Ethics & Engagement across the Wellcome Trust Major Overseas Programmes

We are at the very early stages of the project and things have started well. We have already identified 2 of the target 26 private international sponsors and all 26 villages where we plan to deploy new village malaria workers have been identified. The target population to be covered by the new VMWs is 18033 people. The national scheme already has over 1000 VMWs but the funding is renewed on a roughly triennial basis. This small scheme will be useful to pilot long-term sustainable funding solutions and also to explore ways to encourage local and national sponsorship. We will start by expanding the scheme in a province already included in the national scheme with 6 new villages. This will allow us to take advantage of the training and reporting infrastructure already in place in this province. Also 20 villages have been identified in a province currently without VMWs.

The whole team will get together in Cambodia in early October to discuss the website design and smart phone technology aspect of the project. We will also visit our two VMWs and take some photos for the website and other publicity purposes. With the website up and running, a few team members will take advantage of their presence at the ASTMH meeting in November this year to publicise the scheme and recruit more sponsors.

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Comment by Sara-Canavati on August 29, 2012 at 13:37

Lisa! Great posting. I think this is a rather sustainable  idea as GFR6 is finished and VMWs in zone 3 have no support at the moment. Let me know how I can collaborate from from this side.

Looking forward to meeting in October!!

Best, sara

Comment by Dina Rippon on September 3, 2012 at 10:28

Thanks for the fantastic update Lisa. So good to hear that things are going well. What a huge target population needs to be covered - this just goes to show how important the work of the VMWs will be! Once your website is up and running, will you send us a link to it? Really looking forward to seeing how this unfolds.

Comment by Sara-Canavati on September 3, 2012 at 10:34

Dina, agreed! This is such a fantastic initiative that Lisa is starting.  VMWs are considered as one of the main elements for malaria elimination in Cambodia. Now they have extended their target population groups to migrants called: MMWs, mobile malaria workers, and to plantations, called PMWs Plantation malaria workers. It is really exiting to see such an initiative.

Comment by Lisa Jane White on September 3, 2012 at 10:58

We are in the process of setting up a preliminary website and will send the link as soon as it's up and running. I would like to point out that the VMW scheme already operating in Cambodia, being run by Dr. Po Ly, is vast and highly successful. We are supporting it just a little with this initiative. However, although we are starting small, we have high hopes for expansion in the future. The funding that currently supports the excellent national scheme may or may not be available in the future. Also, after malaria elimination is achieved, it would be a tragic waste to disband such an effective public health infrastructure instead of using it to attack other public health problems.  

Comment by Michael Parker on September 7, 2012 at 17:25

Hi Lisa, Thanks for the update. It's an important initiative and it sounds like things are going well. If you need any input from any of us here in Ethox leading up to the October meeting or after please do get in touch. We're more than happy to help in any way you think might be useful.

Comment by Lisa Jane White on September 9, 2012 at 5:25

Thanks! Dr. Nguon suggested that we consider ways of promoting and enambling community-level sponsorship of the VMWs. To do this we would have to understand attitudes towards the VMWs within the community, thier value, and individual villagers' willingness to pay towards the service. Any suggestions about how to do this would be very welcome.

Comment by Michael Parker on September 14, 2012 at 19:59

Hi Lisa. I think it depends how far you want to go with this and what kind of information you think you would need. If you were going to do this systematically across many locations it sounds like it could be a big project. An alternative might be to some community engagement work which brought some members of the communities together in something like a focus-group format to discuss this. It might be worth you contacting Vicki Marsh in Kilifi about this because she has done some work using something like this 'deliberative' format that you might find useful as a starting point.

Comment by Lisa Jane White on September 17, 2012 at 1:47

Thanks. I'll bring this up with the team and let you know what we plan to do. 

Comment by Phaik Yeong Cheah on October 18, 2012 at 10:51

We are pleased to announce that we had our first formal meeting at the National Malaria Centre of Cambodia on the 10-11th of October. To date, we have identified 26 new villages and  4 VMW sponsors. We discussed budgeting, the website design, recruitment of sponsors, monitoring and evaluation. We also discussed the potential ethical issues e.g. confidentiality of sponsors (should a sponsor be linked to a village or village malaria workers), conflicts of care, the relationship between the VMW and other health workers, sustainability and the assumed responsibilities (intended or not) of the VMW beyond malaria.

On Day 2, we visited 2 existing villages and met some village malaria workers. Each village usually has 2 VMWs, one male and one female, usually husband and wife. The VMWs must be a village resident, more than 18 years old, be a respected person in the village, must be accessible to the community, but must not be a political figure.

The team is currently working on sponsor recruitment, wesbite design, and drafting an ethics research plan.  

Comment by Michael Parker on October 20, 2012 at 10:13

Thanks for the update Phaik Yeong. It sounds like the project is moving forward really well. It's great to hear that you had a chance to talk about the kinds of ethical issues/difficult decisions that the Village Malaria Workers might face in their work. This is something that is not often discussed - I mean the day-to-day practical ethical issues faced by front line research actors, rather than the high level stuff that tends to be the focus of discussion more often. Did you keep some notes on these discussions? It would be great to talk to the VMWs in a few months and see whether ethical issues they faced in their work we the ones they were expecting.

It would also be good to know from other groups who are working with volunteer health workers or health workers who are peripatetic e.g. 'backpack health workers' in other countries about the comparable ethical challenges they face... Any thoughts anyone?

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