How home-based malaria case management has helped reduce malaria in Rwanda

Caption: Community health workers attend an anti-malaria mobilisation event By Hudson Kuteesa The Ministry of Health has introduced a home -based malaria case management in fighting the disease. A big number of them no longer have to travel from home to go for malaria treatment at a health centre. Actually, 70 percent of the malaria cases in the district are managed from home where community health workers (CHWs) find them for treatment. The CHWs carry out rapid malaria tests, and give treatment to the malaria patients from as young as children above six months to all ages except pregnant mothers who may need more sophisticated medical care. In each village, there are at least three trained health workers. The Ministry of Health gives training to health care providers who train community health workers, equipping them with knowledge of how to diagnose and treat malaria at community level without the patients necessarily going to facility level. The home-based malaria case management is one of the many initiatives the Ministry of Health introduced to fight against malaria in the country by making sure that citizens have enough access to treatment, developed and implemented with partners under the new Malaria Contingency Plan in January 2016 in response to the surge in malaria cases. With up to 45,000 CHWs in the country, Dr. Aimable Mbituyumuremyi, The Head of the Malaria and other Parasitic Infections Unit at the Rwanda Biomedical Center refers to it as “a critical measure” that touches Rwandans in a timely manner that helps to stop the spread of malaria. “Many people with malaria are found where they are, we bring services closer to them: they get tested and treated by the community health workers from their communities. This is a very great measure that is bringing results,” he said. Between November 2016 to March 2017, severe malariacases were reduced by 50% due to this among other interventions implemented under the malaria contingence plan. As part of the contingence plan, MoH started providing free malaria diagnosis and treatment to people who cannot afford it. The beneficiaries fall under the Ubudehe I and Ubudehe II to ensure that all financial barriers are no longer hinder health service delivery. “Deciding to offer services at no cost has increased access and equity of services which has positively impacted lives since November 2016. There are no more malaria deaths of people in category one and two because of lack of services,” said Dr. Mbituyumuremyi in an interview with The New Times. The contingence plan, among other things, involves; extension of Indoor Residual Spraying (IRS) in districts with high malaria incidence where 5 out of 8 were sprayed (Nyagatare, Kirehe, Bugesera, Gisagara and Gatsibo); reinforcing communication strategies, putting more emphasis on environmental hygiene and sanitation, appropriate use of treated bed nets and seeking early treatment. WHAT OFFICIALS SAY: Gerald Ndenzumunsi, a leader of Community Health Workers in Simbi sector in Huye district says with the home-based malaria case management initiative, citizens were saved from suffering from home and the distances they would have to travel to get medical help.“People no longer get severely ill since they are reached with help in time. The initiative really helps,” he said.According to the World Health Organization, community-based case management of malaria is a key approach to increasing access to effective antimalarial treatment in Africa. In his World Malaria Day statement, Dr. Olushayo Olu, the World Health Organisation Country Representative recognised the efforts of the government of Rwanda along with other African governments in controlling malaria. According to Olu, Africa has made significant progress against malaria. The world malaria report of 2016 showed that the estimated new cases of malaria in the region have dropped by 23 percent while related deaths have dropped by 31 percent, with most prevented deaths being children under five. “This achievement reflects the extra ordinary commitment of individuals, communities, health care workers, families, national authorities and partners to change behaviour, scale up cost effective prevention, and to manage patients. A critical strategy to prevent malaria has been increased use of insecticide treated mosquito nets and indoor residual spraying. The results of this accelerated prevention are impressive,” he said. Caption: Indoor residual spraying in Huye “WHO and the international community recognize the leadership of the government of Rwanda in controlling malaria. From 2016, the government of Rwanda and partners developed and implemented the malaria contingence plan with multi-sectoral approach to address malaria cases in the country,” he says. According to USAID Mission Director to Rwanda, Marcia Musisi Nkambwe, home-based malaria case management is a key strategy for implementing the global consensus of reducing malaria incidence and mortality rates by at least 90% by 2030 and attaining the SDGs targets. Citing strategies put in place by the Ministry of Health in fighting malaria, she described Rwanda’s government as people “who work tirelessly in the fight against malaria every day”. “Your hard work and unflagging dedication is saving lives and ensuring the health of so many across this wonderful country,” she said.Eugene Muzuka, the mayor of Huye district stresses the importance of the CHWs in the fight against malaria in his district,“Our citizens are very happy with this and are thankful to the Ministry of Health. They also thank the community health workers for their intervention and timely provision of diagnosis and treatment services,” he said. Caption:Community health workers working in Indoor Residual spraying talk about some of what they do at the world malaria day In his speech at the World Malaria Day, he urged the citizens to actively take part in the fight against malaria as they make full use of all the preventive measures that the government has put in place. “Let us do it all; sleeping under treated mosquito nets, closing doors and windows in the evening or draining the stagnant water. If you have any symptoms, don’t delay to approach the community health workers for help,” he said. Dr. Jeanine Condo, the Director General of Rwanda Biomedical Centre, says that of the ten leading districts in having many malaria cases, six are found in the Southern Province. She called for active participation of citizens in fighting the disease. “The Ministry of Health reminds you to take part in the fight against malaria in your communities,” she said. Among other things, the home-based malaria case management also helps in shifting the tasks from health workers to community members. The idea of task-shifting has gained prominence as Rwanda strives to achieve the Sustainable Development Goals.

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How home-based malaria case management has helped reduce malaria in Rwanda