Community Healthcare Providers’ Perspective on Malaria Control in Difficult Terrains (DAMaN) in Odisha, India

Abstract

Introduction: Malaria remains a major public health challenge, especially in remote areas with limited healthcare. The WHO-endorsed Mass Testing and Treatment (MTaT) strategy targets high-prevalence regions by screening and treating entire populations. In India, Odisha’s DAMaN programme integrates MTaT with health services to combat malaria in tribal communities. This study explores community healthcare providers’ perspectives on MTaT under DAMaN. Methods: The study involved 53 community health workers (CHWs) from five districts, including Accredited Social Health Activists, Auxiliary Nurse Midwives, and Community Health Officers. Data were analysed using thematic analysis. Results: Three themes emerged: 1) Equity in malaria service delivery among remote, hilly areas and vulnerable tribal populations, 2) Non-malaria service benefits from mass testing and treatment of malaria in remote areas, and 3) Challenges and suggestions for addressing implementation gaps. The DAMaN programme has significantly reduced malaria prevalence and improved healthcare access in remote villages by integrating malaria control with broader health services and fostering community engagement. It has strengthened trust in public healthcare systems and improved health outcomes. However, challenges like infrastructure, workforce limitations, socio-cultural resistance, and resource availability need to be addressed to sustain its impact. Conclusion: Suggestions for improving scheduling flexibility, increasing camp frequency, incentivising volunteers, and fostering inter-departmental collaboration could further strengthen DAMaN’s effectiveness and sustainability.