Background: Despite recent advances in malaria diagnosis and treatment, many isolated communities in rural
settings continue to lack access to these life-saving tools. Community-case management of malaria (CCMm),
consisting of lay health workers (LHWs) using malaria rapid diagnostic tests (RDTs) and artemisinin-based
combination therapy (ACT) in their villages, can address this disparity.
Methods: This study examined routine reporting data from a CCMm programme between 2008 and 2011 in
Saraya, a rural district in Senegal, and assessed its impact on timely access to rapid diagnostic tests and ACT.
Results: There was a seven-fold increase in the number of LHWs providing care and in the number of patients
seen. LHW engagement in the CCM programme varied seasonally, 24,3% of all patients prescribed an ACT had a
negative RDT or were never administered an RDT, and less than half of patients with absolute indications for
referral (severe symptoms, age under two months and pregnancy) were referred. There were few stock-outs.
Discussion: This CCMm programme successfully increased the number of patients with access to RDT and ACT, but
further investigation is required to identify the cause for over-prescription, and low rates of referrals for patients
with absolute indications. In contrast, previous widespread stock-outs in Saraya’s CCMm programme have now
been resolved.
Conclusion: This study demonstrates the potential for CCMm programmes to substantially increase access to lifesaving
malarial diagnostics and treatment, but also highlights important challenges in ensuring quality