Barriers to community case management of malaria in Saraya, Senegal: training, and supply-chains

Abstract

BackgroundHealth workers in sub-Saharan Africa can now diagnose and treat malaria in the field, using rapid diagnostic tests and artemisinin-based combination therapy in areas without microscopy and widespread resistance to previously effective drugs.ObjectiveThis study evaluates communities’ perceptions of a new community case management of malaria programme in the district of Saraya, south-eastern Senegal, the effectiveness of lay health worker trainings, and the availability of rapid diagnostic tests and artemisinin-based combination therapy in the field.MethodsThe study employed qualitative and quantitative methods including focus groups with villagers, and pre- and post-training questionnaires with lay health workers.ResultsCommunities approved of the community case management programme, but expressed concern about other general barriers to care, particularly transportation challenges. Most lay health workers acquired important skills, but a sizeable minority did not understand the rapid diagnostic test algorithm and were not able to correctly prescribe arteminisin-based combination therapy soon after the training. Further, few women lay health workers participated in the programme. Finally, the study identified stock-outs of rapid tests and anti-malaria medication products in over half of the programme sites two months after the start of the programme, thought due to a regional shortage.ConclusionThis study identified barriers to implementation of the community case management of malaria programme in Saraya that include lay health worker training, low numbers of women participants, and generalized stock-outs. These barriers warrant investigation into possible solutions of relevance to community case management generally.

Community case management in malaria: review and perspectives after four years of operational experience in Saraya district, south-east Senegal

“…In contrast to a previous assessment of the CCMm programme in Saraya which found wide-spread stock-outs of ACT and RDTs soon after the programme’s implementation [24], this study documented overall availability of these supplies suggesting that early logistical challenges have already been overcome.…”

Towards eliminating malaria in high endemic countries: the roles of community health workers and related cadres and their challenges in integrated community case management for malaria: a systematic review

“…Authority does not allow personnel with short-term training to prescribeStock out of supplies especially anti-malarialsPoor supervision especially in the hard to reach areasFunding instability. The programme is donor funded and subjected to delays in funding disbursementLack of community involvement and ownershipNo evidence yet on impact and no evaluation strategyAPEs are not paid3.Yansaneh et al [33]CHVsCHVs are not remunerated and have to do other income generating activitiesNot available when needed as they are not paid for their service4.Nanyonjo et al [30]CHWsPatients may not complete referrals5.Heidkamp et al [26]CHWsStock-out of essential suppliesPoor supervision from higher cadres6.Druetz et al [35]CHWsCommunity preference on qualified health workersCHWs not known to peopleMedicine stock-outLong distance to CHWs7.Banek et al [13]CMDsPatients overloadLack of supervisionLimited malaria knowledgeTensions with community membersLack of remuneration from the government8.Hamainza et al [22]CHWsLack of remunerationNegative attitudes to care given by CHWsWeak social responsibilities9.Abbey et al [24]CHWsHigh attrition rate of CHWs especially in hard-to-reach areas10.Tine et al [14]CHWsMedicine and RDT stock-out11.Ndiaye et al [39]CHWsMedicine and supply RDT stock-out (ACT, RDT, gloves, case files, patients forms)12.Blanas et al [28]CHWsACT and other supplies stock-outsExpired medicines or unavailable in villagesScepticism from villagesTransport problems, poor infrastructure and long distances for referrals13.Counihan et al [25]CHWsRDT and other medical supply stock-outs after ini...…”

“…Most studies mentioned stock-outs of ACT and other anti-malarials [21, 26, 27], test kits for malaria [13, 14, 25, 28] and gloves, among others [29]. …”

“…Second, distances from where they were stationed to households in need affected their service delivery [13], and the referral of their patients [30]. Third, lack of transport and poor roads caused delays in service delivery in some studies [13, 28]. …”

Stock‐outs of essential health products in Mozambique – longitudinal analyses from 2011 to 2013

“…In addition to their impact on the quality of patient care, ruptures of EHP stocks may contribute to an increased workload for already stressed healthcare staff, as patients require additional visits or referrals to access recommended services. These additional visits and/or referrals may contribute to low morale and high turnover among staff at rural health centres, further affecting service quality and hindering the scalability of health programmes (McDougal et al 2012;Blanas et al 2013;Penfold et al 2013). The lack of medicines at public clinics often results in low patient satisfaction (Newman et al 1998;Peltzer 2009), leading patients to access medical care at private clinics and pharmacies where medicines are often more expensive (Mendis et al 2007); together, this undermines patient confidence in formal health services and may result in increased utilisation of health services via traditional and alternative healers (McCombie 1996;Varga & Veale 1997;Sato 2012).…”