Tuberculosis (TB) remains a leading cause of morbidity and mortality, requiring timely case identification for transmission control. This requires rapid screening to identify individuals eligible for molecular testing. While artificial intelligence-enabled cough-audio classifiers show promise, little is known about how they are perceived or how they may be integrated into health services in high-burden settings. This exploratory study was conducted as part of the clinical evaluation of the Cough Audio triaGE for TB ((4)-CAGE-TB) application. Data were collected in 2023–2024 across ten health facilities in Kampala, Uganda, and Cape Town, South Africa. In-depth interviews were conducted with healthcare providers (n = 109), clients (denoting individuals receiving care) (n = 57), and TB programme stakeholders (n = 14), complemented by facility observations. Data were analysed thematically to examine TB screening practices, experiences with digital health technologies, and perceptions of cough-audio–based screening. We found that TB screening was clearly articulated in national policy but inconsistently implemented; it was often reactive, driven by symptoms or clinical suspicion despite a policy shift towards risk-based screening. Clients did not recognise screening as a distinct moment, limiting opportunities for health education. Cough-audio screening was perceived as a potentially valuable innovation for improving objectivity and prioritisation for confirmatory testing. Participants suggested it could enhance engagement, strengthen recognition of TB risk, and improve linkage to testing. Enthusiasm was tempered by concerns about accuracy, workflow integration, and infection prevention. Trust in the technology was closely tied to trust in providers and the health system, underscoring its relational nature, and its positioning as a complement to clinical judgement. Overall, cough-audio TB screening holds promise not as a standalone diagnostic tool, but as a means of reshaping screening within routine care. Its impact will depend on context-sensitive integration into workflows, diagnostic cascades, and care relationships. Qualitative evidence is essential to guide implementation beyond algorithmic performance. Author Summary In many countries, TB remains a major cause of illness and death. A key challenge is identifying people early enough so they can be tested and treated. New digital tools that can analyse cough sounds are being developed to identify people who might have TB, but we know little about people’s attitudes to these tools and how they could be used in health facilities. Through interviews with healthcare staff, people attending health facilities, and TB programme staff in Uganda and South Africa, we explored their experiences of TB screening and how they viewed using cough sounds to identify people with TB. We found that although TB screening is part of national policy, it is not consistently implemented in healthcare facilities, with limited opportunities to engage with people seeking care and explain TB screening. Using cough sounds for TB screening was seen as promising because it could make screening more structured, objective, and facilitate linkage to confirmatory testing. However, participants raised concerns about accuracy and how the tool would fit into busy routines. Overall, our findings show that these technologies are not just technical tools, but part of how care is organised and experienced.

Objective The primary objective of this scoping review is to identify and synthesize the existing evidence on the applications, reported outcomes, and key methodological considerations of user-centered design (UCD) and related participatory design methodologies including human centered design (HCD), co-design, participatory design and co-creation of digital health innovations within resource constrained settings. Introduction A critical challenge in global health is the high failure rate of technologically sound innovations. This is due in part to insufficient consideration of the end-user’s environment, literacy levels, and socio-cultural beliefs. UCD is an iterative design process that grounds development in an understanding of the user’s needs, contexts, and feedback. It sits within a wider family of related approaches such as HCD, co-design, participatory designs and co-creation, while related to UCD, is distinguished by its emphasis on equitable partnership, where end-users are not merely informants but co-designers and co-developers of the innovation. These approaches have emerged as promising methodologies to develop more relevant, acceptable, and sustainable digital health solutions. In disease diagnostics, despite increasing interest, there is lack of a consolidated review mapping the full scope of how these methodologies are applied, across which types of digital health and diagnostic innovations, and with what outcomes. Inclusion criteria Studies conducted in low-resource settings, published between 2015 and 2026 that apply UCD or a related participatory design methodology to the development, adaptation or evaluation of a digital health innovation and, where reported, outcomes such as usability, patient satisfaction, innovation success, adoption, scalability and sustainability. Studies that name such an approach without describing the activities undertaken are also eligible, and the completeness of reporting will be recorded and reported as a finding of this review. Methods Guided by the JBI methodology for scoping reviews and reported in accordance with PRISMA-ScR, we will search MEDLINE, Embase, CINAHL, Scopus, Web of Science, IEEE Xplore, the ACM Digital Library, the WHO Global Index Medicus, and Google Scholar, together with named grey literature sources, for peer-reviewed articles, conference proceedings, and grey literature published in English and French from 2015 to 2026. Data extraction will include information on study characteristics, the design approaches and processes applied, the completeness with which they are reported as well as the outcomes.

Malaria, diarrhea and acute respiratory infections (ARIs) are the major causes of mortality in young children in sub-Saharan Africa. Here we provide support for the hypothesis that children can be protected from these diseases by improvements in house design. We designed a novel double-story house, called a Star Home, to provide an insect-proof, cleaner, cooler and smoke-free environment, with a reliable supply of water and sanitation. We conducted a cluster-randomized controlled trial where households with children under 13 years of age were randomly allocated (1:4.7) to living in 110 Star Homes or in 513 traditional mud and thatched-roofed houses. The primary outcome of childhood malaria incidence was met: after 3 years, children living in Star Homes had 44% less malaria (incidence rate ratio (IRR): 0.56 (95% confidence interval (CI): 0.43-0.72), P < 0.0001) compared to children living in traditional homes. Children in Star Homes had 30% less diarrhea (IRR: 0.70 (95% CI: 0.53-0.91), P = 0.0070) and 18% less ARIs (IRR: 0.82 (95% CI: 0.73-0.93), P = 0.0010) than children living in traditional homes. Children under 5 years of age living in Star Homes were also taller for their age than those living in traditional homes. Our house design is intended to inspire those working in the building sector and with local communities to develop innovative designs for healthier homes. Major improvements in rural house design have the potential to make a substantial public health impact across hot, humid regions of Africa. ClinicalTrials.gov: NCT04529434 .

Background: Malaria is resurging in sub-Saharan Africa due to climate change, emerging drug and diagnostics resistance, new vectors and reduced international funding. These challenges highlight the need to expand access to malaria diagnosis and surveillance beyond the public sector. A large share of care seeking occurs in the private sector. Hence, strengthening connections with private providers has the potential to improve diagnostic coverage and close surveillance gaps. In Kenya ~ 40% of malaria cases are managed in the private sector, however data regarding the quality of care provided and malaria cases in this context remain largely unlinked to routine public malaria surveillance systems. Here we describe a digital mobile engagement of private community-based providers to expand malaria case detection and improve quality of care and completeness of surveillance data. Methods: A cross-sectional study was conducted in Kisumu County, Kenya engaging five private health facilities, 25 private chemists, and 50 community health promoters. Providers were digitally supported to perform and report malaria rapid diagnostic tests using an AI-enabled mobile application that captured photographic images of test outcomes and transmitted them to County surveillance dashboards. Analyses examined malaria positivity by provider type, demographic patterns of infection, and distribution of test outcomes across commonly used malaria test brands. Differences were assessed for statistical significance using chi-square tests. Results: Between July 2024 and June 2025, 26,090 malaria tests were recorded through an AI-supported digital surveillance system across private health facilities, private chemists, and community health promoters. Overall, 25,993/26,090 (99.6%) test records were valid; 7,035/25,993 (27.1%) were positive. Malaria positivity differed significantly by provider type: 1,523/3,930 (38.8%) among community health promoters, 3,260/9,364 (34.8%) among chemists, and 2,252/12,699 (17.7%) among private health facilities (p < 0.001). Positivity was highest among children. WHO prequalified malaria rapid diagnostic test brands showed significant heterogeneous positivity across provider types (all p < 0.001). Conclusions: Digitally integrating private and community-based providers into malaria surveillance substantially increases the capture of malaria cases into formal surveillance systems and provides important information for targeted quality improvement of the private sector diagnostic performance.

Objectives. This study examined how global policy stakeholders view the potential of digital tools for tuberculosis screening and triage. A smartphone-based application using cough audio for triage, which is currently under development, was utilized to inform the discussion and generate insights relevant to the broader adoption of digital health technologies in settings with a high tuberculosis burden. Design. Qualitative, semi-structured interviews were conducted online with fifteen experts involved in tuberculosis screening, triage, and diagnostic evidence and policy at global level. Interviews were transcribed verbatim and analysed thematically. Results. Participants viewed digital tools as having the potential to strengthen the tuberculosis diagnostic pathway by reducing administrative workload, supporting earlier case identification, and offering more discreet and accessible entry points into care. At the same time, they identified persistent barriers to implementation, including limited infrastructure, funding constraints, gaps in digital literacy, and the absence of clear governance frameworks. Participants emphasised the importance of human-centred design, context-specific adaptation, and equitable access. Conclusions. Digital tools hold promise for optimizing the tuberculosis diagnostic pathway in high-burden settings, but their effective integration requires coherent policy guidance, investment in infrastructure and workforce capacity, and design approaches that support usability and equity.

In remote communities in the Greater Mekong Subregion, maintaining community-based malaria care is vital to achieving the goal of malaria elimination. This project aimed to collaborate with the community members and implementers of malaria and health programmes, our key stakeholders, to co-create engagement activities that promote the integration of community-based malaria activities that best fit the local context. This article describes the design, implementation and results of this co-creation process, and highlights key learnings and insights, enabling factors and challenges. In Buntharik district, Ubon Ratchathani province bordering Laos in northeastern Thailand, we adopted a co-creation framework to design and develop iterative and responsive engagement activities, and used a theory of change framework to outline the necessary steps and conditions to achieve the desired co-creation outcomes. Data were recorded in engagement logs, meeting minutes, observation notes, and participant evaluation to measure the results of engagement and extract key learnings from implementation. Between April 2023 and June 2024, 36 in-person engagement activities were conducted with approximately 550 participants, to co-create and evaluate locally-owned health education materials—the 2024 Buntharik health calendar—that integrates malaria information with priority local health issues. The co-created calendar offered one potential entry point to maintain malaria awareness in low transmission areas, but future initiatives ideally should secure additional funding sources to maintain the capacity of local health workers. We found that responding to local health concerns and expectations of the communities and stakeholders is the key enabler to co-creation. However, in the context of changing policy, careful thought about the range of scenarios in which co-creation is applied is crucial to plan for sustainability of the integration. Learning from the context of this engagement, new champions could emerge from involving additional stakeholders beyond those involved in malaria service implementation. Drawing from this stakeholder engagement work, the co-creation process showed strong potential for ensuring the sustainability of community-based health care in the context of declining awareness and advocacy, such as in the case of malaria elimination. The process and its learning can be adopted to any ongoing local collaborative partnership and future participatory action research and community-informed policy considerations.

Tuberculosis (TB) remains a serious health threat and strains of TB resistant to first-line therapies account for significant TB-related morbidity and mortality. Widely recognized as a disease of poverty concentrated in low- and middle-income countries, drug-resistant tuberculosis (DR-TB) is a result of deep-seated deprivation and the shortcomings of under-resourced health systems. Traditionally, the response to TB, and particularly DR-TB, has been focused on dealing with the infection and preventing onward transmission, for example, through isolating people with TB in sanatoria or specialized hospital wards. Recently, activists and policy makers have recognized the need to put people affected by the disease at the center of TB programs, but this is just the beginning of the necessary “just” transition from inequitable and unsustainable approaches to addressing TB to ones that are inclusive, community-centered, and resilient. In this article, we examine antimicrobial resistance in TB and highlight the need for a multisectoral, justice-oriented approach that goes beyond biomedical paradigms—we propose a “just” transition that addresses the unequal burden of human suffering and injustices that have become systemic in TB programs. We see a “just transition” as involving long-term structural changes to technologies, policy, infrastructure, scientific knowledge, and practice.

INTRODUCTION:To evaluate the impact of a novel design "Star Home" on the incidence of malaria, respiratory tract infections and diarrheal diseases among children, randomly selected households in Mtwara, Tanzania were offered a free, new Star Home. Drawing on longitudinal qualitative research that accompanied the Star Homes study, this article describes the experiences of residents and the wider community of living with these buildings. METHODS:A total of four rounds of face-to-face interviews were undertaken with residents of Star Homes (n = 37), control (wattle/daub) homes (n = 21), neighboring households n = 6), community members (n = 17) and community leaders (n = 6). The use of Star Homes was also observed over these four time periods between 2021 and 2023. Interviews were conducted in Swahili, transcribed, and translated into English for thematic analysis. RESULTS:Star Homes residents appreciated several aspects of the Star Homes, including overall comfort, access to water and electricity, and clean toilets. There were concerns about some design elements, such as poorly closing doors, stoves perceived as inefficient, and the façade, which was susceptible to rainwater ingress. The houses were not always used as intended by their developers, for example, residents were sleeping downstairs instead of upstairs because of cold floors or difficulties using the stairs. Star Homes residents described how the structures triggered praise but also envy from other community members. CONCLUSIONS:The findings highlight the need for close attention to the use of novel design houses and careful sensitization around the potential benefits of dwellings to ensure that the intended health impacts of interventions are achieved.

Introduction: Bacterial pathogens exhibiting antimicrobial resistance (AMR) are a health threat for humans, companion animals and livestock. Surveillance underpins appropriate AMR responses, but can be biased or expensive. Surveillance using Lot Quality Assurance Sampling (LQAS) has shown promise in human health settings; more evidence on its applicability and acceptability in livestock populations is needed. Drawing on in-depth interviews, this article examines stakeholder perspectives on LQAS for AMR surveillance in livestock in Germany. Methods: Twenty-five stakeholders were interviewed. They included employees of German universities, research institutes, Federal animal health services / veterinary laboratories, animal producer associations, and veterinarians. Detailed notes of online interviews were analyzed using a framework approach. Results: Respondents were concerned about AMR in livestock and also about restrictions on antibiotic treatment options. They described the multifaceted, legally prescribed data gathering for farmers to monitor antibiotic consumption and the widespread use of antibiograms to guide treatment in Germany. Respondents saw potential benefits of LQAS for AMR surveillance, in terms of reducing the sample sizes and the need for antibiotic susceptibility tests, but there were questions about surveilling commensal bacteria, with concerns about it leading to further restrictions on antibiotic consumption and driving food production overseas. Conclusion: An LQAS approach to AMR surveillance requires locally responsive guidance to alleviate concerns about further restriction of treatment options (and about animal welfare). Given existing data collection, recording and reporting burden for farmers and veterinarians, early engagement is needed to agree the rationale and benefits of LQAS, particularly if surveilling resistance in commensal bacteria is considered.

Respiratory tract infections (RTIs) remain an important cause of mortality and morbidity, particularly among older adults. Annual influenza epidemics cause around 127,000 deaths in India of which 65% are among adults of 65 years and older. Because of India's rapidly growing older adult population, RTIs are likely to become an even greater public health issue and implementing effective preventive strategies will be crucial. To inform pharmaceutical and non-pharmaceutical prevention strategies for RTIs among older adults, this study explored the perceptions of RTIs and their implications for disease preventive practices of older adults visiting a tertiary hospital in Mysuru, India. Qualitative research methods, including structured observations and in-depth interviews with older adults and healthcare workers were used. Deductive and inductive analysis highlighted how common colds and influenza infections were regarded as inevitable and not considered severe illnesses by older adults. Whereas COVID-19 prompted fear because of severe illness episodes and sudden deaths among family members. Common colds and influenza were often related to eating 'cold' food and a 'cold' environment, and preventive measures reflected these beliefs. Language played a significant role in the understandings of RTIs in older adults. Different terms for influenza, common cold and vaccination in Kannada and English could lead to lack of awareness of preventive measures including vaccination for RTIs. Because of campaigns during the COVID-19 pandemic, older adults were familiar with non-pharmaceutical prevention techniques such as hand hygiene and social distancing. In conclusion, using relatable medical terms when providing information about RTI prevention and the possibility of taking a holistic approach towards prevention and healthy aging including diet, vaccination and non-pharmaceutical practices means that those are more likely to resonate among the targets. To promote preventive practices, those would ideally also describe the health risks of common RTIs.

Introduction Continuous monitoring of critically ill children is essential for the timely identification of deteriorating vital signs. However, monitoring is often intermittent in low-resource settings, affecting the quality of care. This study assessed the implementation barriers and facilitators of a locally adapted, robust, low-cost continuous monitoring system (IMPALA) in Malawi. Methods A mixed-method implementation study of the IMPALA system in the paediatric High-dependency unit of a tertiary hospital from November 2022 to October 2023. Data were collected through over 300 hours of observations, in-depth interviews with 14 healthcare providers and nine caregivers of admitted children, and questionnaire-based surveys from 24 healthcare providers and 72 caregivers. Qualitative data were analysed thematically using inductive and deductive approaches. Descriptive statistics (frequencies, percentages, means, and standard deviations) were calculated for categorical and continuous variables. Results Healthcare providers and caregivers indicated that the IMPALA monitors improved care by providing the ability to measure reliably multiple vital signs, with long-lasting (4 hours) backup power and alarm provisions. Healthcare providers reported spending less time on child monitoring after the introduction of IMPALA (1.8 hours per day pre-IMPALA (95% CI: 1.19-2.48) compared to 3.3 hours post-IMPALA (95% CI: 2.36-4.23; p < 0.00). Still, they recognised alarm fatigue, limitations in knowledge of the technology, and staff shortages as barriers to the use of IMPALA. Some caregivers expressed concerns about the reliability of the monitoring system. Conclusion The continuous monitoring device was well-received overall by healthcare providers and caregivers. It was perceived to save time and improve the quality of care. Opportunities to further enhance engagement with the device include strengthening caregivers' knowledge and involvement to address their mistrust or misconceptions about the device, minimising false alarms, and providing ongoing training to healthcare providers so that new, existing, and rotating staff know how to engage with the device.

Improved cooking stoves (ICS) are intended to reduce indoor air pollution and the inefficient use of fuel yet there is often reticence to shift permanently to ICS. Drawing on a scoping review, this article aims to provide a comprehensive overview of factors affecting the acceptability of ICS. A scoping review was carried out using a systematic search strategy of literature. All articles identified in three major databases that included Pubmed/Medline, Scopus and Web of Science underwent screening followed by content analysis to generate major and minor themes using a structured social level analysis. The analysis identified factors at micro, meso, and macro-social levels that potentially contribute to an adoption of an improved cooking stove (ICS). The findings from the review were discussed and refined among a group of experts identified based on their prior academic or commercial contributions related to ICS. Adoption of ICS was dependent on functional outputs (e.g. cleanliness, and cooking efficiency) while meeting local social and cultural demands (e.g. cooking large meals, traditional meals, and taste). Health and cost benefits played an important role in the adoption and sustained use of ICS. The adoption of ICS was enabled by use among neighbors and other community members. Sustained use of ICS depended on fuel supply, fuel security and policies promoting its use. Policies offering subsidies in support of supply-chain garnered institutional trust among community members and resulted in the sustained use of ICS. In addition to design attributes of ICS that could meet both scientific and social demands, policies supporting promotion of clean energy, subsidies and supplies can substantially enhance the adoption of ICS.

[This corrects the article DOI: 10.1371/journal.pone.0329265.].

Vaccinating health care workers (HCWs) is a common way to prevent influenza-related infection, transmission to patients and absenteeism of HCWs. In India, influenza contributes to 130,000 deaths per year, yet vaccination uptake of HCWs is low. Fifteen percent of the HCWs received one or more vaccinations in 5 years. This study explored the social context of influenza vaccine uptake among HCWs, including physicians, nurses and medical students at a teaching hospital in Mysuru, South India, to generate insights to inform influenza vaccination campaigns targeting HCWs. Qualitative methods, including in-depth interviews with HCWs and structured observations at various departments of the hospital were applied. The results indicate that influenza vaccination uptake among HCWs is low due to personal factors related to little perceived personal threat, emphasis on other prevention techniques to avoid transmission, cost of the vaccine and needle anxiety. Besides, institutional factors, absence of recommendations from superiors and lack of promotion campaigns contribute to low uptake. In conclusion, HCW vaccination education and promotion regarding diminishing personal and transmission risk of the influenza virus, uniform vaccination guidelines and strategies to improve access including for those who are burdened by the cost of the vaccine are suggested.

BACKGROUND:Sub-Saharan Africa faces a double burden of disease due to the continued high prevalence of infectious diseases such as HIV and tuberculosis, and a concurrent increase in non-communicable diseases. The co-occurrence and clustering of multiple diseases can cause a syndemic, synergistically interacting epidemics, driven by context. METHODS:This cross-sectional study investigated potential syndemics in Eswatini, by determining geospatial disease concentration and estimating interaction between four diseases and the impact of context on these interactions. Using data from the WHOPEN@Scale household survey, we estimated generalised linear models with a quasi-Poisson link, incorporating three-way interaction terms. Joint effect estimates and the relative excess risk due to interaction (RERI) between diseases and contextual factors were estimated. RESULTS:Conditions with comorbid depression were concentrated in the middle of the country near the capital, and the combinations without depression mostly in the north. Additive interaction was found between HIV and diabetes across all three contextual factors, in particular for people who are the sole household member aged 30 or above RERI: 0.46 (95% CI 0.12 to 0.80) and those who had lost their partner RERI: 0.44 (95% CI 0.02 to 0.86). CONCLUSIONS:We show that HIV and diabetes exhibit syndemic properties, indicated by geospatial variation, additive interaction as well as interaction with context. The lifelong chronicity and stigmatising nature of both diseases emphasise the importance of the social and financial context surrounding affected individuals. While the other disease pairs did not exhibit syndemic properties, the worst health outcomes among the double-exposed stipulate that comorbidity remains important within treatment guidelines.

Background: Despite the annual burden of seasonal influenza in India and previous experiences with pandemics, influenza vaccination rates remain low among the general population and healthcare workers (HCWs). Although health authorities recommend vaccination for high-risk groups, including, awareness and coverage among these groups remain inadequate. Drawing on a cross-sectional questionnaire-based survey, this article examines influenza vaccine uptake and related socio-demographics, attitudes and practices among HCWs in a tertiary hospital in Mysuru, South India. Methods: A team of trained research assistants administered a questionnaire-based survey to 427 HCWs (response rate: 99 %). Statistical analyses, including bivariate and multivariate logistic regression, were performed. Results: Among the 427 HCWs surveyed, the influenza vaccination rate was 14 %, despite 82 % awareness rate. Vaccination rates varied significantly based on job roles, with physicians and physicians in training exhibiting the highest rates, and nurses and other health workers reporting zero vaccination rates. Regression analysis revealed that HCWs that perceived influenza as a serious disease were 2.77 times more likely to be vaccinated compared to those who perceived it as not serious or indicated being unsure, after adjusting for age, gender and position (95 % CI: 1.26 to 6.06). Conclusions: Influenza vaccination uptake among HCWs in Mysuru was low, particularly among nurses. The disease was often perceived as low risk. Targeted interventions, designed with collaboration with target groups to adapt to their needs, are crucial. Efforts to raise awareness about the risks of influenza and to enhance vaccine accessibility would further support increased uptake.

Numerous challenges, such as lengthy treatment course, side effects, and distance to healthcare facilities contribute to suboptimal Tuberculosis (TB) treatment completion. Digital adherence technologies (DATs), such as smart pillboxes and medication labels, could be an alternative to facilitate TB treatment continuation. In-depth interviews with people undergoing treatment for drug susceptible TB, health care providers (HCPs) and other key actors were conducted to evaluate their experiences with DATs in ten health facilities across four different regions in Tanzania. This study is part of a multi country cluster randomized trials conducted under the ASCENT consortium. Interviews were conducted with a total of 41 individuals, 19 people with TB and 22 HCPs and key actors. One of the main findings indicates that participants found that the daily reminders provided by the DATs, particularly the alarm from the smart pillboxes, helped in supporting treatment continuation and establishing a routine around medicine intake. DATs use was linked with reducing the financial burden of treatment, improving people with TB-HCPs relationship, and decreasing workload for HCPs. Although DATs were generally perceived as reliable, occasional technical malfunctions, such as battery depletion in smart pillboxes, were reported. The requirement of having access to a cellphone and a power source emerged as specific barriers for medication label users. This study highlights the initial willingness and sustained enthusiasm for using DATs among respondents. DATs were perceived as useful tools, aiding individuals with treatment continuation through daily reminders and fostering stronger connections with HCPs. Nevertheless, issues such as poor network connectivity and the need for access to a working cellphone posed difficulties in usage. Findings from this study suggest the potential for improvements in the technologies and indicate that a thorough assessment of people’s life conditions and needs prior to treatment initiations is important to determine the suitability of providing a DAT.

In sub-Saharan Africa, non-communicable diseases (NCDs) are testing already-stretched health systems. In Eswatini, until 2020, care for hypertension and diabetes was only provided in tertiary health facilities. During the first phase of the COVID-19 pandemic, the Eswatini Ministry of Health expedited NCD care decentralization to primary facilities. Drawing on in-depth interviews, observations and a questionnaire-based survey, this article examines experiences of expedited NCD care decentralization. Respondents included people living with diabetes and/or hypertension (17 interviews and 248 survey respondents), nurses at primary care facilities (31 interviews) and programme managers (5 interviews). The interviews and observations indicated that the process of decentralization was initially uneven, blurred by the previous delivery of health promotion, incomplete training and the staggered nature of implementation. Reports of shortages in medicines and equipment were common and programme managers and health staff shared concerns about this undermining relationships with clients (and impacting treatment seeking). In primary facilities, NCD services were often delivered in an integrated way with consideration for co-morbidities. NCD clients expressed a strong preference for and overwhelmingly positive opinion of the decentralized services. Nonetheless, the identified challenges to delivering person-centred NCD care highlight the need to examine alternative service delivery models.

In Thailand, since the 2000s, malaria post (MP) workers have been tasked with promptly detecting and treating all malaria cases to prevent onward transmission in the communities. Expanding their roles to provide health services beyond malaria has been proposed as a strategy to sustain their activities until elimination is reached. This article examines the perspectives of stakeholders on community-based malaria care to assess prospects for expanding the role of MPs. The study incorporated in-depth interviews (IDIs) and focus group discussions (FGDs). In forested communities and local health facilities in northeast Thailand bordering Lao PDR and Cambodia, where malaria transmission is low, IDIs were conducted with 13 MPs and 23 community members. An additional 14 policymakers and implementers across the health sector in Thailand were interviewed. The respondents highlighted how in these border areas population groups most at risk of malaria, namely forest goers and migrants, are reluctant to visit public health facilities. In these areas, MP workers are well integrated in their communities and remain relevant although the communities no longer see malaria as spriority. Common conditions such as dengue, diabetes, insect bites, diarrhea, mental illness and substance abuse, were identified as local health concerns needing potential add-on services from MP workers. Although challenges in terms of training, supervision, and financing were raised, opportunities included additional funds from local administrative offices to maintain and integrate malaria activities with other health programmes. Changes to the roles of MPs should be adapted to changing local needs, some of which were identified in this study, should avoid duplication and potential tensions with other local health programmes, and need to build on the capacity of the community and primary care system. These enabling factors are worthy of consideration by any malaria programmes looking into maintaining their village malaria workers in the Greater Mekong Subregion.