Putting malaria treatment in the hands of communities

December 2013

A project run by the WHO Malaria Programme with a grant from the Government of Canada seeks to reduce deaths in children under 5 years of age living in remote rural areas.

The idea is to build capacity and equip community volunteers to recognize, diagnose and treat malaria, diarrhoea and pneumonia - the 3 top childhood killers. Between 2013 and 2015, more than 7500 community health workers living in a thousand villages across 5 countries in sub-Saharan Africa will be trained to care for 1.2 million children.

"80% of [child] deaths are precipitated by 3 diseases - malaria, pneumonia and diarrhoea. This is senseless, because we have excellent tools to diagnose and treat all of them.”

Dr Bacary Sambou, Technical Officer, WHO Democratic Republic of Congo office

“Too many young children are dying in rural, remote parts of this country, and 80% of those deaths are precipitated by 3 diseases - malaria, pneumonia and diarrhoea. This is senseless, because we have excellent tools to diagnose and treat all of them,” says Dr Bacary Sambou, a technical officer in the WHO Country Office of the Democratic Republic of the Congo (DRC) office. “It makes me angry and sad. But we are about to make a big change, by reaching more children with diagnosis and treatment, right where they live.”

The Rapid Access Expansion Programme

Dr Sambou directs a programme called the Rapid Access Expansion Programme – RAcE 2015 for short – in the DRC. The programme, run by WHO with a grant from the Government of Canada, covers 4 African countries in addition to DRC: Malawi, Mozambique, Niger and Nigeria. All levels of WHO, including headquarters staff in the Global Malaria Programme, the Regional Office for Africa, inter-country support teams and WHO country offices are involved in the project. All 5 countries share a challenge: they have many remote villages located far from the closest health station – sometimes as much as 50 km. This kind of distance can make it impossible for parents to get help during the critical first hours after malaria strikes a young child, when prompt treatment would prevent disabling complications or death.

A village leader welcomes a woman selected as a community vulunteer.

The programme’s objective is to select community volunteers living in remote villages and train them to identify and treat 3 diseases. They are being trained to recognize the symptoms of malaria in children under the age of 5 years, diagnose with a rapid test and treat affected children with an artemisinin-based combination therapy, a highly effective and safe antimalarial treatment. The community volunteers are also being trained to treat diarrhoea with oral rehydration salts plus zinc; and how to recognize pneumonia and treat it with the antibiotic amoxicillin. The programme provides all the tests, medication and storage equipment they need.

Areas with high child malaria deaths selected

The project is ambitious: Over a period of 4 years, some 7500 community health workers living in a thousand villages across the 5 countries will be trained and, when the programme reaches scale, will be able to care for 1.2 million children. In the DRC, the project is being carried out in the Tanganyika health district of Katanga, an area in the country’s south-east that is home mainly to subsistence farmers and forest-dwelling autochthonous communities. In Tanganyika some 1500 community volunteers will serve a population of 150 000 children aged 2 to 59 months each year.

“This region was selected because we have a high number of cases malaria here, and the most recent studies by our organization have shown there is a very high mortality rate from the disease among its children,” explains Dr Pascal Ngoy, Health Director of the International Rescue Committee, DRC. His organization has been selected to provide administrative and technical supervision of the project, working closely with WHO and the Ministry of Health.

A forest-dwelling woman stands in front of her hut in Katanga, Democratic Republic of Congo.
WHO/Franco Pagnoni

The first step has been to sensitize the communities themselves to the new set-up by teaming up with churches, schools and community groups, which will lead to word-of-mouth awareness. Following their training, the volunteers will set up practice in their homes and also reach out actively to villagers and to autochthonous communities living in nearby forests. The national health system will provide support. District nurses will supervise community health workers and back up their efforts, for example, by handling referrals. Other district health personnel, including the Head of District Health Management Team, will be involved.

In December 2013 staff from WHO and the DRC Ministry of Health met during 4 days in Kinshasa to reach consensus on how to integrate malaria, diarrhoea and pneumonia services – while adhering to WHO standards and respecting community needs. Overall, it is expected that the RAcE 2015 programme will generate evidence for new WHO recommendations on how to mobilize a community health workforce to reduce deaths from childhood illnesses, using malaria as an entry point.