Community health volunteers improve access to malaria case management in Siaya County, Kenya

Malaria remains a major health challenge in western Kenya, where transmission persists despite decades of control efforts. Community health volunteers (CHVs) are increasingly engaged in community case management (CCM) to expand timely malaria care, but quantitative evidence of their contributions is limited. This analysis evaluated the effectiveness of CHVs in malaria case management and their impact on healthcare access in Siaya County. Data from 1.4 million encounters recorded by 936 CHVs and 86 health facilities (HFs) across 713 villages (2021-2023) were analyzed. The outcomes included coverage, testing practices, test positivity rates (TPRs), malaria incidence, and adherence to treatment guidelines. CHV coverage was defined as adequate at one CHV per ≤ 500 people; HF access was estimated via the two-step floating catchment area (2SFCA) method, incorporating proximity and utilization, with access scores classified as adequate or inadequate. CHV coverage was adequate for 82.5% of the villages vs. 30% for HFs. CHVs managed 28.1% of all encounters, including 12.1% of suspected malaria cases and 15.6% of rapid diagnostic test-positive cases. A greater proportion of CHV-suspected patients reported fever (77.0% vs. 53.1%). HFs more suspected and febrile cases, but afebrile testing was similar. CHVs recorded higher TPRs than HFs did (82.0% vs. 64.3%). Nearly all confirmed malaria cases received antimalarials. Incorporating CHV data increased malaria incidence estimates by 18% (467 vs. 549 per 1,000 population). CHVs extend access to malaria diagnosis and treatment, particularly in areas with limited HF coverage. Their practices align with national guidelines, and program expansion with adequate support could enhance malaria control in resource-limited settings.