Improving HMIS Thru Case Management

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Community Case Management of Malaria
RBM Case Management Working Group Meeting,
Geneva, 8-9th July
Dr Wilson Were CAH/CIS
Child Adolescent Health and Development
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Outline of Presentation

1. Overview of malaria control and access to
   treatment
2. Home management of malaria strategy
3. What it takes to implement HMM
4. Evidence for community based malaria case
   management

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The Global Burden of Malaria
GLOBALLY 300 MILLION MALARIA CASES A YEAR
1 MILLION DEATHS, 90 IN CHILDREN IN AFRICA
MOST DEATHS OCCUR AT HOME WHAT CAN WE DO AT
HOME TO STOP THE SCOURGE?
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Global Status of ACT Implementation
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ACT Scale up 2001-2009
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1) Challenges of Access to Effective Treatment

• Most malaria treatments-
• gt 30 -70 occur outside the public health
  facilities
• are self-medications, in sub-optimal dosage and
  quality
• are out-of-pocket expenses in unregulated
  informal private sector
• cost poor people a high proportion of family
  income
• 50 -70 childhood deaths occur without contact
  with public health services
• 90 deaths are children dying within 48 hrs of
  onset of illness

How to do we achieve global RBM and MDG targets
for access to effective treatment within 24 hrs.
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2) Challenges of Access to Effective Rx Reaching
Malaria Targets Goals

• Roll Back Malaria Partnership
• The aim (of Roll Back Malaria) will be to halve
  malaria-associated mortality by 2010 and again by
  2015
• Millennium Development Goals
• MDG 6 Target 8 Have halted by 2015 and begun to
  reverse the incidence of malaria and other major
  diseases
• MDGs 1, 4 and 5 malaria-related.
• World Health Assembly 2005
• Ensure a reduction in the burden of malaria of at
  least 50 by 2010 and 75 by 2015.

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What is Home Management of Malaria? (HMM)

• Is a strategy to enhance access to appropriate
  and effective malaria treatment in the community
  or home through early recognition of, and prompt
  and appropriate response/treatment to malarial
  illness".

Photos TDR HMM research team
Note HMM should be designed as an integral part
of the overall malaria case management strategy.
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HMM Strategic Components

1. An effective communication strategy for behaviour
   change to enable individuals/caretakers recognize
   malaria illness early and take an appropriate
   action.
2. Equipping the community service providers with
   the necessary skills and knowledge to manage and
   respond to malarial illness.
3. Ensuring availability and access to pre-packed
   antimalarial medicines in the community as close
   to the home as possible.
4. A good mechanism for supervision and monitoring
   of the community activities.

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What is in the Package for HMM?...

• Trained community providers (CHWs, Medicine
  Sellers or Retailers) provided with
• ACTs for treatment of uncomplicated malaria.
• rectal artemisinin suppositories for pre-referral
  treatment of severe malaria.
• rapid diagnostic tests where applicable.
• information, education and communication
  materials.
• simple patient registers and reporting forms.
• medicine storage boxes

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What is the Evidence for Community Based
Management of Malaria?

1. Studies have shown good outcomes and impact

Under-five overall mortality reduced by 40
(Kidane, 2000)
Reduction in severe disease by 25-50 (Pagnoni et
al 1997Sirima et al., 2003)
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Feasibility and Acceptability of Using ACTs
Ghana Experience