title: Understanding and improving access to prompt and effective malaria treatment and care in rural Tanzania: the ACCESS Programme.
abstract: 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.
authors.affiliation: Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland. manuel.hetzel@unibas.ch
authors.forename: Manuel W
authors.initials: MW
authors.lastname: Hetzel
authors.forename: Nelly
authors.initials: N
authors.lastname: Iteba
authors.forename: Ahmed
authors.initials: A
authors.lastname: Makemba
authors.forename: Christopher
authors.initials: C
authors.lastname: Mshana
authors.forename: Christian
authors.initials: C
authors.lastname: Lengeler
authors.forename: Brigit
authors.initials: B
authors.lastname: Obrist
authors.forename: Alexander
authors.initials: A
authors.lastname: Schulze
authors.forename: Rose
authors.initials: R
authors.lastname: Nathan
authors.forename: Angel
authors.initials: A
authors.lastname: Dillip
authors.forename: Sandra
authors.initials: S
authors.lastname: Alba
authors.forename: Iddy
authors.initials: I
authors.lastname: Mayumana
authors.forename: Rashid A
authors.initials: RA
authors.lastname: Khatib
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Njau
authors.forename: Hassan
authors.initials: H
authors.lastname: Mshinda
mesh_terms: 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
chemical_list: D000962:Antimalarials