Treatment and access are the driving forces in MSF's malaria treatment strategy:
MSF Executive Summary

25 April 2008

Since 2005, MSF has been working with the health authorities in Mali to fight malaria by implementing a new treatment protocol: artemisinin-based combination therapy (ACT). This treatment is essential if patients are to be given appropriate care. To this end MSF set up a project in the district of Kangaba, located in the Koulikoro region in the south of Mali. The project comprised two main phases.

© Bruno De Cock/MSF

The first phase aimed to increase the availability of treatment on the basis of rapid diagnostic tests (RDT) and ACT in seven community health centres (CSCOMs) in the district. Health personnel were trained in the new protocols and the population was made aware of the changes. From the outset of the project, RDT and ACT were given to patients on a free-of-charge or low-cost basis. A fee was still payable for consultations and other treatments. The number of people visiting the centres increased in relation to the period prior to MSF’s involvement. However, this experience showed that there are limits to supplying free or heavily subsidised medication without altering a system where patients must pay for care.

The results achieved during this initial phase (August 2005 - November 2006) show that attendance at the CSCOMs remained very low despite the increase in the availability of treatment and the improvements made in the quality of care. Health needs, particularly those relating to malaria, were not being met satisfactorily. These interim results led to a reorientation of the project in order to reduce the financial barriers for patients.

In addition to the support given during the first phase of the project, the second phase – which is still ongoing – aims to improve accessibility. The fact that care is provided free of charge to all children under five years of age, combined with free treatment for pregnant women suffering from fever, and a low fixed price that includes total care for an episode of fever in patients over five years of age, resulted in significant increases in the use of CSCOM services. Furthermore, community agents known as "malaria agents" have been selected and trained to provide free care for cases of simple malaria in children under ten years of age in inaccessible areas during the high-transmission period for malaria.

These strategies enabled MSF and the health authorities in Kangaba district to have a rapid impact on the attendance levels at health centres and, therefore, to improve coverage of needs. In a setting where the morbidity and mortality linked to malaria are high and poverty is widespread, the measure of free care for the patient appears to be crucial in order to obtain rapid results in improving people’s health. This makes it possible to ensure that the grants awarded to the health system reach the population, including the most vulnerable groups.

Going beyond the context of Kangaba, we would like these results to lead to reflection on free healthcare as an essential strategy in the fight against malaria in Mali and elsewhere, particularly for the most vulnerable groups, such as pregnant women and children under five years of age.