PROMOTING EFFECTIVE MALARIA TREATMENT AT THE COMMUNITY LEVEL THROUGH DRUG VENDORS' THE BUNGOMA EXPER - PowerPoint PPT Presentation

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PROMOTING EFFECTIVE MALARIA TREATMENT AT THE COMMUNITY LEVEL THROUGH DRUG VENDORS' THE BUNGOMA EXPER

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BY HEZRON NGUGI. AMREF KENYA. 2. BUNGOMA DISTRICT STATISTICS. Population - 906,000 people ... 1998: Sulphadoxine pyrimethamine (SP) made first line treatment ... – PowerPoint PPT presentation

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Title: PROMOTING EFFECTIVE MALARIA TREATMENT AT THE COMMUNITY LEVEL THROUGH DRUG VENDORS' THE BUNGOMA EXPER


1
PROMOTING EFFECTIVE MALARIA TREATMENT AT THE
COMMUNITY LEVEL THROUGH DRUG VENDORS.THE BUNGOMA
EXPERIENCE
  • BY HEZRON NGUGI
  • AMREF KENYA

2
BUNGOMA DISTRICT STATISTICS
  • Population - 906,000 people
  • Size - 2068km2
  • Population lt5 yrs. - 19
  • Population lt20yrs. - 60
  • Absolute poverty rate - 55.1
  • Food poverty rate - 57.1
  • I.M.R. - 92/1000
  • Childhood mortality rate - 126/1000
  • H/Facilities - 52 (hos. 6, H/C 15, dis. 21,
    N/Homes 10

3
GOVERNEMENT POLICY ON ANTIMALARIAL DRUGS
  • 1998 Sulphadoxine pyrimethamine (SP) made first
    line treatment and AQ 2nd line drug for
    malaria treatment
  • 1999 Efficacy studies on 33 SPs carried out.
    Only five passed
    the dissolution test
  • - No system for post-registration surveillance
  • 2000 The legislation changed to allow SP sold
    over the counter
  • 2002 Plans under way to change drugpolicy
    adopt combination therapy due to high P.
    falciparum resistance to SP

4
SPECIFIC ACTIONS/DECISIONS
  • Innovative approaches in case management adopted.
  • - Public and public sectors partnership
    strengthened
  • - Demand for correct and appropriate malaria
    treatment at community level increased.
  • Adjustments in the program intervention mix.
  • Additional resources provided by USAID through
    the QAP (Centre for Human Services)

5
OUTCOME
  • The two strategies vendor to vendor and
    neighbour to neighbour introduced
  • Wholesalers, their attendants and mobile drugs
    vendors identified
  • IEC materials (job aids, brochures, promotional
    materials) developed, produced and distributed
  • A total of 143 vendors (wholesalers, their
    attendants, mobile drug vendors) trained
  • About 600 drugs outlets (shops/kiosks, clinics)
    reached and trained. Each sell SPs to about 5
    people per day
  • SP drug stocked and sold in 22 of shops in rural
    areas
  • 150 villages involved in neighbour to neighbour
    approach
  • About 150,000 people reached by the neighbour to
    neighbour approach within 3-4 months

6
DATA USED
  • CARE SEEKING DATA
  • 90 of children treated at home using drugs
    purchased from shops and rural pharmacies
  • 87 of shopkeepers had no training in drug
    dispensing
  • 60 of rural pharmacies manned by unqualified
    persons
  • 2-3 inappropriate drugs used for home treatment
    wrong doses, wrong combination, expired drugs
    e.t.c.
  • Over 60 different brands of anti-malarials in the
    market and most of them of poor quality.
  • Late referral of sick children to health
    facilities.
  • 72 of under five child deaths occur at home.

7
Drugs outlets/Policy data
  • About 2,500 drug outlets, obtaining their drugs
    from a few wholesale shops, pharmacies and mobile
    vendors.
  • Classroom training approach difficult due to a
    large number of outlets.
  • Outlets closer to people and offer credit.
  • Government health facilities lack drugs
    frequently and are not easily accessible.
  • Outlets already stocking other anti-malarials
    (not SPs) and other drugs.
  • SP allowed to be sold over the counter in 2000.
  • Five SP drugs passed quality control tests in
    1999 and were recommended by the government.

8
Decision making process
  • Participatory approach used by PIT (officials
    from QAP (of U.S.A) DHMT and AMREF.)
  • Meeting to select PIT members, team leader and
    discuss logistics held with DHMT.
  • Meetings held with NMCP officials and SP drugs
    manufacturers.
  • Identified mobile vendors invited to a meeting.
  • Wholesalers visited in their premises, consensus
    reached on training content, duration and
    facilitators.

9
Advantages of the approach
  • Consensus is reached on implementation strategy.
  • Local partners (DHMT) owned the program and
    included it into their own health plans.
  • Relationship between the public sector (Ministry
    of Health) and Private sector (drug outlets and
    manufacturers) improved-suspicions reduced.
  • Multiplier effect-more people reached.
  • Cost effective as training and logistical support
    is low.

10
Disadvantages of the approach
  • Takes time to reach consensus.
  • Difficult to marry the private sector and public
    sector ways of working.
  • Difficult to sustain interest/motivation of the
    private sector.
  • Restrict the number of anti-malarials sold by
    drug vendors to only those approved by the
    Ministry of Health.
  • Some pharmaceutical firms feel threatened when
    use of their products are discouraged.
  • NB. No other sources could have been used to
    meet the same needs.

11
Advice to be given
  • Use participatory approaches in all phases of the
    project.
  • Local partners (DHMT) should own the program.
    CAs should offer technical and managerial
    support.
  • Use simple and understandable language in your
    IEC and Health learning materials.
  • Field supervision and regular meetings with drug
    outlet officials is important.

12
Challenges
  • Failure by the government to enforce the
    legislation.
  • Wrong drugs packaging and labelling.
  • High attrition rate by wholesale/pharmacy
    attendants.
  • Maintaining/sustaining motivation of the drug
    vendors.
  • Harassment of mobile drug venders by the police.

13
Acknowledgements
  • USAID for supporting the program .
  • Centre for Human Services (QAP) for availing
    resources and for technical support.
  • Bungoma-DHMT for implementing the program.
  • CORE group and AMREF for sponsoring my trip to
    the USA.
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