Lessons learned in home management of malaria : implementation research in four African countries

Overview

Improving child survival required investment in approaches that empower the rural poor, giving them the tools to recognize the signs and symptoms of malaria and to take prompt and appropriate action – thereby preventing death. Presumptive treatment of malaria has remained the one affordable option for ensuring prompt and effective treatment at community level. Over the past several years, WHO/TDR has funded several studies on home management of malaria (HMM) with the intention of developing a strategy to increase access to effective antimalarial treatment close to the home, thereby addressing the failure of the formal health system in many endemic countries to deliver effective treatment promptly to those in need.

This guide focuses in particular on four countries – Burkina Faso, Ghana, Nigeria and Uganda – where country teams have completed communitybased studies on HMM, assessing its operational feasibility, acceptability and (in Burkina Faso) impact on severe disease. All country teams have submitted final 08 BURKINA FASO GHANA NIGERIA UGANDA reports to TDR, and some have published their findings in scientific journals and made presentations at national and international level. Summaries of the studies are given in Annexes 1–4. These reports and publications have focused mainly on results, without documenting in depth the implementation process. Now that many countries are moving towards implementation of large-scale HMM programmes, there is a need to document the large body of experience that has been gathered during the work already done and to make this information available to malaria control programmes in endemic countries.

The document is a comparative analysis and documentation of the processes that have enabled teams to implement HMM in various settings. It complements other WHO publications on the subject (WHO, 2004, 2005) in that it focuses on the processes, challenges, and lessons learnt in implementing the HMM strategy in the four African countries. It offers an insight for all those who may be involved in implementing HMM strategies, especially malaria control programme officers in endemic African countries. The processes outlined in the document should not be regarded as prescriptive: they may be adapted to suit particular situations.