PMI Quarterly Status Report April 2011 June 2011

Transcription

1 PMI Quarterly Status Report April 2011 June 2011 Submitted by: The Johns Hopkins Bloomberg School of Public Health Center for Communication Programs & Uganda Health Marketing Group - UHMG

2 ACRONYMS ACT AMFM BCC CCP FLB HF IEC IPC ITN LLIN KAP MIP MOH NDA NMCP PW RDT SS UHMG Artemisinin-based Combination Therapy Affordable Medicines for Malaria Behaviour Change Communication Johns Hopkins University Bloomberg School of Public Health/Center for Communication Programs First Line Buyer Health Facility Information Education and Communication Interpersonal Communication Insecticide treated nets Long Lasting Insecticide Treated Nets Knowledge, attitude/perceptions and Practices Malaria in Pregnancy Ministry Of Health National Drug Authority National Malaria Control Program Pregnant Woman Rapid Diagnostic Test Support Supervision Uganda Health Marketing Group 2

3 TABLE OF CONTENTS ACRONYMS.2 EXCECUTIVE SUMMARY...4 INTRODUCTION... 5 OVERVIEW OF MALARIA CONTROL ACTIVITIE 6 PROGRESS ON MALARIA CONTROL ACTIVITIES.6 1. STRENGTHEN DISTRICT LEVEL PROFESSIONAL ASSOCIATIONS.7 2. MALARIA CASE MANAGEMENT DIAGNOSIS, TEARTMENT AND IPTP.7 3. INCREASE DEMAND FOR MALARIA CONTROL SERVICES AND PRODUCTS....9 PLANNED ACTIVITIES FOR THE QUARTER -APRIL JUNE

4 Executive Summary The AFFORD/Uganda Health Marketing Group (UHMG) through funding from PMI is strengthening malaria management in six focus districts of Apac, Katakwi, Kumi, Soroti, Serere, and Ngora. During the third quarter of AFFORD year 6, UHMG/AFFORD worked towards scaling up and strengthening gains made in the previous quarter. The major emphasis during this quarter was on demand creation for prompt diagnosis, and treatment of malaria. UHMG/AFFORD launched the mass media campaign based on the concept of The power of day one which emphasized the need for seeking diagnosis and treatment on day one of observing symptoms of fever. This mass media campaign was supported by community based meetings. The goal of the community dialogue meetings was to improve knowledge of the community members in malaria management, HIV/AIDS, and MCH services to increase demand for needed health products and services. Under the result area of strengthening prompt diagnosis and treatment and IPTp, during the quarter, 15 out of the targeted 18 master trainers were oriented on MIP, ACTs and RDTs. The training was based on the approved MOH guidelines. During the orientation, practical sessions on rapid diagnostic tests for malaria (RDTm) use were carried out A major breakthrough for UHMG during this quarter was receiving approval from the GLOBAL FUND as a first line buyer of AMFm ACTs. UHMG/AFFORD established business relationship with CIPLA for procurement of AMFm ACT LUMARTEM. Overall, UHMG/AFFORD have made significant progress towards achieving the annual targets under each of the 4 result areas as is indicated the table under the section progress of malaria control activities. 4

5 Introduction This report covers activities undertaken in the third quarter of Year six of the AFFORD Health Marketing Initiative in Uganda, funded by the United States Agency for International Development (USAID) Cooperative Agreement: 617-A This award was made on September 21, 2005 to The Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP). The AFFORD Health Marketing Initiative that ended its 5 year USAID funded project in September 2010 has received a 3 year extension until September 2013 with the primary responsibility of strengthening UHMG and helping them grow into a sustainable entity AFFORD II as it is known has the primary responsibility during this extension period to ensure that UHMG is strengthened to become sustainable and develops cutting edge competencies in technical, marketing, financial and Institutional areas. AFFORD II through UHMG will continue to consolidate its activities and will focus on the 3 key result areas: Specifically, AFFORD II will build on the foundation of AFFORD I to achieve: 1) Increased organizational sustainability of Uganda Health Marketing Group (UHMG); 2) Increased availability, affordability of health services and products; and 3) Enhanced knowledge for self-efficacy and correct use of health services and healthy practices. This report focuses on the PMI malaria activities that have been undertaken by UHMG/AFFORD during the quarter April June

6 OVERVIEW OF ACTIVITIES IMPLEMENTED DURING THE QUARTER Key activities to strengthen previous achievements in malaria control through the private health sector were planned and implemented during this quarter (April-June 2011). Innovative capacity building and health communication techniques were employed to increase effectiveness and success of the planned activities. Activities, which were implemented during this quarter include: Design and implementation of malaria case management through a multi-channel communication campaign. Demand creation for malaria diagnosis and case management using interpersonal communication through community dialogue meetings Capacity building of malaria case management services through clinical audits and mentoring of health workers at Good Life Clinics and Good Life Shops. Orientation of master trainers and supervisors in malaria control using RDTs and ACTs in case management, pharmaceutical dispensing policies and malaria in pregnancy services delivery. Support the master trainers to conduct quarterly support supervision/mentoring visits Promotion of RDTs and ACTs and increase their availability through the private sector Progress of Malaria Control Activities Through collaboration and involvement of district health teams (DHT), UHMG/AFFORD initiated activities to establish local capacity and ownership of malaria control services. The district health office team; District Health Officer (DHO), Malaria Focal Persons (MFP), District Health Educators (DHE) and other members of the DHT were involved in the implementation of supported activities including community dialogue meetings and home visits in the community. This approach was utilized to enhance district involvement and ownership of the malaria control services, and sustainability of the program achievements. Details of achievements during the quarter are presented in the following sections. 6

7 Below is a summary of achievements against target under each of the 4 result areas: Activity & Performance Indicator/s Quarterly achievements Cumulative Annual Q1 Q2 Q3 Totals Target Objective 1. To strengthen professional associations and private health networks in UHMG supported districts for quality malaria control services delivery Registration of district drug shop associations Objective 2. To strengthen prompt and accurate diagnosis and treatment in the private heath sector Orientation of master trainers for integrated malaria services clinical and dispensing audits Suspected malaria cases seen in GLC 84,705 85, , , ,000 Malaria lab tests done in GLCs - 76,863 97, , ,000 % of suspected malaria lab testing - 89% 95% - 85% Objective 3. To strengthen IPTp services in the private health sector New ANC clients seen in GLC - 9,677 11,140 20,817 30,000 Number of IPT1-4,031 5, ,000 Number of IPT2-2,584 3,089 5,673 15,000 Proportion of IPT2-27% 28% 27% 50% Objective 4. To increase awareness and demand for malaria prevention and treatment services among the target population Number of community dialogue meetings ,282 2,005 4,400 held People reached through community - 19,025 31,224 50,249 88,000 dialogue meetings Radio spots aired Radio talk shows aired Progress on implementation 1. Strengthen district level professional associations and private health sector networks In the previous quarter, UHMG supported the formation of six drug shop associations in six focus districts. During this quarter, UHMG facilitated 5 of the drug shop associations to get registered with the registrar of companies. These associations are seen as viable avenues of promoting access to quality health care through the private sector. Membership registered in these associations is as follows, 22 in Apac, 13 in Ngora, 24 in Katakwi and 30 in Kumi. 2&3- Strengthen prompt, accurate diagnosis and treatment; and IPTp services in the private heath sector During the quarter, 15 out of the targeted 18 master trainers were oriented on MIP, ACTs and RDTs). The training was based on the approved MOH guidelines. During the orientation, practical sessions on rapid diagnostic tests for malaria (RDTm) use were carried out. UHMG guided the master trainers to draw a district specific work plan for subsequent trainings that 7

8 Master trainers were scheduled to facilitate at the learning centers on MIP, ACTs and RDTs for the private sector health care providers from GLC & GLS. Malaria Case management through the Private Health Sector In the previous quarter, UHMG supported malaria case management and malaria in pregnancy (MIP) prevention and control services in the GLC/GLS. Focus was on building capacity for malaria case diagnosis, management and delivery of malaria in pregnancy services. During this quarter, services data collection tools were provided to improve on data collection and reporting. Support supervision was conducted through clinical, and pharmaceutical dispensing audits. UHMG will continue with this same exercise during the 4 th quarter, as a follow up activity for district trainers orientation. Results realized in malaria case management and MIP services during the 3 rd quarter are summarized in the table below. Malaria in Pregnancy (MIP) & Malaria Case Management Services Through GLCs Malaria Control Services Indicator. Q1 Q2 Q3 Cumulative Target Results Suspected malaria cases seen in GLCs 84, , , ,000 Malaria lab tests done in GLCs - 76,863 97, , ,000 % of suspected malaria lab testing - 89% 95% - 85% New ANC clients seen in GLC ,140 20,817 30,000 Number of IPT , ,000 Number of IPT ,089 5,673 15,000 Proportion of IPT2-27% 28% 27% 50% 8

9 4. Increase demand for malaria control services and products During this quarter the communication activities focused on increasing demand for utilisation of malaria services. Emphasis was on increasing knowledge and understanding of the dangers of malaria in pregnancy, children under five years and the community members in general. The availability and accessibility of efficacious malaria diagnosis and treatment, coupled with increased awareness will increase utilisation of malaria services. In addition, malaria control services were integrated in overall health promotion services for MCH, HIV prevention and referrals from the community level to health facilities. Training of district trainers/supervisors on Integrated Malaria and HIV/AIDS Control Services; Maternal & Child Health A 2 day residential training for trainers was conducted. Participants came from all the 6 districts ( Soroti, Kumi, Ngora, Serere, Katakwi and Apac). The training targeted members of the DHT, who in turn trained community resource persons village health team (VHT) members. Members of DHT who participated in this training included; Malaria Focal Persons, District Health Educators, Health Assistants and Health Educators. Community Dialogue Meetings The goal of the community dialogue meetings was to improve knowledge and health behavior of the community members in Malaria management, HIV/AIDS, MCH services so that they are able to demand for appropriate health products and services. The trained community resource persons facilitated community dialogue meetings. These forums serve as a platform for community members to develop practical measures to solve specific health problems in the community These meetings not only covered topics on malaria management but also focused on the linkage between malaria and its effect on people living with HIV/AIDS, and the health and safety of mothers and children. Topics covered Facts on Malaria Importance of malaria laboratory diagnosis management of fevers at household level HIV prevention behavioral approaches: Malaria among PLHAs Malaria in Pregnancy Benefits of HIV testing & recurrent fevers. In total, 24 participants were oriented as supervisors for integrated community dialogue meetings on malaria, HIV/AIDS and MCH services from the six districts. These supervisors in turn trained Village Health Teams (VHT) and offered support supervision during the community dialogue meetings and home visits in the six districts implementing PMI malaria control services. The tables below show numbers reached at each level of this cascaded training: 9

10 Training of VHTs on conducting Integrated Community Dialogue Meetings & Home Visits District Target Actual Percentage. 1 Katakwi % 2 Kumi % 3 Soroti % 4 Apac % 5 Serere % 6 Ngora TOTAL Community dialogue meetings for Malaria Prevention and Case Management District Sub County Meetings Participants Kumi Atutur Soroti Asuret Apac Aduku TOTAL Integrated Community dialogue meetings Distric Sessions Total F M t Soroti 204 5,344 3,113 2,231 Apac 221 5,601 2,963 2,638 Serere 175 4,629 2,403 2,226 Kumi 243 6,281 3,803 2,478 Katak 201 5,194 2,770 2,424 wi TOTAL Subsequent to their training, VHTs conducted community dialogue sessions that focused on HIV/AIDs prevention, malaria control, maternal and child health. As a result, participants of these meetings discussed their health needs in a comprehensive manner. During the community dialogue meetings, Health Assistants and Health Educators supported VHTs in health education to ensure that correct messages were transmitted and provided back up support in responding to difficult questions that VHTs found challenging to answer. 27,049 people were reached which 15,052 females. 10

11 Community Dialogue Meeting Session - Soroti - Integrated Home Visits VHTs were trained and facilitated to conduct home visits in their respective catchment areas. UHMG/AFFORD developed a standard home visit checklist to guide the VHTs during the home visits. The exercise started two weeks after the community dialogue meetings. A total number of 9,068 households were visited by VHTs to verify practical use of knowledge gained during meetings, suggest areas for improvement where they deemed it necessary, and re-enforce messages given during community dialogue meetings. The five districts covered included Kumi, Soroti, Serere, Katakwi and Apac. - Challenges encountered during community dialogue meetings As this was a busy planting season in some districts like Katakwi and Serere, it was difficult to get people to converge in one place. VHTs therefore spent more time conducting house-to-house sessions. In all five districts the population wanted subsidized LLINs which we were unable to provide, this discouraged many from attending community meetings - Lessons Learnt Integrating all the three programs yields greater outputs and reduced operating costs because it is beneficial to the target community and the implementers. Integrating provision of LLINs in this program can increase community involvement and yield better outputs. - Achievements More women were sensitized in all districts compared to men, which is good because women are more vulnerable to malaria, HIV and AIDS and suffer most when it comes to Child & Maternal Health. Furthermore, majority caregivers of under-fives who are most vulnerable to malaria are women. A total number of 2,168 pregnant women were reached during this quarter and linked to the UHMG supported mothers clubs, which will help reduce MIP. 94% of VHTs turned up for malaria management training and also acquired additional knowledge on HIV/AIDS and Maternal & Child Health. Provision of Job aids and stationery made work easier, VHTs were able to follow and take notes during the training. IMPLEMENTING A MULTI-CHANNEL MALARIA COMMUNICATION CAMPAIGN During the quarter, UHMG/FFORD completed designing concepts for the multi-channel malaria campaign and launched the campaign through radio spots, radio talk 11

12 shows, branding facilities with stickers, posters and job aides. This campaign will run for a period of 6 months. 840 radio spots were aired emphasizing the power of day one (importance of seeking early treatment for malaria and getting a blood test prior to treatment). 13 Talk Shows were held on different Radio Stations; TBS Radio for Soroti, Etop Radio for Serere, Continental Radio for Kumi, TBS Radio for Katakwi and Radio Apac for Apac District emphasizing malaria control messages that was given during the sensitization at the community dialogue meetings. Panelists on the talk shows included: DHOs, DHEs, VHTs and representatives from the drug shop Associations. In addition 4,500 posters and 1500 stickers were printed for distribution through GLCs to support the power of day one malaria lab testing and treatment campaign. WORLD MALARIA WEEK COMMEMORATION UHMG/AFFORD chose to commemorate the 4 th World Malaria Day in Teso Sub region where its PMI funded programs are currently being implemented. Soroti district was selected for the commemoration activities. The planned activities included: Free testing and treatment for Malaria; Provision of IPTp using DOTs; Community dialogue meetings; Sensitization of school pupils on malaria prevention; Clinical Audits and Radio talk shows. Three Good Life Clinics were facilitated to conduct free testing and treatment for Malaria. These were: Soroti Medical Associates, Madera Health Centre III and Teso Safe Motherhood. In total 998 patients were tested using RDTs out of which 341 tested positive for malaria. All the 341 patients received free Antimalarials (Lonart) - Achievement A number of tests that were carried out turned out to be negative thus reducing on the indiscriminate use of antimalarials for all fevers. This helped clinicians to understand that not all fevers are malaria. The case World Malaria Day Activities - Soroti 12

13 management focal person Dr. Albert Okwi took time to explain to the health workers the dangers of dispensing antimalarials basing on symptoms. - Challenges A number of patients that presented with symptoms of Malaria got negative tests and were not given Lonart, which annoyed them. These patients were counseled and informed that they could be having other illnesses such as bacterial infections. However the challenge was that these patients did not have the money to seek treatment The proprietors of the selected health centers felt that UHMG/AFFORD should provide compensation for using their facilities because on these two days, no malaria cases were managed by the clinics thus resulting in loss of revenue. However, UHMG supported the above facilities with free SP tablets, water purification tablets (Aquasafe), water dispensers and metallic cups in order for them to provide IPTp using the MoH recommended guidelines of Directly Observed Treatment. During the same week, skills of health workers from participating clinics were further assessed and onsite refresher training based on the identified gaps was provided. In total, 4 clinics and 7 drug shops were visited and 11 Health workers benefited from this exercise, especially on using RDTs, ACTs and IPTp. - Challenges All the facilities visited lacked job aides for malaria management and the health workers had not been exposed to any kind of CME. The issue of self-medication among the public is still a major problem. 5. PLANS FOR NEXT QUARTER Malaria activities In the next quarter, (July - Sep 2011), UHMG/AFFORD will build on accomplishments of the previous quarters, and further strengthen malaria prevention and case management services in the private sector. Support supervision will be intensified to ensure that health workers and facilities are grounded in new approaches to malaria case management. UHMG will support activities at community level and provider level. Highlights of planned activities are listed below. Multi-channel malaria campaign, which was launched at the end of last quarter, will continue into the fourth quarter. 13

14 UHMG/AFFORD will facilitate national level medical practitioners and mid-wives to provide mentorship for strengthening district networks in the private health sector Support the district level task force to supervise, mentor and collect data on malaria services supported Signing of Memorandum of Understanding (MoUs) with selected good life clinics and drug shops Support the district task force to conduct quarterly support supervision/mentoring visits to GLC Promote RDTs and ACTs and increase availability through the private sector. During the quarter, master trainers trained in conducting clinical audits at GLCs and DS will train 171 health workers from Good life clinics on MIP, & 143 health workers from Good life drug shops on malaria case management using RDTs and ACTs. Conduct dispensing audits in 120 accredited drug shops in the selected districts END OF REPORT 14