1 HOME-BASED CARE FOR MALARIA CAMPAIGN THE GHANA EXPERIENCE MRS ABA BAFFOE-WILMOT

2 PRESENTATION OUTLINE RATIONALE ENABLING FACTORS THE HOME-BASED CARE CAMPAIGN ACHIEVEMENTS CHALLENGES PROSPECTS CONCLUSIONS

3 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

4 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)

5 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

6 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

7 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

8 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

9 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

10 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

11 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)

12 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

13 ACHIEVEMENT LEAFLETS AND PAMPHLETS/ POSTERS PRODUCED FOR MOTHERS AND CARETAKERS /CHEMICAL SELLERS MORE MOTHERS PURCHASING CHLOROQUINE TABLETS FOR THEIR CHILDREN WHEN ILL

14 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

15 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

16 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

17 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

18 CHALLENGES-5 ENSURING ACCESS TO HIGHER LEVEL OF CARE MANPOWER: INCREASED WORKLOAD OF SUPERVISING DATA CAPTURE: –MONITORING HOME-BASED CARE

19 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.

20 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

21 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

22 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