New tools are said to be the answer to the question of malaria eradication. Even with the not so new tools available – ACTs, RDTs, IRS, LLINs, IPTp, IPTi – progress toward elimination can be made if health workers are trained in their appropriate use. Ssekabira and colleagues found that training improved some aspects of malaria case management such as reduced treatment of people testing negative in the lab, but they also pointed out that there needs to be integrated ‘team based’ training around all these tools in order to achieve success.
In their focus on training for improved malaria case management SSekabira’s group learned that ‘integrated’ means getting all clinical and laboratory staff on board as well as ensuring adequate procurement/supply of drugs, equipment and supplies, supportive supervision and especially adequate human resources to be trained, deliver services and supervise. This is a tall order, but alternative is bleak.
The advent of large scale donor funding of malaria control in the past six or so years began with a focus on malaria commodities. Concern was expressed to achieve coverage targets – 60% in 2005, 80% in 2010 – which was thought to be possible only if enough drugs, supplies and materials were made available to endemic countries.Â In this context, countries were reluctant to ‘waste’ their donor dollars and euros on health systems strengthening, human resource development and operations research.Â SSekabira’s efforts show these seeming peripheral elements actually provide a crucial framework without which all the malaria commodities in the world will really go to waste in storerooms and warehouses.
The use of Rapid Diagnostic Tests (RDTs) provide a simple example of the commodity vs. integrated approach.Â Harvey et al. reported that, “Manufacturerâ€™s instructions like those provided with the RDTs … are insufficient to ensure safe and accurate use by CHWs. However, well-designed instructions plus training can ensure high performance.”
Training resources exist, as for example Jhpiego’s Malaria in Pregnancy Resource Package, which is freely available online. Management Sciences for Health has training tools for the procurement and supply management. Greater use of such tools is needed so that the billions of dollars and euros spent on commodities will actually save lives.