the ambitious goal of diagnosing and treating 85% of children younger than five within the first 24 hours of fever onset—an objective that requires extensive community mobilization and outreach.

Community Health Workers Roles and Responsibilities

CHWs follow a rigorous protocol of fever evaluation, rapid antigen malaria diagnostic testing using a finger-prick assay, and on-site treatment with ACTs. Their responsibilities include the following:

• Conducting regular home visits with families to discuss malaria prevention and treatment; 
• Determining which pregnant women and children younger than five are not sleeping each night under a LLIN, and providing information, training, and resources necessary to achieve nightly bed net use for these target populations;
• Identifying simple malaria cases among children younger than five via diagnosis using rapid antigen assay tests;
• Administering ACT within 24 hours of symptom onset for children younger than five with positive rapid tests;
• Following up with each patient within 24, 48, and 72 hours of treatment to track progress and determine future steps;
• Identifying pregnancies early, referring pregnant women to the health center for prenatal consultations, providing counseling and follow-up to promote healthy pregnancy, and ensuring intermittent preventative malaria prophylaxis adherence;
• Tracking births and deaths in the community.

CHWs work on average 20 hours/week, including being “on call” to community members 24 hours/day. CHWs are integral members of the health care team, paid a monthly salary and provided health benefits for their valuable and challenging work, which enables them to support their families as they fulfill their responsibilities with the necessary commitment and accountability.

Project Muso builds on our relationships with local leaders by connecting local religious leaders and their faith communities with the Community Health Worker in their area. By connecting Community Health Workers to help those in need in their communities, religious leaders are an important connection for active referrals and rapid case findings to the CHWs.