Impact and Efficiency of the Integration of Diagnosis and Treatment of Pneumonia in Malaria Community Case Management in Madagascar

In Madagascar, in February 2014, the Ministry of Health and UNICEF implemented a program integrating the diagnosis and treatment of pneumonia into malaria community case management. The objectives of this program were to improve the management of cases of malaria and pneumonia by community health workers to alleviate the problem of accessibility to care and to reduce the number of severe cases treated at health facilities. This paper aims to assess the effectiveness and the efficiency of this. Two districts were taken into account: Andapa received only basic activities ensuring the functionality of the community sites (control district) and Antalaha where all activities related to the program were implemented (treated district). To assess the impact of the program, we use the difference in difference methodology and we compare the period before the implementation of the program in January 2014 and the period when the program is implemented in February 2016. Then cost-effectiveness analysis was made. In Antalaha, although the program has no significant impact on pneumonia, the situation is better than that of Andapa, as in the case of malaria management, the difference is significant between the two districts. The cost-effectiveness analysis also demonstrated that the cost per case of additional malaria and pneumonia treated by CHWs is 2.52 USD (2.44-3.50). However, skills of CHWs should be strengthened especially concerning pneumonia cases management.