Many communities lack access to health facilities due to distance or seasonal rains.Â Strategies that ensure residents of these communities get appropriate malaria treatment promptly should be a central part of any country’s national malaria plan. According to WHO the HMM strategic components include –
- Availability of and access to effective, high-quality, prepacked antimalarial medicines at the community level.
- Training of community-based service providers to ensure they have the necessary skills and knowledge to manage febrile illness or malaria.
- An effective communication strategy to ensure correct early care seeking behaviour, and appropriate and effective home care of a febrile illness or malaria.
- A good mechanism for supervision and monitoring of the community activities.
Elmardi and colleagues describe their efforts to provide home management of malaria in less accessible areas of Sudan, and not only include provision of artemisinin-based combination therapy (ACTs) at the village level but also the training of community volunteers to use rapid diagnostic tests (RDTs).
Research sponsored by WHO/TDR has shown that community volunteers have had an important impact on coverage of appropriate ACT treatment of malaria:
- 77% where there were village volunteers
- 33% through health facilities alone
The Sudan experiment in 20 villages provides some important management lessons. All but one volunteer followed treatment guidelines.Â On the other hand only 14 relied on the RDT results when treating, and thus provided ACTs for other febrile conditions.
The importance of supervision to reinforce training was underscored here. Supervision is important even for regular health workers in clinics, let along volunteers in villages, but we know that many health systems do not have or utilize the necessary logistics to carry out supervision on a regular basis. The same rains that make it difficult for villagers to reach clinics may make it difficult for health workers to make supervisory visits.
The community volunteers in Sudan were not much different from health workers in clinics in believing that their judgment is better than RDTs.Â This is unfortunate.Â The community volunteers were also exposed to pressure from clients who were reluctant to accept that they did not have malaria when they made their complaints.
As mentioned by WHO, home management of malaria needs an effective communication strategy.Â Community members have their own perceptions of malaria. Communication must be grounded in an understanding of what the community believes and expects.Â Only then will local volunteers be able to convince people on the accuracy of RDTs.
Of course it would help greatly if village volunteers had medicines to treat other common ailments so clients with these complaints will not have to go away empty handed.