MIN/Sp/AU/CAMH3/6 Malaria Page 17 2.4.3 Treatment Coverage Since 1998, most countries in the sub-region have established sentinel sites for drug efficacy monitoring. Based on the results, all countries except Swaziland and Algeria have reviewed their antimalarial treatment policies and adopted ACTs as 1st line treatment for malaria. By the end of 2007, 25 countries are implementing an ACT treatment policy with 20 of them implementing countrywide 7 . Availability of funds from the GFATM and other funding initiatives has enabled countries to implement the new treatment policies. The policy change from chloroquine to ACT for malaria treatment has slowed down the implementation of home management of malaria (HMM). By the end of 2007, none of the countries has implemented ACT use in home management of malaria except in a few pilot projects. Across the region, 34% of children with fever receive any antimalarial treatments. In countries with data for 2005-2006, access to any antimalarial medicine ranged from 5% to 62% as shown in figure 2. During the same surveys, it was estimated that children in the Gambia 52%, Tanzania 51%, Ghana 48% and Sierra Leone 45% received antimalarial treatment within 24 hours. Although some countries may have achieved the Abuja target, most of these treatments were with chloroquine and other less-effective medicines 8 . In the 14 countries with recent data that have adopted the ACT policy, the median proportion of children under five years with fever receiving an ACT was only 2% (range < 1 to 13). The major constraints to scaling up ACTs in these countries are funding since the medicines are more expensive and inadequate supply chain management infrastructure. 7 8 WHO Reports. UNICEF & RBM (2007) Malaria & children progress in Intervention coverage. Status Report on Malaria in Africa 2008