Co-creation of community-based innovations to improve access to malaria treatment in conflict-affected regions of Cameroon

Abstract Background: In conflict-affected regions of Cameroon, access to malaria care is severely hindered by displacement, insecurity, and disrupted health systems. In response, we conducted an operational research aimed at breaking barriers to malaria services in conflict-affected communities of Cameroon. Methods: In 2021, a participatory co-creation workshop was held on the 21st and 22nd of October 2021, bringing together stakeholders from government health services, community leaders, internally displaced persons (IDPs), and community health workers (CHWs)to collaboratively design interventions aimed at addressing barriers to accessing malaria treatment. The workshop built on prior formative research conducted in 80 conflict-affected communities across the South West and Littoral regions of Cameroon, which identified context-specific challenges to malaria care. The design process included plenary sessions, group discussions, and facilitated brainstorming, and employed participatory methods to ensure that community voices shaped the development of the interventions. Lessons learned: Three community-based innovations were co-created through this process. Community Health Participatory Approach (CoHPA) was designed to replace the traditional top-down community dialogue structure with a participatory, inclusive model. The Health Voucher System was designed to address financial and geographical barriers, a voucher-based system was introduced to enable access to subsidized malaria services. Vouchers covered malaria testing, treatment, and transport to health facilities. The Supportive Supervision Model was developed to enhance the capacity and motivation of CHWs, who play a crucial role in delivering malaria services in hard-to-reach areas. Discussion: The co-creation process was key to developing contextually relevant and community-owned malaria interventions. It led to three innovations: the CoHPA model, which introduced internal community-led accountability mechanisms; a Health Voucher System that addressed both financial and transport barriers to care; and a supportive supervision model that aimed to improve CHW performance through bi-directional feedback and recognition. While each intervention introduced novel, context-sensitive elements, concerns remain about their scalability, sustainability, and integration into existing health systems without continued support and investment Conclusion: The co-creation process produced three community-driven interventions with potential to break key barriers in access to malaria case management in conflict-affected communities of Cameroon. Pilot implementation and community buy-in for integration into national health systems are essential next steps.