Understanding and improving access to prompt and effective malaria treatment and care in rural Tanzania: the ACCESS Programme.
BACKGROUND
Prompt access to effective treatment is central in the fight against malaria. However, a variety of interlinked factors at household and health system level influence access to timely and appropriate treatment and care. Furthermore, access may be influenced by global and national health policies. As a consequence, many malaria episodes in highly endemic countries are not treated appropriately.


METHODS
The ACCESS Programme aims at understanding and improving access to prompt and effective malaria treatment and care in a rural Tanzanian setting. The programme's strategy is based on a set of integrated interventions, including social marketing for improved care seeking at community level as well as strengthening of quality of care at health facilities. This is complemented by a project that aims to improve the performance of drug stores. The interventions are accompanied by a comprehensive set of monitoring and evaluation activities measuring the programme's performance and (health) impact. Baseline data demonstrated heterogeneity in the availability of malaria treatment, unavailability of medicines and treatment providers in certain areas as well as quality problems with regard to drugs and services.


CONCLUSIONS
The ACCESS Programme is a combination of multiple complementary interventions with a strong evaluation component. With this approach, ACCESS aims to contribute to the development of a more comprehensive access framework and to inform and support public health professionals and policy-makers in the delivery of improved health services.
Hetzel
Manuel W
MW
Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland. manuel.hetzel@unibas.ch
Iteba
Nelly
N
Makemba
Ahmed
A
Mshana
Christopher
C
Lengeler
Christian
C
Obrist
Brigit
B
Schulze
Alexander
A
Nathan
Rose
R
Dillip
Angel
A
Alba
Sandra
S
Mayumana
Iddy
I
Khatib
Rashid A
RA
Njau
Joseph D
JD
Mshinda
Hassan
H
D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D002675:Child, Preschool; D005260:Female; D006293:Health Promotion / Q000379:methods; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D008288:Malaria / Q000188:drug therapy*; D008297:Male; D010594:Pharmacies; D011247:Pregnancy; D016730:Program Development; D019035:Rural Health Services / Q000600:supply & distribution*; D012424:Rural Population; D040241:Social Marketing; D013636:Tanzania
D000962:Antimalarials