In Sierra Leone 65 percent of deaths in under-five children are caused by malaria, with people often turning to ineffective traditional remedies or waiting too long to seek treatment. Médecins Sans Frontières is working to tackle these odds with a programme in which community members test and treat each other.
In Bo and Pujehun districts, MSF-trained community malaria volunteers administer user-friendly rapid diagnostic tests (RDTs) to children or pregnant women suffering fever, and give medicine to those who test positive for malaria. MSF aims to test and treat people within 24 hours, at no cost.
A September 2008 MSF report on malaria concluded providing free malaria testing and treatment has dramatically increased the number of people seeking care and surviving.
So far 44,182 people have been tested since the programme began in 2008, 74 percent of whom were confirmed to have malaria, says MSF assistant medical coordinator in Bo, Patrick Tyre.
“Unlike other malaria reduction programmes that have limited coverage and charge fees for treatment, [in this one] volunteers are trained to reach all areas, and testing and treatment is free,” said MSF’s Tyre.
Joseph Timmy, one of 140 volunteers in Gondama, 11km from Bo, told IRIN: “We are not health professionals, but we were intensively trained by MSF to fight malaria in our local communities where people still hold on to traditional and superstitious beliefs.” Before the programme began most people would turn to traditional healers ior fake doctors, known as ”pepper doctors”.
Malaria contributes to Sierra Leone’s high child mortality rates, which at 262 children out of 1,000 live births dying before they reach age five, are the world’s worst.
Before the programme got underway most sufferers would go to a local herbalist, a “pepper doctor” or a black-market drug seller to treat fevers, Timmy said. Just 12 percent of children suspected of having malaria received effective treatment from their local health services, according to MSF’s Sierra Leone head, Johan Mast. Villagers told IRIN most of them could not afford the transport or consultation fees.
While it is too early to determine the full impact of the programme, Mast says malaria-related consultations in Gondama hospital have gone down since the project started.
Results from similar projects elsewhere in West Africa have been positive: in Mali free community-based malaria care, backed up by free health-centre care, led to three times more malaria cases detected and treated than in the year prior to the programme, according to MSF.
The introduction of RTDs– though a flawed tool – have helped lower Senegal’s malaria infection and death rates by 74 percent.
Aminata Kanneh, mother to two-year-old Borbor, told IRIN she had almost given up hope when the local “pepper doctor” could not cure her son. She eventually turned to a community volunteer who referred the boy – an advanced case – to the Gondama hospital. “I had almost given up hope but now I have seen great improvement in the health of my son,” Kanneh said.
RTDs have also reduced the proportion of non-malaria fevers from being misdiagnosed. “If the RDT result is…negative we will do further investigation to determine the underlying cause of the fever,” Tyre assured IRIN.
But many question if programmes such as this – which are expensive to run – are sustainable.
MSF, traditionally an emergency-response-only NGO, set up operations in Sierra Leone in 1995 during the war, and remained because Sierra Leone’s “extreme health gaps” fit an emergency scenario, said Mast. But MSF cannot stay forever; staff are already planning a handover to the government, he said.
The government has low capacity when it comes to health sector financing, said a government health official, who worries it will be impossible to sustain such quality care.
Pregnant and breastfeeding women and under-fives are exempt from paying health care fees, according to a 2005 health care policy, but the policy has never been enforceable, partly because state medical workers are paid so poorly that they charge fees anyway. A January 2006 MSF study of healthcare access in Bo, Bombali, Kambia and Tonkolili districts revealed only 3.5 percent of the above groups had received free healthcare in 2005. NGO health experts, such as Save the Children’s head of health and HIV, Simon Wright, say with the right planning, sustaining care while reducing costs is feasible.
“Governments can and should develop financing plans to provide such treatments free [to patients], especially to reduce child mortality. With planning, mobilising donor money and national resources, long-term predictable funding is achievable so that user fees can be removed.