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Open Access Open Badges Research

The amount and value of work time of community medicine distributors in community case management of malaria among children under five years in the Ejisu-Juaben District of Ghana

Peter Agyei-Baffour1*, Kristian S Hansen2, Edmund N L Browne1 and Pascal Magnussen3

Author Affiliations

1 Department of Community Health, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, UPO, PMB, KNUST, Kumasi, Ghana

2 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom

3 DBL-Centre for Health Research and Development, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark

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Malaria Journal 2012, 11:277  doi:10.1186/1475-2875-11-277

Published: 16 August 2012



The contribution of community medicine distributors (CMD) to prompt health service delivery in areas described as “hard-to-reach” is important but the value of their work time remains unknown and thus makes it difficult to design appropriate regular financial incentives to motivate them. This makes CMDs feel their efforts are not recognized. An attempt to estimate the value of 54 CMDs’ work time involved in community case management of malaria (CCMm) in a rural district in Ghana is presented.


Time spent by CMDs on CCMm activities were recorded for a period of 12 months to determine the work-time value. Cost analysis was performed in Microsoft Excel with data from CMD records and at 2007 market price in Ghana.


A CMD spent 4.8 hours, [95% CI: 3.9; 5.3] on all CCMm-related activities per day. The time value of CMD work ranged from GH¢ 2.04 (US$ 2.24) to GH¢ 4.1 [US$ 4.6] per week and GH¢ 19.2 - 86.4 (US$ 21.10-94.95) per month. The gross wage outside CCMm as reported by CMD was GH¢ 58.4 [US$ 64.69] and value of foregone income of GH¢ 86.40 (US$94.95) per month, about 14-times higher than the monthly incentives of GH¢ 6.0 given by the CCMm programme.


The value of work time and the foregone income of CMDs in CCMm are high and yet there are no regular and sustainable incentives provided for them. The results are significant to policy in designing incentives to motivate CMDs in large-scale implementation of CCMm.

Community case management; Value of work time; Community medicine distributors; Malaria in children under five years; Ghana