Understanding and Improving Access to Prompt and Effective Malaria Treatment and Care in Rural Tanzania: the ACCESS Programme

This research  project on malaria interventions was designed to evaluate the ACCESS programme, a programme intending to understand and improve access to prompt and effective malaria treatment and care in a rural Tanzanian setting. The programme's strategy, as stated here, "is based on a set of integrated interventions, including social marketing for improved care seeking at the community level as well as strengthening of quality of care at health facilities. This is complemented by a project that aims to improve the performance of drug stores. The interventions are accompanied by a comprehensive set of monitoring and evaluation activities measuring the programme's performance and (health) impact....With this approach, ACCESS aims to contribute to the development of a more comprehensive access framework and to inform and support public health professionals and policy-makers in the delivery of improved health services."

The document describes the programme and its baseline study in preparation for extended monitoring and evaluation (M&E). The baseline in preparation for the larger project found uneven coverage of treatment and access to medications for malaria in both the intervention and comparisons sites.

The research was designed to look at various intervention areas. The communication-related intervention area uses behaviour change campaigns, including:

1. Sensitising community leaders to gain their support and collaboration;
2. Social marketing of information to mothers and caregivers of children under 5 years old and pregnant women. "Messages stress the importance of prompt recognition of malaria symptoms and immediate correct treatment with the recommended first-line drug... Health facilities and licensed drug stores and Accredited Drug Dispensing Outlets [ADDO...] are promoted as sources of proper treatment and advice. Prevention methods, such as the use of [insecticide-treated nets] ITNs and Intermittent Preventive Treatment in pregnancy (IPTp) are also advocated. Finally, one set of messages highlights high fever with convulsions (locally known as "degedege") as a sign of severe malaria that can and should be treated at health facilities (rather than by traditional healers)...";
3. Efficient and cost-effective communication channels and materials to disseminate behaviour change messages include road shows on the platform of a truck used as a mobile stage for a show. The show includes: a dance competition; comedies and role plays of "appropriate treatment seeking and consequences of delaying treatment"; a public lecture on malaria transmission, signs and symptoms, and dangers of malaria; a cinema show featuring stories on prompt and effective malaria treatment; and question-and-answer sessions with promotional stickers, leaflets, and T-shirts, as well as a permanent billboard presence on main roads and a poster campaign;
4. Special campaigns in Mother and Child Health (MCH) clinics;
5. A study of the "shamba component" - the farming period when people live away from the village, a period being studied as a heightened risk period.

Click here to read the full text of this document.

Editor's note, August 22 2008:

To date, the following articles have been published as a result of the research summarised above:

• Hetzel MW, Obrist B, Lengeler C, Msechu JJ, Nathan R, Dillip A, Makemba AM, Mshana C, Schulze A, and Mshinda H (2008) Obstacles to prompt and effective malaria treatment lead to low community-coverage in two rural districts of Tanzania. BMC Public Health, 8: 317.
• Hetzel MW, Dillip A, Lengeler C, Obrist B, Msechu JJ, Makemba A, Mshana C, Schulze A, Mshinda H (2008) Malaria treatment in the retail sector: drug sellers’ knowledge and practices in rural Tanzania. BMC Public Health, 8: 157.

• Hetzel MW, Alba S, Fankhauser M, Mayumana I, Lengeler C, Obrist B, Nathan R, Makemba AM, Mshana C, Schulze A, Mshinda H (2008) Malaria risk and access to prevention and treatment in the paddies of the Kilombero Valley, Tanzania. Malaria Journal 7: 7.

• Obrist B, Iteba N, Lengeler C, Makemba A, Mshana C, Mshinda H, Nathan R, Alba S, Dillip A, *Hetzel MW*, Mayumana I, Schulze A (2007) Access to Health Care in Contexts of Livelihood Insecurity: A Framework for Analysis and Action. PLoS Medicine/ 4(10): e308.

• Mayumana I, Kessy F, Comoro CJ, Obrist B (2007) Understanding resilience pathways in malaria case management in the light of rural livelihood: The case of the Kilombero District, Tanzania. [PDF] Consortium for Research on Equitable Health Systems (CREHS) Exchange Newsletter 2: 2-3.
• Hetzel MW, Msechu JJ, Goodman C, Lengeler C, Obrist B, Kachur SP, Makemba AM, Nathan R, Schulze A, Mshinda H. (2006) Decreased availability of antimalarials in the private sector following the policy change from chloroquine to sulphadoxine-pyrimethamine in the Kilombero Valley, Tanzania. Malaria Journal 5: 109.