Quantifying and valuing community health worker time in improving access to malaria diagnosis and treatment

Background: Community health workers (CHWs) are members of a community who are chosen by their communities as first-line, volunteer health workers. The time they spend providing healthcare and the value of this time are often not evaluated. Our aim was to quantify the time CHWs spent on providing healthcare before and during the implementation of an integrated programme of diagnosis and treatment of febrile illness in three African countries. Methods: In Burkina Faso, Nigeria and Uganda, CHWs were trained to assess and manage febrile patients in keeping with Integrated Management of Childhood Illness recommendations to use rapid diagnostic tests, artemisinin-based combination therapy and rectal artesunate for malaria treatment. All CHWs provided healthcare only to young children usually under 5 years old, and hence daily time allocation of their time to child healthcare was documented for one day (in the high malaria season) before the intervention and at several time points following the implementation of the intervention. Time spent in providing child healthcare was valued in earnings of persons with similar experience. Results: During the high malaria season of the intervention, CHWs spent nearly 50 minutes more in daily healthcare provision (average daily time 30.2 minutes before the intervention versus 79.5 minutes during the intervention; test for difference in means p< 0.01). On average, the daily time spent providing healthcare during the intervention was 55.8 minutes (Burkina Faso), 77.4 minutes (Nigeria) and 72.2 minutes (Uganda). Using the country minimum monthly salary, CHWs time allocated to child healthcare for one year was valued at USD 52 in Burkina Faso, USD 295 in Nigeria and USD 141 in Uganda. Conclusion: CHWs spend up to an hour and a half daily on child healthcare in their communities. These data are informative in designing reward systems to motivate CHWs to continue providing good quality services