Improving Access to ACTs Through Licensed Chemical Sellers in Ghana David Ofori-Adjei 1, Sylvester Segbaya 2, Kwadwo Koram 1, Kwame Adogboba 3, and Nana Enyimayew 3 1 Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana; 2: 2 National Malaria Control Programme, Ghana Health Service, Accra, Ghana; 3 Health Partners Ghana, Accra, Ghana ICIUM 2011, Antalya, Turkey1

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 ICIUM 2011, Antalya, Turkey2

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 ICIUM 2011, Antalya, Turkey3

Interventions A 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 Messaging In 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. ICIUM 2011, Antalya, Turkey4

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. ICIUM 2011, Antalya, Turkey5

Proportion of LCS holding stocks of SP, ACTs or Chloroquine (2008 – 2011) ICIUM 2011, Antalya, Turkey6

Top 3 antimalarials sold by LCS (2008 – 2011) ICIUM 2011, Antalya, Turkey7

MAM Training and LCS knowledge * = significant difference ICIUM 2011, Antalya, Turkey8

MAM training of LCSs and dispensing * = significant difference ICIUM 2011, Antalya, Turkey9

MAM training of LCSs and Referrals ICIUM 2011, Antalya, Turkey10

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 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. ICIUM 2011, Antalya, Turkey11

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. ICIUM 2011, Antalya, Turkey12