Agnes Aubouy in a commentary in International Health

http://inthealth.oxfordjournals.org/content/3/4/219.full.pdf

Reviewed by David Hercot

The issue of home-based malaria (diagnosis and) treatment is very controversial and this commentary is a contribution to that debate. Some people, also in our network, think that in many situations, home-based treatment of malaria is desirable. This author clearly has a different opinion, but I have been disappointed by her paper, which is rather unbalanced opinion and doesn’t add much to the current debate. She repeats the frequently made argument that community programmes are weak and that provision of malaria treatment by community workers or at household level is a double edged. When CHW tackle only malaria, it could mean we are missing out on other diseases often falsely identified as malaria. Programme with more integrated approach are probably better but then increase the risk of delaying the recourse to a skilled healthcare worker for serious events. The author’s conclusion is that we should focus on strengthening the health sector.
I think that she could have brought a more balanced opinion by looking at the relatively lower cost of community programmes and their greater access to remote populations, especially being available at more flexible hours, also when danger signs are present and barriers to reach other forms of care are high. In my view community programmes are an essential component of every health system, for rich and poor countries. The discussion should not be if we should organise it, but how to organize it. As we mentioned in our viewpoint (Ooms et al 2010), it is up to the country to decide on the right mix between skilled care and community health care, instead of northern based researchers giving the directions.
Ooms,G.; Hercot,D.; Assefa,Y.; Van Damme,W., 2010,  The New Dichotomy in Health Systems Strengthening and the Role of Global Health Initiatives: What Can We Learn from Ethiopia? JPHP 31 1 102 109,  http://dspace.itg.be/handle/10390/6120

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