Summary of recommendations.

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，诸多国家正考虑拓展专职疟疾社区卫生工作者（Community Health Workers，CHWs）的职能范围，使其同时承担疟疾防控与有限初级卫生保健服务工作。扩充职能后的社区卫生工作者模式的可接受性、可行性与服务保真度，是该卫生保健模式成功落地与可持续发展的核心要素，相关数据也可为政策调整提供科学依据。为进一步优化面向疟疾消除的社区卫生工作者扩充职能模式，本研究依托一项已证实有效的临床试验开展混合方法研究，旨在评估缅甸地区该模式的可接受性、可行性与服务保真度。本研究作为该临床试验的组成部分收集数据，具体包括：对6名社区领导者与14名卫生利益相关方开展的半结构化定性深度访谈、36组焦点小组讨论、69次针对社区卫生工作者的督导记录，以及6次社区卫生工作者实地观摩访谈；此外还面向643名社区成员开展了定量横断面调查。研究采用主题分析法与描述性分析法分别处理定性与定量数据，并通过三角验证法保障研究严谨性。调研结果显示，各级卫生利益相关方、社区卫生工作者与社区成员均认可该扩充职能模式的价值，总体认可率达97.4%（626/643）；该模式贴合社区卫生服务需求，93.0%的受访者（598/643）认可其服务适配性，且在卫生监管框架内强化了社区卫生工作者的职能定位。该模式的落地具备可行性：社区卫生工作者积极性高昂，服务执行保真度达97.1%（67/69）；同时社区成员对扩充职能后的社区卫生工作者服务依赖度极高，占比达98.3%（632/643）。但研究同时发现，该模式在培训、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，社区卫生工作者扩充职能模式具备落地可行性，且获得了社区成员与利益相关方的广泛认可。若能进一步加大投入并优化完善该模式，在疟疾消除场景中推广应用，将有助于实现疟疾消除目标，并提升疟疾消除地区的初级卫生保健服务质量。