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Table 3 Summary of supportive factors and potential challenges for consideration in the design of the SMC intervention
| Supportive factors | Potential challenges |
|---|---|
| Malaria is seen as a community priority | Role of CCGs and scope of services offered unclear across community and health facility levels |
| Communities have a good understanding of the signs and symptoms of malaria, ways of preventing malaria, and the biological groups most at risk | A range in skills and experience in the management of malaria among CCGs |
| Wide support for a community level distribution of drugs | Health facility staff perceive CCGs to provide low quality of care |
| Community level support for and trust in CCGs | Weak referral linkage between community and health facility levels |
| Close proximity of CCGs to beneficiaries which could enable high intervention coverage and facilitate effective follow-up and monitoring of adverse events | Community referral action potentially hindered by perception of inadequate skills among health facility staff, inconsistent ACT supply and potential cost of transport and malaria treatment |
| High levels of community acceptability of ACT | Differing opinions on the most effective distribution approach—fixed-point or household-to-household |
| Supportive supervision system between health facility and CCGs established (though weak in some areas) | A lack of consensus over the suggested management of the intervention and potential roles of the health facility and community leadership |
| High levels of trust in community traditional and religious leadership, and general consensus that they should play a pivotal role in mobilization for the programme | Low storage capacity at the community level |
| Community leadership frequently involved in disseminating health information to their communities and so have basic health knowledge and local information dissemination systems are established | Potential security issues relating to the distribution of drugs at the community level |
| Simple, visual communication materials written in local languages could be well accepted | Varying levels of capacity for effective reporting among CCGs |
| Low levels of community literacy (particularly among women) which may inhibit understanding of any written guidance or communication materials as well as record keeping capacity | |
| Potential suspicions of ‘outside’ interventions, exacerbated by negative associations with the polio campaign |
