Early diagnosis and treatment of malaria cases is one of the basic elements
of the current global malaria control strategy. In order to provide this s
ervice to people in rural areas there is a need for new cost-effective appr
oaches. To ensure that such new approaches are acceptable to the target com
munities, it is important to know the rationale for people's malaria treatm
ent-seeking behavior. The present study provides insights into the reasons
for people's preferences for different types of healthcare facilities and d
escribes variation of these preferences within a rural community in Sri Lan
ka. The study reports on the experiences with the establishment of a villag
e health facility and its effect on the treatment-seeking behavior of the p
opulation. After the introduction of the village treatment center it quickl
y took over the role of main provider for diagnosis and treatment of malari
a from the government facilities. The treatment center did not improve the
response time in seeking treatment for young children, but the delay for ad
ults was reduced by 1-2 days. Mothers with small children often preferred t
he government facilities since they wanted a more qualified opinion than av
ailable from the locally recruited staff of the village treatment center. T
he treatment center significantly reduced the stress and discomfort experie
nced by the elderly and handicapped segment of the community. The study ind
icated that the effective catchment area of a village treatment center will
be influenced by the degree of initial support from key individuals in the
communities, the selection procedure and training of assistants, and the h
istory of the relationships between different villages to be served by the
center, The government health services and communities across the dry zone
of Sri Lanka could benefit substantially from the establishment of more vil
lage treatment centers. To ensure the long-term sustainability of these typ
e of facilities it is necessary to assess the feasibility of charging a use
r fee and establishing multi-purpose clinics. Government policies and admin
istrative procedures will need to be adjusted to make the successful operat
ion of village treatment centers possible. (C) 2000 Elsevier Science Ltd. A
ll rights reserved.