Clinton Health Access Initiative
In Tanzania, 90% of the population live in areas at risk of malaria and each year 10 to 12 million people contract the disease, which is preventable and treatable, with children under five and pregnant women most at risk. Not all fevers are caused by malaria. For this reason, people with fever should be tested to confirm if they have malaria before taking treatment. However, malaria tests are not carried out in private drug stores, (rather than licensed public pharmacies) where many people seek care for fever.
CHAI Tanzania’s project sought to dramatically increase access to high quality care for malaria, pneumonia, and diarrhea (two other common problems that cause fever) by improving the capacity of accredited drug dispensing outlets (ADDOs) to diagnose, treat, make referrals and track these conditions. The project also aimed to improve malaria testing within autonomous laboratories.
To ensure that the ADDOs could effectively treat patients and encourage demand for medication, the ADDOs were provided with information on where they could purchase high-quality, low-cost medicines. The ADDOs and laboratories were also trained on reporting data on malaria, pneumonia, and diarrhea to the integrated surveillance system.
CHAI developed a mobile-based surveillance system so that important data could be captured easily by the ADDOs and laboratories using mobile phones and shared at speed with the Ministry of Health to help them make more informed decisions about the action needed to fight the disease. As it was so successful, the surveillance system was expanded to four more regions. Therefore, the project led to an increase in the visibility of data on malaria from private healthcare providers.
As a result of the project, ADDOs and autonomous laboratories were better able to provide high quality febrile illness management. This was demonstrated by the ADDOs’ adherence to national guidelines for diagnosis and treatment of malaria, pneumonia, and diarrhoea, especially for children under five. Within the autonomous labs, the project observed an increase in malaria test accountability and a move away from using non-calibrated microscopy to using more mRDT — a more accurate and reliable test for malaria. Lastly, the project contributed to the empowerment of women as over 60% of the ADDO dispensers reached were women.
Provide feedback on performance to improve surveillance systems
The project found that integrating an automated feedback mechanism within the surveillance system can improve the practice of healthcare providers such as in terms of providing good quality data and making appropriate referrals.
Ensure that surveillance data is used at all administrative levels
National, regional and at council –to increase ‘buy-in’ and visibility of findings, and to better enable comprehensive decision making and health planning.
The proportion of trained ADDO dispensers that provided a referral to a patient with a danger sign increased from 5% to 97% at.
The proportion of trained lab technicians who can correctly perform and interpret microscopy/blood slides for malaria testing increased from 27% to 88%.
The availability of targeted medicines i.e., ACTs, Amox-DT and Zinc/ORS increased from 5% to 40%.