Modelling health systems barriers to successful malaria management

Bhargavi Rao,David Schellenberg,Azra Ghani

doi:10.1186/1475-2875-11-s1-p126

Abstract

Background The success of national malaria control strategies is increasingly recognised to be limited by the capacity of the health system to deliver interventions at the required levels of coverage and quality [1]. It is critical to better understand how to deliver a proven intervention, such as Artemisinin Combination therapies (ACTs), most effectively through an existing system, and where the barriers are to achieving its predicted potential. Few models address the delivery of case management: the Piot model [2] or the “community effectiveness framework” [3] has been used to describe how a cascade of interacting health-systems barriers may sequentially reduce the effectiveness of treatment interventions. [4,5] However the end-estimate of correct treatment is lower than estimates from health facility surveys. [1,4-12] We investigated whether an alternative decision-tree approach may more closely estimate rates of appropriate treatment for malaria and also nonmalarial febrile illness (NMFI).

Highlights

The success of national malaria control strategies is increasingly recognised to be limited by the capacity of the health system to deliver interventions at the required levels of coverage and quality [1]
Scenarios of perfect case management steps all improved correct fever management using both models, except in the case of perfect Artemisinin Combination therapies (ACTs) stock; a decision tree approach predicted a 12% reduction in correct management of all cases compared with a 63% increase with the community effectiveness approach
Using the decision-tree model, increases in availability and rapid diagnostic tests (RDTs) improved overall management of fever upto 65% of all attendees, and reduced overtreatment of nonmalarial febrile illness (NMFI) with unnecessary antimalarials by over 35%, but did not substantially improve appropriate treatment rates of malaria cases

Summary

Introduction

The success of national malaria control strategies is increasingly recognised to be limited by the capacity of the health system to deliver interventions at the required levels of coverage and quality [1]. It is critical to better understand how to deliver a proven intervention, such as Artemisinin Combination therapies (ACTs), most effectively through an existing system, and where the barriers are to achieving its predicted potential. Few models address the delivery of case management: the Piot model [2] or the “community effectiveness framework” [3] has been used to describe how a cascade of interacting health-systems barriers may sequentially reduce the effectiveness of treatment interventions. [4,5] the end-estimate of correct treatment is lower than estimates from health facility surveys.

Methods

Results

Conclusion