In many parts of the world, malaria remains one of the most serious public health challenges. The past four decades have heralded important progress against the disease, but malaria persists as a scourge in many areas, especially in sub-Saharan Africa. Fighting malaria effectively requires multiple fronts: the disease affects and threatens the most vulnerable people, who often reside in some of the world’s most challenging environments. However, a crucial criterion for meaningful success in malaria prevention and treatment relies on training the right kind of healthcare workers and ensuring that they are available when and where needed. This article focuses on why training healthcare workers is a key to winning the fight against malaria; summarises where malaria training stands now; and finally, why those investments in frontline heroes of public health matter for public health outcomes.
The Malaria Challenge: An Overview
Malaria, a disease caused by parasitic microorganisms that are transmitted by the bites of infected mosquitoes of the genus Anopheles, is a life-threatening illness. In addition to fever, chills, and flu-like symptoms, malaria can lead to brain, kidney, or lung damage, and death. According to the World Health Organization (WHO), there were an estimated 241 million cases worldwide in 2020, and more than 627,000 malaria-related deaths globally. The vast majority of malaria cases occur in sub-Saharan Africa, where medical infrastructure is often poor under-resourced, and overtaxed.
The Role of Healthcare Workers in Malaria Control
Health workers are the main actors in malaria control, providing the spectrum of activities (diagnosis, treatment, and prevention) to patients and communities. The following list outlines the main activities performed by health workers to counter malaria:
- Early diagnosis and treatment: People need to be diagnosed accurately and promptly so that they can be treated appropriately. Health workers must be educated to recognize the symptoms, carry out diagnostic tests, and prescribe the right antimalarial drugs.
- Prevention and Education: Healthcare workers teach communities which methods they can use to prevent malaria infection, for instance, insecticide-treated bed nets, indoor residual spraying, and antimalarial prophylaxis.
- Data collection and surveillance: They gather data on the number of malaria cases in a population, including where the cases arise. This helps them to track the burden of malaria and whether the responses devised are effective or not. These data are useful for adapting public health strategies and resource allocation.
- Community engagement: connecting with populations and ensuring adherence to preventative and treatment measures is a key piece of their role. Health workers are often involved in educating the community through workshops and outreach programs.
The Need for Comprehensive Training
There has been a relatively successful endeavor to train healthcare workers in joint practices of malaria control, of which the technical aspect is just one part, along with:
- Technical skills and knowledge: Health workers need to know the latest about treatment protocols, diagnostic tools, and correct clinical management. Training needs to cover: malaria case detection and diagnosis, including the administration of an RDT for malaria, when appropriate and available antimalarial drug administration.
- Cultural Competency: It is also important to understand the cultural context in which healthcare workers operate; training must include cultural sensitivity to enable them to achieve effective communication with diverse populations and to deal with local misconceptions about malaria or barriers to treatment.
- Leadership and management: for healthcare workers effectively to coordinate malaria control activities, they must also have training in leadership and management, including basic elements of project management, team leadership, and resource allocation.
- Continuing Education: As time passed, due to changes like the disease itself, both new methods to control the disease and treatment changed. Hence, all healthcare workers need to have continuing education in this area, possibly in the form of refresher courses, to remain abreast of the changes and best practices.
Current Training Programs and Their Impact
Several programs and movements exist to improve health workers’ training in endemic areas, and each has a slightly different scope and methodology. However, there are unifying objectives:
- Malaria control: WHO’s Global Malaria Programme is the source for the technical and operational recommendations and training materials used by malaria control programs worldwide. By disseminating these global standards, WHO helps to ensure that health workers have access to the advice and information they need to do their jobs well.
- The Roll Back Malaria Partnership: Delivering Malaria Control (Geneva, Switzerland) — a global effort to scale back malaria through advocacy, coordination, and financial support for national malaria control programs. The Partnership provides training for healthcare personnel, to develop clinical and laboratory capacity and improve quality of care for patients with malaria.
- Local and National Training Programmes: Many of the countries across the global burden of malaria have created their training programs, ie, the national malaria control programs (NMCPs), individual countries, such as Nigeria, Kenya, and India, have tailored training programs for their health facility workers at all levels.
- NGO and Community-Based Training: Non-governmental organizations (NGOs) and community-based organizations often have important roles in this area by offering face-to-face training and workshops at the local level to address the specific needs of different regions.
The Impact of Training Investments
Investing in the training of healthcare workers has profound and far-reaching impacts:
- Improved Case Management: Health workers using well-designed diagnostic devices can diagnose malaria more accurately and target the correct treatment as well. This improves patient outcomes and reduces patient mortality.
- Increased Prevention: Worker-led education and information campaigns lead to more widespread use of preventive measures, such as bed net use and indoor spraying, thereby decreasing the incidence of the disease.
- Stronger Health Systems: Training programs contribute to building a stronger health system. Providing training to personnel helps create an understanding of workers that allows them to better use resources in place, solve problems, and apply effective malaria control programs.
- Community engagement: A well-trained health workforce can interact more effectively with community members, hear them out, promote healthy practices, and get them engaged in malaria prevention and control efforts. This can all lead to greater ownership of the malaria control agenda.
Challenges and Recommendations
Despite the progress made, several challenges remain in training healthcare workers for malaria control:
- Resource constraints: Limited financial resources and infrastructure can constrain the ability to roll out comprehensive training programs It takes concentrated action by governments, international organizations, and donors to overcome these kinds of constraints.
- High turnover: High turnover rates of healthcare workers in some geographies can lead to continuity issues and affect the quality of care. Providing worker retention strategies and ongoing support is crucial.
- Adapted to Local Contexts: Local adaptations of training modules must be possible, to account for local contexts and realities, especially the specific obstacles in each region. This can help facilitate learning by plugging in training programs to local specificities and indigenous or local contexts.
- Monitoring and evaluation: Ongoing monitoring and evaluation enable program officials to assess whether a training program is enhancing healthcare worker performance and to make adjustments in training approaches or components as deemed necessary by the feedback or process analysis. Written, verbal, and participatory mechanisms gather feedback from healthcare workers and community members, enabling the calibration of training approaches and their effective adaptation to specific contexts.
This includes training healthcare workers. Investing in malaria-specific training for frontline health workers delivers dual benefits: it enhances disease prevention and treatment, improves health outcomes, and strengthens health systems by recognizing these workers as essential agents of change. There is more work to do. But as long as there is investment – in training, in people, and the abilities of health workers – there is hope for triumphing over malaria and working towards a malaria-free future.
