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HOME-BASED CARE FOR MALARIA CAMPAIGN

• THE GHANA EXPERIENCE

MRS ABA BAFFOE-WILMOT

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PRESENTATION OUTLINE

• RATIONALE

• ENABLING FACTORS

• THE HOME-BASED CARE CAMPAIGN

• ACHIEVEMENTS

• CHALLENGES

• PROSPECTS

• CONCLUSIONS

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RATIONALE

• HOME MANAGEMENT OF MALARIA EXISTS IN THE COMMUNITIES – BUT INAPPROPRIATELY

• STUDIES IN 3 DISTRICTS SHOWED THAT:

• EARLY AND APPROPRIATE HOME MANAGEMENT OF MALARIA IS POSSIBLE THROUGH:

– STRONG, EFFECTIVE AND SUSTAINED IEC TO IMPROVE HEALTH SEEKING BEHAVIOUR

– USE OF APPROPRIATE PREPACKS

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RATIONALE-2

• 71% MOTHERS ARE ABLE TO RECALL HOW TO ADMINISTER DRUGS CORRECTLY BUT ONLY 14.6% GIVE CORRECT DRUG/DOSAGE/DURATION AT HOME (N = 489)

• 63% MOTHERS KNOW THAT CHILD SHOULD BE SPONGED, GIVEN ANTIPRECTICS BUT ONLY 2.7% PRACTICE IT (n= 489)

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RATIONALE-3

DRUG VENDORS/CHEMICAL SELLERS:

• ONLY 52% KNOW CORRECT TREATMENT FOR MALARIA YET

CUSTOMERS ASK THEM OF THEIR OPINION ON DISEASE

• ONLY 42% SELL FULL DOSES OF ANTI-MALARIA DRUG ALWAYS

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ENABLING FACTORS-1

• COMMUNITY HEALTH NURSES AND HEALTH OFFICERS UNDER THE COMMUNITY HEALTH PLANNING AND SERVICES CARRY OUT HOME VISITS/ SOME LIVE IN THE COMMUNITY SO EASILY ACCESSIBLE FOR ADVISE/REFFERAL

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ENABLING FACTORS-2

• INTEGRATED CHILD SURVIVAL INFORMATION CAMAPAIGN BY JHU/USAID (“HE-HA-HO” = HEALTHIER HAPPIER HOMES)

• COMMERCIAL MARKETING AND DISTRIBUTION OF PREPACKAGED CHLOROQUINE TABLETS BY DRUG MANUFACTURER

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THE HOME-BASED CARE CAMPAIGN

OBJECTIVE:• INCREASE PROPORTION OF

CAREGIVERS WHO ARE ABLE TO RECOGNISE AND RESPOND APPROPRIATELY TO MALARIA

• MOTIVATE PRIMARY CAREGIVERS TO GIVE CORRECT TREATMENT AT HOME AND REFER PROMPTLY AND TIMELY

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THE CHOSEN MEDIUM-RADIO AND TELEVISION

• AVAILABILITY: OVER HALF OF THE POPULATION IN GHANA OWN A RADIO SET

• WIDER COVERAGE, GEOGRAPHICAL AND LANGUAGE– EASILY ACCESSIBLE.REACHES LISTENERS

AT THEIR HOMES

– COST-EFFECTIVE: CHEAPER (RADIO

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CHOSEN MEDIUM-2

• PORTABLE.EASY TO CARRY ALONG TO MARKET, FARM, SHORE, OFFICE

• HIGHLY CREDIBLE.MOST PEOPLE BELIEVE WHAT THEY HEAR FROM RADIO/TV AS TRUE AND FACTUAL

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THE CAMPAIGN

• DIFFERENT LOCAL LANGUAGES

• ON TV: PICTURES OF MOTHER WHOSE CHILD IS ILL WITH FEVER

• MOTHER GOES TO DRUG STORE TO PURCHASE MALARIA DRUG (TABLETS)

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THE CAMPAIGN

• SHE IS OBSERVED DISSOLVING THE TABLETS IN JUICES/PORRIDGE FOR CHILD

• PUBLIC ADVISED TO CONSULT NEAREST DRUG STORE FOR CORRECT DOSE FOR CHILD

• SAME MESSAGE AIRED ON RADIO

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ACHIEVEMENT

• LEAFLETS AND PAMPHLETS/ POSTERS PRODUCED FOR MOTHERS AND CARETAKERS /CHEMICAL SELLERS

• MORE MOTHERS PURCHASING CHLOROQUINE TABLETS FOR THEIR CHILDREN WHEN ILL

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CHALLENGES-1

• OPPOSITION FROM PHARMACIES THAT WE ARE DISCOURAGING USE OF SYRUPS (PHARMACISTS IN KUMASI WENT ON DEMOSTRATION)

• MOTIVATION AND COMMITMENT OF ALL STAKEHOLDERS VERY IMPORTANT

• ADDITIONAL RESOURCES NEEDED; I.E. TRANSPORT FOR SUPERVISION AND REFFERAL, FUNDS TO MOTI VATE AND HEALTH STAFF CLOSE-BY

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CHALLENGES-2

• REGULAR TRAINING AND UPDATES OF COMMUNITY-BASED AGENTS WHO ARE THE AUTOMATIC NEXT LEVEL OF CARE FROM THE HOME

• MAKING AVAILABLE EDUCATIONAL MATERIALS TO INFORM/EDUCATE MOTHERS AND CHILD CARETAKERS

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CHALLENGES-3

• REGULAR VISITS TO HOMES BY HEALTH STAFF REQUIRED

• MONITORING OF PATTERN OF DRUG USE, SIDE EFFECTS AND RESISTANCE VERY IMPORTANT

• ENSURING COOPERATION FROM HEALTH STAFF:POLICY ISSUES

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CHALLENGES -4

• ENSURING QUALITY OF CARE AT HOME: CORRECT DRUG DOSING AND DURATION

– IS PRE-PACKAGING FROM AN APPROVED SOURCE THE ANSWER

• KNOWING WHEN TO GIVE UP AND SEEK HELP– INTENSIFIED/SUSTAINED HEALTH

EDUCATION: COST IMPLICATIONS

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CHALLENGES-5

• ENSURING ACCESS TO HIGHER LEVEL OF CARE

• MANPOWER: INCREASED WORKLOAD OF SUPERVISING

• DATA CAPTURE: – MONITORING HOME-BASED CARE

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ISSUES TO CONSIDER

• POLICY IMPLICATIONS: TABLETS /SYRUPS TO BE PHASED OUT?

• ARE WE ENDORSING SELF-MEDICATION/DRUG ABUSE/ LEADING TO DRUG RESISTANCE DEVELOPMENT?

• WILL HEALTH STAFF COOPERATE: EXTRA RESPONSIBILITY OF SUPERVISING.

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ISSUES CTD

• CAN WE COPE WITH THE EXTRA RESOURCE IMPLICATIONS?:– DRUGS:SIMPLE, ATTRACTIVE

PACKAGING– REMUNERATION OF STAFF TO

SUPERVISE– TRAIN/EQUIPPING COMMUNITY-

BASED PROVIDERS TO GIVE RIGHT DOSE/INFORMATION

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PROSPECTS

• CHEMICAL SELLERS TRAINING MANUAL IS BEING DEVELOPED

• RADIO DISTANCE LEARNING FOR COMMUNITY HEALTH NURSES IS BEING DEVELOPED

• PERSON TO PERSON CONTACT TO EDUCATE AND EXPLAIN

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CONCLUSION

• HOME MANAGEMENT OF MALARIA/FEVERS IS GOING ON

• NEED TO EDUCATE THE MOTHERS CARETAKERS TO DO IT CORRECTLY

• THE MOST POPULAR MEDIUM HAS BEEN USED

• NEED TO GO DOWN: PERSON TO PERSON CONTACT TO HAVE THE MAXIMUM IMPACT