Transcript Improving HMIS Thru Case Management

Community Case
Management of Malaria
RBM Case Management Working Group Meeting, Geneva, 8-9th July
Dr Wilson Were
CAH/CIS
Child Adolescent Health
Geneva 8-9th July 2009
1 |RBM Case Management Working Group Meeting,
and Development
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
2 |RBM Case Management Working Group Meeting, Geneva 8-9th July 2009
The Global Burden of Malaria
GLOBALLY 300 MILLION MALARIA CASES A YEAR
MOST DEATHS OCCUR AT HOME;
WHAT CAN WE DO AT HOME TO STOP THE SCOURGE?
3 |RBM Case Management Working Group Meeting, Geneva 8-9th July 2009
Global Status of ACT Implementation
Countries which adopted ACT
Countries Deploying ACTs
Countries Deploying ACTs at Community
Countries which need ACT policy
4 |RBM Case Management Working Group Meeting, Geneva 8-9th July 2009
Update:
June 2008
160
140
120
100
80
60
40
20
0
6-24 months from adoption to implementation
Forecast
90
160
80
70
130
60
97
50
82.7
40
30
20
31.3
0.5
0.6
2.1
10
5
0
2001
2002
ACT procured
2003
2004
2005
2006
No countries: ACT 1st line
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2007
2008
2009
No countries deploying
Cumulative number of countries
180
Millions of ACT treatment courses
ACT Scale up 2001-2009
1) Challenges of Access to
Effective Treatment
1. Most malaria treatments:
> 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
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.
6 |RBM Case Management Working Group Meeting, Geneva 8-9th July 2009
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.
7 |RBM Case Management Working Group Meeting, Geneva 8-9th July 2009
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.
8 |RBM Case Management Working Group Meeting, Geneva 8-9th July 2009
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
10 |RBM Case Management Working Group Meeting, Geneva 8-9th July 2009
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 1997;Sirima et al., 2003)
All-cause mortality, children under-five, by intervention
and no intervention, Ethiopia
Proportion of children progressing to severe malaria, treated
with pre-packs and not with pre-packs, Burkina Faso
15
percentage
mortality/1000
60
40
20
10
5
0
0
Intervention
No intervention
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pre-pack
not pre-packs
Feasibility and Acceptability of
Using ACTs: Ghana Experience…
1. Community acceptability of CDDs
2. Prompt care seeking for children with fever
P ro mpt treatment-Fever o nset and seeking care- rural
57.3
60
50
40
28
30
20
14.6
10
0
Same day
Next day
More t han 2 days
Source TDR/IR: Garshong, B et al 2007, Feasibility and acceptability of using ACTs for HMM in Ghana.
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Tigray Community ACT Project:
Quarterly Health Centre & Hospital Inpatient Cases
Total Inpatient
Mal. Inpatient
% Mal. Inpatient
3000
100
90
80
2500
2000
Impact
1500
1000
500
M
JJ 05
A
S -0
O 5
D NJF 0
- 5
M 05 0
A 6
M
JJ 06
A
S -0
O 6
D NJF 0
- 6
M 06 0
A 7
M
JJ 07
A
-0
7
A
M
M
A
M
JJ 05
A
S -0
O 5
D NJF 0
- 5
M 05 0
A 6
M
JJ 06
A
S -0
O 6
D NJF 0
- 6
M 06 0
A 7
M
JJ 07
A
-0
7
0
70
60
50
40
30
20
10
0
Control
Intervention
Report of ACT Deployment at community level: Tigray Regional Health Bureau, Ethiopia, May 2008
13 |RBM Case Management Working Group Meeting, Geneva 8-9th July 2009
Evidence on Programme Level or
Large Scale Implementation
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ACT Implementation Status in Africa
Countries which adopted ACT policy
Countries Deploying ACTs
Countries with ACTs at Community level
Countries which need ACT policy
Countries without malaria
WHO/GMP, June 2008
15 |RBM Case Management Working Group Meeting, Geneva 8-9th July 2009
HMM country experience: Cambodia
100
90
80
70
%
60
Non-Intervention
50
Out-reach Areas
40
Village Malaria Workers
30
20
10
0
Community
Effectivenes
Confirmed Dx
Yeung S et al, Access to ACTs in remote Cambodia,7:96 Malaria Journal 2008
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HMM country experience: Rwanda
USAID, BASICS & MSH external evaluation report of HMM, PNLP Rwanda, 2007
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Increasing Access
Rwanda Launches ACTs for
HMM and use in private sector
AMD 25th April 2007
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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
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WHO Publications
http://www.who.int/malaria/homemanagementtechnicalreports.html
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