COMMUNITY PARTICIPATION IN MALARIA SURVEILLANCE AND TREATMENT .3. AN EVALUATION OF MODIFICATIONS IN THE VOLUNTEER COLLABORATOR NETWORK OF GUATEMALA

In most rural areas of Latin America, malaria surveillance and treatme nt is carried out by a network of unpaid village malaria workers, know n as Volunteer Collaborators, who are trained and supervised by the Na tional Malaria Service. To identify ways in which the performance of t hese volunteer workers could be improved and to test changes that woul d make the Volunteer Collaborator Networks (VCNs) a more attractive mo del for community participation in malaria case detection and treatmen t in other regions, we tested a series of modifications in the VCN of Guatemala. These modifications included improved methods for selecting , supervising, and evaluating the volunteer workers and for collecting blood smears and reporting results, and the use of volunteer workers, known as Volunteer Medicators, who administered presumptive antimalar ial therapy without taking a blood smear. A cost-effectiveness analysi s of the modified VCN was also carried out. Two years after the modifi cations were introduced, Volunteer Collaborators identified nearly twi ce as high a percentage (33% versus 17%) of patients with suspected ma laria in their villages. Delays in examining blood smears were reduced from 23 days to 11 days and delays from blood smear examination to cu rative treatment were reduced from 21 days to 7 days. The Volunteer Me dicators identified and treated only a slightly higher percentage of p atients than the Volunteer Collaborators (36% versus 33%). However, th e cost of maintaining a network of Volunteer Medicators ($0.61 per pat ient treated) was much lower than the traditional VCN ($2.45) or the m odified VCN ($1.85). Thus, with a few, simple and relatively inexpensi ve modifications, the efficiency and cost-effectiveness of Volunteer C ollaborators can be markedly improved. Additionally, the VCN can be mo dified to make it a more suitable model for community-based malaria co ntrol and surveillance networks in other malarious areas of the world, which differ in terms of their level of endemicity, the goals of the malaria program, or the available health care infrastructure.