Swiss TPH

Access to effective malaria treatment in Tanzania and its impact (ACCESS)

With the ACCESS programme we aim to understand and improve access to prompt and effective treatment and care in rural Tanzania, with a focus on malaria treatment. It is being implemented in Kilombero and Ulanga districts in a highly malaria endemic rural area. The ACCESS strategy is based on a set of integrated interventions that include (i) social marketing for improved care seeking at the community level, (ii) strengthening the quality of case management in health facilities and (iii) strengthening the commercial drug retail sector. The interventions are accompanied by a comprehensive set of monitoring and evaluation activities embedded in a demographic surveillance system, as well as in the nearby semi-urban centre of Ifakara.

The investigation of treatment seeking and illness perception revealed a better overlap of local and biomedical illness concepts than reported in earlier studies from the same area. This likely reflects the intensive social marketing and health education campaigns introduced during the past decade. However, an estimation of community effectiveness revealed that only 22.5% of the children and 10.5% of the adults received prompt and appropriate antimalarial treatment, despite high health facility usage rates. The quality of case management was not satisfactory. As an alternative distribution channel for ACTs, upgraded drugstores may be the most realistic option, and this is currently being investigated in two pilot programmes in Tanzania.

The insights gained in the ACCESS studies helped to design a generic access framework embedded into the context of livelihood insecurity. This framework links social science and public health research with broader approaches to poverty alleviation. Apart from offering an analytical frame for further scientific research, it suggests access policies and interventions that reach beyond health services.
Go to picture gallery