| ICIUM2011 MALARIA/TB PANEL DISCUSSION 17 NOVEMBER 2011 DR HODA Y. ATTA Scaling up community management of malaria - challenges and successes in EMRO countries

| LEVELS OF MALARIA CASE MANAGEMENT INTERVENTION  Early Diagnosis, Treatment  Referral  Hospital-based Management

| Challenges of Universal Access to Effective Treatment 1.> % of cases occur outside the public health facilities 2.>50% childhood deaths occur without contact with public health services, 90% deaths occur within 48 hrs of onset of illness 3.Self-medications, in sub-optimal dosage are widespread 4.unregulated informal private sector 5.Marketing artemisinin monotherapy, despite the policy to ban it and national adoption of ACT 6.Availability of fake, poor quality antimalaria medicines in the market

| How to increase access to effective treatment ? Deployment of effective quality antimalarial treatment close to the homes through Community Based Management of Malaria ( CBMM) Engaging the formal and informal private sectors CBMM : Afghanistan in 2010 adopted a National Strategy to enhance access to effective malaria treatment in the community through involving trained volunteers in recognition and treatment of malarial illness

| CBMM Strategic Components market role To be provided by Trained community providers (CHWs, Medicine Sellers or drug Retailers) Recommended 1 st line High quality medicine Pre-packaged With Rapid diagnostic test Well thought drug supply management Ensuring availability of effective quality antimalarial medicines in the community and its rational use

| Information/education for CBMM Develop effective communication strategy for behaviour change for individuals/caretakers to take appropriate action 1.Recognizing malaria symptoms 2.Taking appropriate actions for mild cases 3.Adhering to treatment dosages 4.Assess severity, provide supportive care and referral of sever cases

| Challenges to implement CBMM…. 1.Setting up community referral systems 2.Record keeping and reporting tools 3.Quality assurance of ACT and RDT at the point of care 4.Supervision and monitoring community activities 5.Motivation and retention of the community based providers

| Under-five overall mortality reduced by 40% (Kidane, 2000) CBMM Public Health Gains Reduction in severe disease by 25-50% (Pagnoni et al 1997;Sirima et al., 2003) Studies have shown good outcomes and impact Achievement of MDGs and the global target of 80% access to prompt effective treatment within 24 hours of onset of symptoms will be through provision of quality affordable antimalarial treatment wit diagnosis near-the-home.