Lacking access to prompt and effective treatment is a major obstacle to effective malaria control in many endemic settings. Increased resistance to conventional drugs such as chloroquine or sulphadoxine-pyrimethamine forced the global community to think about alternative treatment options and today, highly efficacious artemisinin-based combinations (ACT) are advocated for endemic countries. Initiatives and funding to find new antimalarial agents are more numerous today than some 10 years ago. Nevertheless, a study carried out by the STI and the Ifakara Health Research and Development Centre (IHRDC) in Tanzania showed that as little as 10-20% of people receive appropriate and timely treatment for malaria. This, however, does not only depend on the availability of an efficacious drug in the country. For patients to be able to access effective treatment, aspects of availability close to their home, affordability, accessibility, acceptability, quality of care and the vulnerability-context of the households need to be taken into account.
To investigate obstacles and improve access to malaria treatment, the STI and IHRDC are implementing the ACCESS Programme in two rural districts in Tanzania. The central approaches of the programme are to increase community awareness of malaria and its appropriate treatment through a social-marketing campaign, while simultaneously improving coverage and quality of case-management in the public and private sectors.
Since 2004, the programme has reached out to 114 villages, sensitized over 5000 local leaders, and trained 140 health workers. 40% of the population over 14 years have so far been in contact with the social marketing campaign.
The monitoring and evaluation component of the programme found evidence that illness perception and understanding may nowadays be less prominent obstacles to treatment-seeking in the area, since local and biomedical concepts of malaria appear to overlap considerably. Health-facility attendance is very common for malaria in children. However, frequent non-availability of drugs in health facilities may force many patients to buy more expensive drugs in private drug stores. On the other hand, even with good availability, the quality of advice given by clinicians will determine patients’ adherence to the dosage regimen and finally treatment outcome. The results underline the need for an integrated approach with several interventions, delivered through a strengthened health system. The ACCESS Programme approach aims to contribute to the discussion on how to target limited resources most efficiently in order to improve equitable access to prompt and effective malaria treatment.
Manuel Hetzel
