IRC (International Rescue Committee)
Incentivising private providers in Sierra Leone for malaria testing and effective treatment
While malaria testing and treatment has improved in many public health facilities in Sierra Leone, people who seek treatment from private pharmacies and drug shops can still receive poor care. They’re often not tested before being sold malaria drugs and the drugs supplied may be ineffective or poor quality.
This project aimed to train private outlet staff to test before providing treatment. It also aimed to link providers to improved supply chains to ensure regular access to good quality malaria drugs through collaboration with the National Pharmaceutical Board (NPB) and Ministry of Health and Sanitation (MOHS).
The project sought to research the effects of training, coaching and free malaria tests and drugs on malaria care from private vendors. Malaria data from private drug sellers was to be reported to public health authorities, bringing public and private sector data together under the guidance of the Ministry of Health and Sanitation.
The IRC’s health project trained 76 providers from 38 private outlet staffs in the Western Urban Area to test people before treating them and supply good quality malaria drugs. The intervention included training, coaching and providing free malaria test kits for the caregivers of sick children to enhance the 3T’s (test, treat, track).
Key successes and learnings
The project helped lead to a greater understanding of the quality of care for malaria case management at selected pharmacies and drugstores in the Western Urban Area and among the general population.
An external evaluation found that the project was successfully designed but could have been better controlled and monitored for greater effectiveness as mystery shopper data showed that strict monitoring was required for the habit to become ingrained. In 42% of outlets, provider staff complained about the time it took to administer tests and felt that they were offering more service than they are ordinarily paid to do.
The evaluation also discovered that the impact was high on information availability but low on actual testing habits. In more than half of the beneficiary drug stores, testing was not routinely offered until the evaluation was well under way. According to the results of the two mystery shopper exercises, 56% of cases where customers presented with a fever, they were not offered a test before treatment was administered.