Working with community medicine distributors: Support and motivation

Context: The Ugandan Ministry of Health policy on the home-based management of fever aims to increase access to appropriate and prompt anti-malarial treatment of children under five. Community medicine distributors (CMDs) are a vital component of this strategy at village level. Up till now there have been minimal efforts to facilitate CMDs. JSI/UPHOLD, a USAID-funded project supporting 34 districts of Uganda to improve the access, quality and utilization of social services has attempted to address this gap.

Description: JSI/UPHOLD supported the training of over 24,000 CMDs in malaria case management, record keeping and reporting. CMDs were provided with registers, bags, pens and funding to attend quarterly review meetings. CMDs who participated in net distribution received badges and free bednets. The project encouraged health units improve collaboration with CMDs including joint support supervision meetings. Annual CMD performance is assessed using the Lot Quality Assurance Sampling survey which collects data on indicators addressing the ‘Roll Back Malaria' initiative.

Lessons Learned: The proportion of children who received prompt and appropriate anti-malaria treatment increased from 30.7% in 2004 to 39.7% in 2005 and the CMD reporting rate increased from 30% to 71% in 12 months. CMDs appreciate project support, which has enabled them to collect drugs, submit reports and be updated on current developments in malaria management.

Recommendation: CMDs are a viable option for increasing access to health services at grass roots level. However, for sustainability, their motivation and facilitation needs to be addressed by the community and the health system.