Supervision dataset.

As countries transition to malaria elimination many are considering expanding the role of dedicated malaria community health workers (CHWs) to provide both malaria and limited primary health care services. The acceptability, feasibility and fidelity of an expanded role for CHW are vital factors for the successful implementation and sustainability of this health care model and data are needed to inform policy change.To further inform an expanded CHW model for malaria elimination, a mixed-method study nested in a trial which demonstrated effectiveness was undertaken to determine the acceptability, feasibility and fidelity of an expanded role for CHW in Myanmar. Data were collected as part of the trial including qualitative semi-structured in-depth interview with community leaders (n = 6) and health stakeholders (n = 14), focus group discussions (n = 36), supervision (n = 69) and field observation visits (n = 6) with CHWs. A quantitative cross-sectional survey was administered to community members (n = 643). Qualitative and quantitative data were analysed thematically and descriptively, and then triangulated for rigour. The expanded CHW model was acceptable to different levels of health stakeholders, CHWs and community members (97.4%, 626/643) because it addressed the community demand of health services (93.0%, 598/643) and promoted the roles of the CHWs within the framework of health regulations. Its implementation was also feasible due to the enthusiasm and high fidelity (97.1%, 67/69) of the CHWs as well as reliance of community members on expanded CHW services (98.3%, 632/643). However, aspects of training, supervision, supply chain management, referral mechanisms, and recording and reporting of data could have been improved. The expanded role for CHW model was found to be feasible to implement and acceptable to community members and stakeholders. With further investment and optimisation, wider-scale implementation of the model in malaria elimination settings may contribute to the goals of malaria elimination and effective primary health care in malaria elimination settings.

随着各国逐步向疟疾消除阶段转型，诸多国家正考虑扩充疟疾专职社区卫生工作者（Community Health Workers，以下简称CHW）的职能范围，使其同时提供疟疾防控服务与有限的初级医疗保健服务。CHW职能拓展的可接受性、可行性与执行保真度，是该医疗模式成功落地并实现可持续发展的关键因素，相关数据可为政策调整提供科学依据。

为进一步为疟疾消除场景下的CHW职能拓展模式提供支撑，本研究在一项已证实有效的临床试验中嵌套开展混合方法研究，旨在评估缅甸地区CHW拓展职能的可接受性、可行性与执行保真度。

本研究依托该临床试验收集数据，具体包括：对社区领袖（n=6）与卫生利益相关方（n=14）开展的质性半结构化深度访谈、36组焦点小组讨论、69次CHW督导记录以及6次CHW现场观摩走访。此外，还面向社区居民开展了定量横断面调查（n=643）。

研究采用主题分析法与描述性分析法分别处理质性与定量数据，并通过三角验证法保障研究严谨性。

结果显示，各级卫生利益相关方、CHW与社区居民均认可该CHW拓展职能模式（社区居民认可度达97.4%，即626/643），这是因为该模式契合了社区的医疗服务需求（93.0%，即598/643），且在卫生监管框架内明确了CHW的角色定位。此外，由于CHW的工作积极性与高执行保真度（97.1%，即67/69），以及社区居民对拓展职能后的CHW服务的高度依赖（98.3%，即632/643），该模式的落地具备可行性。不过，培训、督导、供应链管理、转诊机制以及数据记录与上报等环节仍存在优化空间。

综上，CHW职能拓展模式具备落地可行性，且获得社区居民与利益相关方的认可。若能进一步投入资源并优化完善，该模式在疟疾消除场景下的规模化推广，可为疟疾消除目标及疟疾消除地区的优质初级医疗保健服务落地贡献力量。