Table 1.
ACCESS Programme components and corresponding indicators for evaluation (refer to main text for details)
| Indicator | Sources of verification/study methods | Sample | Timing |
|
Intervention area 1: Behaviour change campaign (Expected results: Improved health care seeking behaviour for all fever/malaria episodes) | |||
| Proportion of episodes treated according to national guidelines within 24 h Treatment-shift to qualified providers | Cross-sectional community surveys (fever and degedege) with EMIC tool | Random sample of households | Repeated (baseline, mid-term, end) |
| DSS (morbidity) and health facility attendance | DSS area, all health facilities | Continuous | |
| Equitable access to appropriate treatment | DSS SES data | DSS area, all health facilities | Continuous |
| Intervention area 2: Quality of care in health facilities (Expected results: Improved quality of care in health facilities, especially malaria case-management, incl. diagnosis, prescription, treatment, advice, compliance) | |||
| Proportion of episodes receiving correct prescription and appropriate advice Patient's satisfaction with services | Quality of care surveys in health facilities | Sample of health facilities | Repeated (baseline, mid-term, end) |
| QIRI | All health facilities | Continuous | |
|
Intervention area 3: Malaria case-management in shops (Expected results: Improved quality of malaria case-management in drug selling shop, such as retailing practices, prescriptions, advice) | |||
| Proportion of episodes receiving correct prescription and appropriate advice | Mystery shoppers | All drug stores and random sample of general shops | Annually |
| Shop-keepers' knowledge of malaria symptoms, correct treatment and advice Availability of first- and second-line antimalarial drugs | Cross-sectional surveys in shops stocking drugs | All retailers stocking drugs | Annually |
|
Shamba component (Expected results: Coverage of appropriate malaria treatment and care services extended to underserved areas, incl. shamba households) | |||
| Proportion of households within 5 km range of qualified provider | DSS GPS data | All households, health facilities and shops stocking drugs | Repeated |
| Proportion of episodes in underserved areas/poor households/shamba houses receiving correct treatment | Cross-sectional community surveys (fever and degedege), DSS SES data | Random sample of households | Repeated (baseline, mid-term, end) |
|
Health impact (Expected results: Reduction of malaria related morbidity and mortality, especially in children under five and pregnant women) | |||
| Proportion of malaria-related deaths | DSS mortality data: overall and cause-specific. | All households | Continuous |
| Number of fever episodes. | DSS fever incidence | All households | Continuous |
| Additional studies | |||
| Understanding and perception of malaria, its treatment and prevention | Focus-group discussions | 10 groups of caretakers of children under five years in Ifakara and DSS | Once prior to interventions |
| Risk factors for fatal outcome of degedege | Case-control study | Cases:degedege-related child deaths in DSS Controls: recovered degedege cases | Once |
| Vulnerability and coping strategies of households during the farming season; movement patterns and health seeking | Cohort study with shamba households | Random sample of households with field (shamba) house | Once |
| Antimalarial drug quality | Cross-sectional survey | All drug stocking retailers and health facilities | Once |
EMIC = Explanatory Model Interview Catalogue. DSS = Demographic Surveillance System. SES = Socio-economic Status. QIRI = Quality Improvement and Recognition Initiative. GPS = Geographic Positioning System.