Project Lead(s): Daudi Simba
In Tanzania, malaria is the leading cause of morbidity and mortality, accounting for about 30% of out-patient visits.
Prompt access to antimalarial medications is at the core of an effective treatment program, requiring appropriate treatment within 24 hours of onset of fever.
In Tanzania, drug shops are the commonest source of anti-malarials but, despite the strategy to upgrade them to Accredited Drug Dispensing Outlets (ADDOs), access for people in rural remote areas where the malaria burden and poverty levels are highest is very low.
This innovative strategy took advantage of the surge in the motorcycle transport business as a leverage to expedite access to effective anti-malarials through the ADDO strategy.
The project aimed to extend the ADDO strategy to rural remote areas not attractive to the private sector because of low purchasing power and scattered population.
Community health workers (CHWs) were recruited in villages located five kilometers or more from a health facility or ADDO, and assisted with loans to purchase motorcycles so that they could provide drugs at a small profit margin.
These motorcycles were used to purchase and transport anti-malarial medications from the distributors in urban areas to remote areas where the medications were sold.
A quasi-experimental study was undertaken in Kilosa district, Morogoro, to assess this approach.
A total of 870 children under five years of age were enrolled in the baseline study: 467 from the intervention area and 403 from a control area. Post-intervention analysis involved 1,186 children under age five: 670 from the intervention area and 516 from the control area.
Access to anti-malarials in the intervention area went from 65.5% of the population having access to 88.1% with access – a 22.6% increase.
The number of children treated increased from 53.4% before intervention to 70.8%.
The impact on the actual number of malaria cases was not measured but it was hypothesized that increased access to anti-malarials would reduce the number of cases.
Information about the project has been published.
Plans are to scale the project to the entire district.
The team also plans to engage the following stakeholders: the Kilosa District Council; the Management Science for Health Center for Pharmaceutical Management, an international organization that has successfully worked in Tanzania to establish and scale up the Accredited Drug Dispensing Outlet (ADDO) program throughout the country; the National Malaria Control Programme (NMCP) / Global Fund for AIDS Tuberculosis and Malaria (GFATM; SAREC, a department of the Swedish International Development Cooperation Agency (SIDA); and the Azania Bank.