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.

Hetzel et al. Malaria Journal 2007 6:83   doi:10.1186/1475-2875-6-83