improving access to acts through licensed chemical sellers in ghana david ofori-adjei 1, sylvester...

ICIUM 2011, Antalya, Turkey 1

Improving Access to ACTs Through Licensed Chemical Sellers in Ghana

David Ofori-Adjei1, Sylvester Segbaya2, Kwadwo Koram1, Kwame Adogboba3,

and Nana Enyimayew3

1Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana;

2: 2National Malaria Control Programme, Ghana Health Service, Accra, Ghana; 3Health

Partners Ghana, Accra, Ghana


Objectives

The Mobilize Against Malaria (MAM) project started in Ghana in 2008 to improve access to ACTs through LCS.

The objectives were to measure the effect of an educational intervention delivered by a third party on: the availability of antimalarial medicines stocked by

LCS; knowledge of treatment of malaria in children

under age 5 years, and referral practices.The assessment involved regular annual surveys of LCS practices from 2008 to 2011.


Methods

• Study Site: The study involved LCS in the Ashanti Region of Ghana.

• Design: A questionnaire-based comparative descriptive study of trained and un-trained LCS on the intervention measures

• Setting: LCS shops in selected communities• Study population: LCS selected from six randomly selected

districts in the Ashanti Region of Ghana that were registered with the Pharmacy Council, the national regulatory body.

• Sampling: For each annual survey in 2008 (baseline), 2009, 2010 and 2011 LCS were selected by cluster sampling based on census enumeration areas. In each survey were LCS that had received training and those who were yet to have training.

• Outcome measures: Effect of training on treatment knowledge; stocking and selling of ACTs, SP and CQ; and referral patterns


InterventionsA third party, Ghana Social Marketing Foundation/Family Health International (now Family Health 360) developed, piloted and implemented the interventions which was monitored by our team. The interventions for the LCS comprised 7 modules:• Module 1: Mobilize Against Malaria• Module 2: Malaria Control and Prevention• Module 3: Skills for Dispensing Medicines• Module 4: Malaria Symptom Recognition• Module 5: Malaria Drug Treatment• Module 6: Referral and Record Keeping• Module 7: Client Care and MessagingIn addition the LCS Association was strengthened and linked with the District Health Management Team. Specific messages, posters and audio were designed for the communities as well.


Results

• The number of LCS surveyed in 2008, 2009, 2010 and 2011 were 161, 160, 157 and 160, respectively. There was no difference in the number that had received training in general but there was a significant difference in the number that had received the project intervention between 2009 and 2010 (32.7% and 53.6%, p<0.001).

• Over the period 1135 out of the target of 1200 for the duration of the project received training. LCS in Ashanti Region were trained in management of malaria with ACTs.


Proportion of LCS holding stocks of SP, ACTs or Chloroquine (2008 – 2011)

2008 2009 2010 20110

10

20

30

40

50

60

70

80

90

100

SPACTsChloroquine


Top 3 antimalarials sold by LCS (2008 – 2011)

2008 2009 2010 20110

10

20

30

40

50

60

70

80

90

SPACTsChloroquine


MAM Training and LCS knowledge

2009 2010 2011

NotTraine

d%

Trained%

NotTraine

d%

Trained%

NotTraine

d%

Trained%

Stocks ACTs 52.3 80.8* 80.6 79.5

Know national recommendation for ACTs

56.1 73.1* 73.6 96.4* 74.7 88.5*

RecommendsACTs

10.1 22.7* 59.7 84.3* 67.4 73.8

* = significant difference


MAM training of LCSs and dispensing

2009 2010 2011

No MAMtrainin

g%

MAMtraining

%

No MAM

Training%

MAMtraining

%

No MAMtrainin

g%

MAMTrainin

g%

ACTs commonly sold

9.4 17.3 59.7 79.5* 71.4 90.5*

SP commonly sold

1.9 3.9 20.8 9.6 6.6 7.9

CQ commonly sold

3.7 5.8 1.4 4.8 1.1 0

* = significant difference


MAM training of LCSs and Referrals

2009 2010 2011

No MAM

training%

MAMtrainin

g%

No MAM

Training%

MAMtrainin

g%

No MAM

training%

MAMTrainin

g%

Refer U5 75.7 65.4 59.7 68.3 52.1 44.4

Referral form

5.7 65.4 2.3 47.4 6.0 42.9


Summary

The MAM project contributed to increased availability and use of ACTs in the Ashanti Region. LCS still stocked CQ and SP which was against national policy but the use of CQ or monotherapy had significantly reduced by 2011.

There was no significant change in the referral of children under age 5 from LCS to health facilities. However, record keeping of client and dispensing data improved.


Policy implications

• The results of this study shows that training LCS in stock management and treatment of malaria is a viable option for improving access to ACTs through:– Increased demand for ACTs by LCS Clients – Increased visibility of LCS as service providers in the Public Health

Sector including the National Health Insurance Scheme– Use of LCS as distribution channels for ACTs especially in the context of

the roll-out of AMFm in Ghana• Data collected by LCS as part of their service records may be

integrated into the mainstream national health information system.

improving access to acts through licensed chemical sellers in ghana david ofori-adjei 1, sylvester...

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