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Table 3 Challenges of CHWs, VMWs and lay personnel working on malaria

From: Towards eliminating malaria in high endemic countries: the roles of community health workers and related cadres and their challenges in integrated community case management for malaria: a systematic review

SN Citation Cadre Challenges
1. Rodriguez et al. [20] Health surveillance assistants Short training not in-keeping with medical regulation standards for prescription
Lack of resources to lengthen training
Poor supervision and overburden with patients
Most are found in remote and hard-to-reach areas where frequent supervision is not routine
Job description keeps changing with more introduction of community interventions
Financial instability and poor sustainability because of donor dependence and other unreliable sources
2. Chilundo et al. [21] CHWs Policy conflicts on prescription. Authority does not allow personnel with short-term training to prescribe
Stock out of supplies especially anti-malarials
Poor supervision especially in the hard to reach areas
Funding instability. The programme is donor funded and subjected to delays in funding disbursement
Lack of community involvement and ownership
No evidence yet on impact and no evaluation strategy
APEs are not paid
3. Yansaneh et al. [33] CHVs CHVs are not remunerated and have to do other income generating activities
Not available when needed as they are not paid for their service
4. Nanyonjo et al. [30] CHWs Patients may not complete referrals
5. Heidkamp et al. [26] CHWs Stock-out of essential supplies
Poor supervision from higher cadres
6. Druetz et al. [35] CHWs Community preference on qualified health workers
CHWs not known to people
Medicine stock-out
Long distance to CHWs
7. Banek et al. [13] CMDs Patients overload
Lack of supervision
Limited malaria knowledge
Tensions with community members
Lack of remuneration from the government
8. Hamainza et al. [22] CHWs Lack of remuneration
Negative attitudes to care given by CHWs
Weak social responsibilities
9. Abbey et al. [24] CHWs High attrition rate of CHWs especially in hard-to-reach areas
10. Tine et al. [14] CHWs Medicine and RDT stock-out
11. Ndiaye et al. [39] CHWs Medicine and supply RDT stock-out (ACT, RDT, gloves, case files, patients forms)
12. Blanas et al. [28] CHWs ACT and other supplies stock-outs
Expired medicines or unavailable in villages
Scepticism from villages
Transport problems, poor infrastructure and long distances for referrals
13. Counihan et al. [25] CHWs RDT and other medical supply stock-outs after initial supplies finished
Lack of supervision
14. Brenner et al. [23] CHVs Low turn-over of CHVs
Low motivation
Inconsistent supplies of medicine and supplies
15. Gidebo et al. [66] CHWs Shortage of chloroquine,
Patient pressure to take coartem
16. Delacollette et al. [70] CHWs CHWs’ position remains ambiguous in the healthcare system.
Non-comprehensive care may have negative effect on the sustainability of programme
17. Ajayi et al. [77] CHWs Challenges in their promotion/training activities
 The community members were not in support of the project.
 Some community members felt trainers were wasting their time
 Trainers could not conduct training all the time because of their domestic needs
  1. CHWs community health workers, ASHA accredited social health activist, HCPs home care providers, CMDs community medicine distributors, VMWs village malaria workers, CORPs community-owned resource persons, CCDD volunteer community-directed distributor, VHVs village health volunteers