Theme 1: Issues in service delivery - The devil in the details: early evaluation of home-based management of fever in Nebbi District, Uganda

Every day, 3,000 Africans, mostly pregnant women and children, die of malaria, which in Africa still represents the top disease in both morbidity and mortality. Heads of state of African countries made a commitment, in April 2000 at Abuja, Nigeria, to ensure that at least 60% of those suffering from malaria have prompt access to affordable and appropriate treatment within 24 hours of the onset of symptoms. Prompt access to effective anti-malarial treatment is an essential pillar for reducing the disease burden. One of the strategies to bring treatment as near the home as possible is the Home Based Management of Fever (HBMF), where trained community volunteers use pre-packaged drugs to effectively treat children with fever within 24 hours of onset of illness. This strategy is already being practised on a limited scale in some countries in Africa, and has been scaled up countrywide in Uganda. We illustrate the case of Nebbi District, where implementation started last year in June, trying to identify the strengths, the achievements and the constraints of this programme. In particular, we compare the number of reported cases of malaria in under-5 children before and after the HBMF was introduced.