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Health Systems Research

Source: TropIKA

Title of the session: Health Systems Research

Date: 03 November 2009

Agenda item: Scientific Session 14

Session theme:

Meeting room: Aberdares

Chair(s): Martin Alilio ( Washington DC)Carole Jones (London School of Hygiene and Tropical Medicine)

Presenters:

• Carole Jones (London School of Hygiene and Tropical Medicine)
• Benjamin Palafox (London School of Hygiene and Tropical Medicine)
• Allan Sehapira (Swiss Tropical Institute)
• Louis Akulayi (Population Services International)
• Jayne Webster (London School of Hygiene and Tropical Medicine)
• Frank Baiden (Kintampo Health Research Centre, Ghana)
• Kristian Hansen (London School of Hygiene and Tropical Medicine)
• Helen Counihan (Malaria Consotium)
• Jacklin Mosha (National Institute for Medical Reseach)

TropIKA rapporteur: Francis Anto

Major topics:

• Implementation and sustaining strategies for malaria control through the health system
• Predicting the cost-effectiveness of strategies to scale up malaria case management across health systems
• Diagnosis of delivery system disorders
• Integrated management of febrile illness in children
• Intermittent preventive treatment of malaria in pregnancy
• Malaria rapid diagnosis performance by community health workers
• Potential cost savings by improving malaria diagnosis in low and moderate transmission settings in Tanzania

Keywords:

• Subsidized ITNs
• Rapid Diagnostic Test
• Antibiotic use
• Intermittent preventive treatment in pregnancy
• Over diagnosis

Scope:

• Public-private partnership approach in the distribution of ITNs can improve access to ITNs by pregnant women
• Community-based delivery of IPTp-SP is cost effective, can increase access and improve adherence to timely receipt of two doses of SP.
• Community Health Workers can be trained to diagnose malaria at the community level using RDTs.
• The use of RDT to ensure accurate outpatient diagnosis and subsequent treatment of malaria and non-malaria cases can save 3-8% of a district’s drug budget in high malaria transmission areas and as much as 13% in low transmission areas.

REPORT ON ORIGINAL SESSION

Overview

A study in Uganda has shown that, trained community members such as traditional birth attendants, drug-shop vendors, adolescent peer mobilisers and community reproductive health workers can provide SP to pregnant women in the implementation of IPTp programmes. These community members were able to achieve a higher coverage and birth outcomes were better; compared to those served by the traditional public health centres.

In a similar study in Tanzania, the public-private partnership approach was used in a nationwide delivery of ITNs to pregnant women. Follow-up assessment through in-depth interviews involving the major stakeholders (National Malaria Programme, District Health Management Teams, Health Workers, Community members and partner NGOs) revealed that the concept was acceptable to all of them. According to the health care practitioners the delivery of ITNs was not a medical intervention and did not require any special training and so could be delivered by non-medical persons. The nurses were however concerned about abuse of the system by some mothers. They also complained that the voucher system increased their workload as they needed to do some more documentation before issuing out the vouchers to the pregnant women.

A study in the Brong Ahofo region of Ghana between April and September, 2009 revealed that most mothers/caregivers (95%) of children with febrile illness treated at health facilities in the region were satisfied with the care given to their children. The health of the children improved well at the time of follow-up; 7-14 days post treatment. It was also realized that, whiles 99% of ACTs dispensed at the health centres was the recommended brand by the Ghana Ministry of Health/Malaria control programme, only 47.6% of that dispensed from the District hospital was the recommended brand. Follow-up revealed that, the hospital could procure ACTs from various sources other than the Central Medical Store.

CONTEXT AND ISSUE

• B1 Can Community Health workers use malaria rapid diagnostic tests (RDTs) correctly and safely following a short period of proficiency training?

Key facts and figures

The majority of women (67.5%) who were supplied with SP for IPTp through community-based workers received the drugs timely compared to 39.9% who received theirs through the public health centres (P<0.001). The cost per woman receiving the full course of IPTp was however higher when delivered via community-based workers system at US$2.60 compared to US$2.30 at the public health centres, due to the additional training cost. However, the delivery of IPTp using the community-based workers was cost-effective.

Research Findings

1. Community members (traditional birth attendants, drug-shop vendors, adolescent peer mobilisers and community reproductive health worker) can provide IPTp using SP to pregnant women
2. The use of Rapid Diagnostic Test before the administration of Artemisinin-Based Combination (ACT) treatment can help make some savings compared to presumptive treatment of malaria in terms of the cost of administering ACT to non-malaria positive patients.
3. The public-private partnership approach is acceptable and effective in reaching pregnant women with ITNs.

Future plans

Further research works are ongoing

FINDINGS AND CONCLUSIONS

Recommendations

• Further work is ongoing

Personal observations from rapporteur

It was an interesting presentation

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