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Researchers have found that giving small financial incentives to health workers in developing countries could reduce the malaria death toll.

Doctors and nurses in the children's wards of Guinea Bissau's national hospital — where poor conditions, no direct access to medication, and poorly paid, unmotivated workers are the norm — were trained in standard malaria treatment protocols.

Half of the workers were given a small financial incentive to apply these protocols, US$50 for nurses and US$160 for doctors, while the other half received no extra money. After four weeks, death rates on the wards where financial incentives had been used were half that on the control wards.

These findings were published in the British Medical Journal on 22 October, as part of The Council of Science Editors global theme issue on poverty and health (see Journals team up to highlight poverty and health).

Patrick Moonasar, manager of the South African government's malaria programme, says the study shows that Africa has the capacity to tackle malaria and that with robust training, financial incentives and follow up supervision, health care workers could make a big difference.

"This paper contributes positively to the debate on how we tackle malaria," he says. Moonasar says there must be a "systems-based" approach to dealing with malaria that focuses on improving the skills of health workers and adjusting their income to a level that enables them to live on a par with the middle class in their country.

John Govere, an entomologist working with the WHO malaria programme in Harare, Zimbabwe, says the study reinforces his experience that paid workers are more efficient and more willing to take orders than volunteers.

This was highlighted by an insecticide spraying programme in Kenya which "dramatically improved" once spray operators were paid.

"We found the spraying quality and coverage by volunteer workers to be very poor compared to paid operators — especially in rural settings where people are desperate for an income," Govere told SciDev.Net.

Malaria kills one million people worldwide every year, with 90 per cent of deaths occurring in Africa, according to the WHO. There are an estimated 300 million clinical cases diagnosed each year. 

Link to full paper in the British Medical Journal

Reference: British Medical Journal 335, 862 (2007)

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