1. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 1 |1 | Dr Wilson Were CAH/CIS Community Case Management of Malaria Child Adolescent Health and Development RBM Case Management Working Group Meeting, Geneva, 8-9 th July

2. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 2 |2 | 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

3. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 3 |3 | The Global Burden of Malaria MOST DEATHS OCCUR AT HOME; WHAT CAN WE DO AT HOME TO STOP THE SCOURGE? GLOBALLY 300 MILLION MALARIA CASES A YEAR 1 MILLION DEATHS, 90% IN CHILDREN IN AFRICA

4. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 4 |4 | Global Status of ACT Implementation

5. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 5 |5 | ACT Scale up 2001-2009 Millions of ACT treatment courses Cumulative number of countries Forecast 6-24 months from adoption to implementation

6. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 6 |6 | 1) Challenges of Access to Effective Treatment 1) Challenges of Access to Effective Treatment 1.Most malaria treatments:- l > 30 -70% occur outside the public health facilities l are self-medications, in sub-optimal dosage and quality l are out-of-pocket expenses in unregulated informal private sector l cost poor people a high proportion of family income 2.50 -70% childhood deaths occur without contact with public health services 3.90% 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.

7. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 7 |7 | 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.

8. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 8 |8 | 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". Note: HMM should be designed as an integral part of the overall malaria case management strategy. Photos: TDR HMM research team

9. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 9 |9 | 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.

10. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 10 | 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

11. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 11 | Under-five overall mortality reduced by 40% (Kidane, 2000) What is the Evidence for Community Based Management of Malaria? Reduction in severe disease by 25-50% (Pagnoni et al 1997;Sirima et al., 2003) 1.Studies have shown good outcomes and impact

12. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 12 | Feasibility and Acceptability of Using ACTs: Ghana Experience… 2. Prompt care seeking for children with fever 1. Community acceptability of CDDs Source TDR/IR: Garshong, B et al 2007, Feasibility and acceptability of using ACTs for HMM in Ghana.

13. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 13 | Tigray Community ACT Project: Quarterly Health Centre & Hospital Inpatient Cases Impact Report of ACT Deployment at community level: Tigray Regional Health Bureau, Ethiopia, May 2008

14. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 14 | Evidence on Programme Level or Large Scale Implementation

15. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 15 | ACT Implementation Status in Africa WHO/GMP, June 2008 Countries which need ACT policy Countries which adopted ACT policy Countries Deploying ACTs Countries with ACTs at Community level Countries without malaria

16. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 16 | HMM country experience: Cambodia Yeung S et al, Access to ACTs in remote Cambodia,7:96 Malaria Journal 2008

17. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 17 | HMM country experience: Rwanda USAID, BASICS & MSH external evaluation report of HMM, PNLP Rwanda, 2007

18. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 18 | Rwanda Launches ACTs for HMM and use in private sector Increasing Access AMD 25 th April 2007

19. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 19 | What Partners need to Scale Up HMM implementation Setting up community systems- provider selection, training material development and training Setting up community referral systems and quality of care at health facilities. Record keeping and reporting tools. Quality assurance, supervision and monitoring community activities. Motivation and retention of the community based providers. Photos: TDR HMM research team

20. RBM Case Management Working Group Meeting, Geneva 8-9 th July 2009 20 | WHO Publications http://www.who.int/malaria/homemanagementtechnicalreports.html