Transcript uganda presentation

RBM/IMCI JOINT TASK FORCES MEETING,
SEPT 24-26/2002 HARARE ZIMBABWE.
SCALING-UP HOME BASED
MANAGEMENT OF FEVERS (HBM)
PRESENTED BY Dr. CHRISTOPHER KIGONGO
SMO/MCP
Presentation layout
• Introduction
– HBM what, why
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Objectives
Implementation steps and package
Status of implementation & Achievements
Enabling factors
Scaling-up plan
Challenges
Future Plans & Conclusion
Introduction:What is HBM?
• A strategy through which pre-packaged Chloroquine
and SP are provided at home and community level
for treatment of fevers among children under five
years
• It entails:
– training of mothers to recognize disease and take action
eg treatment at home
– training drug distributors to treat fever cases, advise
mothers/caretakers, and keep record of services provided
– supply of pre-packed drugs to the drug distributors
treatment from trained health workers
Introduction:Why HBM?
• Access to proper malaria treatment is low
– Only 49% of the population live within 5 Km of a formal
health care facility
– Only 42.7% of parishes in the country have HC II
• Home management of fever is already a
problematic reality
– Up to 83% of fever cases are managed outside formal
facilities
– 79% of the above is “self medication “ using western
type of medicine; drugs are given incorrect, in
incomplete doses and often dangerous combinations
Introduction:Why HBM?
• There is evidence that home management reduces
morbidity& mortality & is acceptable
– A pilot project in 3 districts of Uganda with pre-packed
Chloroquine (MUSUJAQUINE) showed high
compliance to treatment
– Educating mothers and providing them with Chloroquine,
for home treatment of fever reduced mortality in children
in Ethiopia
– Provision of pre-packed drugs reduced prevalence of
severe forms of malaria in Burkina Faso
HBM: Objectives
• To increase access to prompt and appropriate
treatment of fever/malaria among children below
five years
• To improve on recognition of children with severe
illness and ensure prompt referral to formal
providers
• To support preventive Malaria control strategies e.g.
IPT & ITNs
Implementation: steps
A national core team was formed to develop guidelines,
packages and tools and build district capacity. Six key steps
were followed:
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District sensitization and planning
Training district trainers
Sensitization of sub counties
Community & selection of drug distributors
Training of drug distributors/mothers
Distribution of drugs at community level
Implementation: package
1.
Communication strategy for behaviour change
2.
Pre-packaged C/Q &SP unit packs (HOMAPAK)
3.
Guidelines for training mothers/caretakers,
drug distributors & community mobilisation
4.
Tools for recording and monitoring
Status of implementation
Steps
Output
No.of districts implemented
Sensitization and planning
with districts
District plans
21
Training of district trainers
District & subcounty trainers
10
Sensitization of sub counties
Community mobilizers
10
Sensitization of communities
& selection of drug
distributors
Selection of
distributors/mothers
10
Training of drug
distributors/mothers
Trained distributors
10
Status of implementation-cont’d
District
1
Adjumani
Nakasongola
Rukungiri
Kumi
Masindi
Kamuli
Kyenjojo
Kanungu
Kabalore
Kiboga
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Steps
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means activity has been completed; ** means that the activity is on going;
Achievements
• National steering committee established
• POA developed and agreed with Partners
• HBM launched by His Excellence the President of
Uganda
• All DDHS sensitized about the HBM
• HBM activities initiated in all 21 first phase districts
Achievements-cont’d
• Communication strategy has been developed
• Guidelines & tools for training district trainers,
selection and training of drug distributors,record
keeping, supervision & monitoring
• Procured 4 million unit doses of HOMAPAK
• Trained 490 district trainers in 10 districts
• Trained 10,000 drug distributors in 5,000 villages
(number of villages 39,690 whole country, 19,330 in 21 districts)
• Baseline survey has been done and data is being
analyzed
Reports from implementing districts
• OPD attendances have reduced
• In patient admissions have dropped as well
• The above have to be verified and effects on
mortality assessed
Enabling factors
• Highest political commitment
• Community’s recognition of malaria as a
problem
• Pro-active program integration & sector wide
approach
• Partner coordination through the ICCM
• Supportive NGOs, Civic & Cultural groups in
addition to the private sector
Unit cost by activity
Activity
Cost in US dollars
District sens. & planning $ 680, 30 people, 2 days
District TOT
$1120, 30 people, 2 days
Sub county sensitization $105, 20 people, 1 day
Village selection of DDs $ 6.2, per village
S/county training of DDs $350, 35 people, 2 days
Drug distribution
No direct cost
Cost of treating a child for 1 year (6 episodes)
$ 0.96
Enabling factors-cont’d
• Strong Malaria-IMCI collaboration
• Strong inter-partner collaboration e.g.
UNICEF/WHO, BASICS/WHO, USAID/DFID,
• Well embracing health sector policy & Strategic
plan
• Available experience from the TDR study home
based management
• Presence of a large number of personnel trained in
IMCI
Enabling factors-cont’d
• Decentralization of political/administrative system with
local councils at village level
• Presence of NGOs within the communities which already
work with mother on nutrition
• Presence of PDCs & CORPs in many communities, not
being used.
• High utilization of the informal sector by community
members.
• The wide network of FM radios (National wide coverage)
• Strong women movement & their empowerment
Scaling up HBM
• Improving the practice of Home management of fever
started in 1999 in 3 districts with support from TDR
• Scaling up commenced 2002 and is done in a phased
manner
- First phase 21 districts (already started)
- Second phase 15 districts (starts February 2003)
African Development Bank 11 districts
Standard Chartered Bank 4 districts
- Third phase 20 districts (starts within one year)
Implementation of Home-Based Management of Fever Strategy in Uganda
Key:
HBM implementing districts
SHSSPP districts (ADB)
HBM scaling-up districts
Challenges
• Emerging Chloroquine & Sulphadoxine-pyrimethamine
resistance
• Low resource base at lower administrative levels
• Sustenance of drug supply
• Referral mechanisms in the health systems still weak
• Negative health workers’ attitude & low motivation
• Supervision of drug distributors- low number of health
workers
• High political pressure to cover the entire country quickly
Challenges
 Private sector involvement for additional drug
supplies
 “Doctors” out of distributors
 How to keep volunteers interested
Future perspectives
• Cover the whole country as soon as possible (in about 1
year)
• Work with the private sector for the development of the
private arm of HOMAPAK.
• Develop unit dose packs for older children and adults
• Monitor drug resistance and adverse reactions
• More operation research and measuring impact
• ITNs promotion to be integrated into HBM
• Subsidies on ITN to be introduced for under fives and
pregnant women in HBM areas.
CONCLUSION
• Scaling up the HBM is challenging but possible
• It requires adequate capacity strengthening at the different
levels and good partner coordination.
• HBM has benefits visible to the community and should be
encouraged every where children are suffering febrile
illness.
I Thank you for listening