Mozambique community case management
It is estimated that Mozambique’s National Health Service (NHS) covers approximately 60% of the population. In 2011, Mozambique launched a revitalization of the community health program with the intent that this cadre of trained community health workers would extend the reach of the NHS and provide health-related care to the remaining 40 percent of the population.
Mozambique’s cadre of Community Health Workers (CHWs) are called Agentes Polivalentes Elementares (APEs). They provide both preventive and curative care under an integrated community case management platform. CHWs are trained to perform rapid diagnostic testing and to provide artemisinin-based combination therapy (ACT) treatment to those with positive test results. CHWs are placed in rural areas and receive a monthly salary of $1,200.00 meticais (approximately $17). They also receive other non-monetary incentives such as bicycles and T-shirts.
According to the National Malaria Control Programme (NMCP), in 2020 there were 6,959 CHWs across the country who reported 12.4 percent of the total number of malaria cases. Mozambique’s cadre of Community Health Workers (CHWs) are called Agentes Polivalentes Elementares (APEs). APEs do the following:
- Serve as the first line of defense against malaria for people living in rural Mozambique
- Work in rural areas between 8 km and 25 km from the nearest health facility
- Link the community to the NHS as the first step in the referral system
- Receive monthly compensation from partners
- Government does not directly pay APEs, because of public service law limitations
The APEs play a critical role in extending malaria services to the rural populations and the country has scaled the program up from 3,477 APEs in 2016 to 7,143 as of the end of 2019 (with the full scale of 8,800 to be deployed by the end of 2020). Generally, access to health services is increasing as indicated by increased fever treatment seeking – from 56% in 2011 and 63% in 2015, to 69% in 2018 (IIM 2018, p. 55).
Artesunate rectal capsules (ARC)
Recommended as a pre-referral intervention for severe malaria at facility and community levels. Currently being rolled out in a phased approached.
First phase: ARC use limited to APEs
- Ensuring equitable, quality and sustainable coverage
- Defining how community initiatives fit within the NHS