Development of human resources in malaria microscopy during and after the malaria elimination phase in China

Introduction Under the context of sustained low malaria incidence in China, maintaining an adequate number of qualified microscopists remains a critical component to ensure and sustain the success of malaria elimination. Therefore, this paper presents the efforts made, achievements attained, and future prospects regarding the development of human resources in malaria microscopy during and after the malaria elimination phase in China. Methods To confirm the competence of malaria microscopists at the national level, six rounds of the External Competence Assessment of Malaria Microscopists (ECAMM) courses, developed and administered by the World Health Organization (WHO), were conducted in China from 2017 to 2024. The number and frequency of certified microscopists participating in the WHO-ECAMM courses were retrospectively reviewed. To support the establishment of core groups at sub-national levels, a model course for the National Competency Assessment of Malaria Microscopists (NCAMM) was revised in accordance with WHO guidelines and implemented from 2019 to 2024. The course schedule and scoring system were detailed, including improvements in evaluation metrics. Participants' competency levels (A, B, C, and D) were determined based on standardized criteria. The relationship between participants' competency levels and their age or years of experience in malaria microscopy, as well as variations in their scores, was analyzed. To guide the future qualification of microscopists in peripheral areas, a proposed framework for human resource development of malaria microscopists was presented, based on the current malaria situation in China. Results A total of 64 microscopists participated in the six WHO-ECAMM courses. The average age of these participants is 41.1 years. Among them, 29 individuals certified at Level 1 and 17 individuals at Level 2 covered NIPD as well as 29 out of 31 provinces. In addition, among the 72 participants who attended the six NCAMM courses, 10 were certified at Level A (the highest level), and 33 at Level B. Factors such as age, place of employment, educational background, and gender did not show a significant impact on participants' competence in malaria microscopy (n = 72; ρ = 0.2, P > 0.05). However, the number of years of experience in malaria microscopy demonstrated a moderate positive correlation with competence levels(n = 72; ρ = 0.4, P < 0.01). Notably, scores for species identification (SI) improved significantly (Z = −7.3, P < 0.01). The proposed structure for human resource development of malaria microscopists includes three core groups operating at the national, sub-national (provincial), and sub-provincial levels. This structure recommends the application of four models for assessing microscopists’ competence. Discussion and Conclusion Based on six WHO-ECAMM courses, the national core group of malaria microscopists was re-affirmed. The NCAMM courses conducted in China have demonstrated sufficient effectiveness as both an evaluation system and a refresher training model. They are expected to be widely implemented at both national and subnational levels to support the development of human resources in malaria microscopy. The predefined structure for human resource development of malaria microscopists provides a systematic framework for assessing and defining the competencies of microscopists in peripheral areas.