Implementing community case management of malaria: Stakeholder insights on advancing equitable access in Kilifi...

Malaria detection in Kilifi, County, primarily relies on intermittent active surveillance at healthcare facilities. To strengthen control of uncomplicated malaria, community health promoters (CHPs) were engaged in community health education, case detection, and treatment. This study examines lessons from integrating CHPs in community case management of malaria (CCMm). We use a mixed-method, concurrent cross-sectional design, to document stakeholder experiences of CCMm within piloted Community Health Units (CHUs) in Kilifi County. Quantitative analysis reviewed routinely collected malaria data from 01/01/2025-30/06/2025. Qualitative data were obtained through in-depth interviews with county and sub-county managers (n = 5), facility in-charges (n = 10), Community Health Assistants (CHP supervisors) (n = 12); group discussions with CHPs (n = 14) and focus group discussions with community members (n = 12). Data were analyzed thematically to describe the CCMm implementation process, enablers and challenges, and perceived outcomes. Stakeholders recognized CCMm as an effective approach for expanding access to malaria testing and treatment in underserved areas. In a pilot involving 10 facilities in Kilifi County, CHPs managed 17% (1,268 of 7,568) of malaria cases. Critical enablers included integration with the Kilifi County Department of Health, which supported CHP training, supervision, and supply of rapid diagnostic tests (RDTs). Community trust and initial facility-based mentorship enhanced CHP competence and promoted acceptance of CHPs in their expanded roles. However, implementation faced challenges, including irregular antimalarial supplies, inconsistent CHP remuneration, limited logistical support, and weak integration with referral and information systems. As donor support phases out, stakeholders underscored the need for increased county government ownership, institutional capacity building, and sustainable resource allocation to ensure the continuity and scalability of CCMm interventions. Stakeholder experiences in Kilifi County underscore CCMm's potential to enhance malaria control, while revealing systemic and resource-related challenges. Addressing these barriers is critical for optimizing equitable, community-level malaria interventions and informing policy in comparable settings.