Transcript Homebase Malaria

HOME-BASED CARE FOR
MALARIA CAMPAIGN
• THE GHANA EXPERIENCE
MRS ABA BAFFOE-WILMOT
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PRESENTATION OUTLINE
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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 ANTIMALARIA 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 MEDIUMRADIO 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 COMMUNITYBASED 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
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