King’s College London Sierra Leone Partnership
Strengthening Health Systems to Improve Fever Management (SHIFT)
The estimated number of malaria cases and deaths in Sierra Leone decreased from 2010–2018. Still, with an estimated 2.4 million cases in 2018, malaria remains a serious public health risk in the country. The entire population is at risk of the disease, but pregnant women and children under five years old are most affected – malaria is the leading cause of death for children under five.
Over 2,240,000 hospital visits are attributable to malaria each year in Sierra Leone. King’s Global Health Partnerships Sierra Leone works with health facilities, academic institutions, and the Government of Sierra Leone to strengthen the health system and improve the quality of care in Sierra Leone. The SHIFT project, which began in September 2017, used a health system strengthening approach to build capacity, skills and processes at Connaught Hospital, the busiest hospital in the country.
KGHP’s multidisciplinary team has supported a range of areas across the hospital, including clinical support, monitoring and evaluation, supply chain management, patient support and advocacy and laboratory capacity building. The project was completed in close collaboration with the Ministry of Health and Sanitation (MoHS) and the National Malaria Control Programme (NMCP).
The quality of malaria care has improved considerably at Connaught Hospital as a result of the SHIFT project. Nurses have a steady supply of RDT tests to diagnose patients; doctors have the confidence to differentiate between malaria and other diseases; and patients can be more confident about the diagnosis and treatment given to them at Connaught Hospital. Diagnosis and treatment have improved. Lives have been saved.
The value of a multidisciplinary team
This was the is most valuable learning from the project. Improvements in data collection and analysis was the product of the technical expertise of laboratory scientists and IT managers. Improvements to the patient experience required an understanding of the hospital holistically, including nursing and doctor practice and patient flow. The project also learned that it’s not always essential to have specific technical experts in every area – resourcing the stock management system with health system professionals, not pharmacists, still delivered big improvements in stock management.
Adaptability was key, best demonstrated in the Covid-19 pandemic. The project supported new areas of work but maintained their core activities. The project shifted from face-to-face patient support to remote psychosocial support for patients isolated in the Covid-19 unit. RDTs were used to differentiate Covid-19 patients from malaria patients. They ran substantial training on the new disease and conducted a hospital needs assessment.
92% of patients with confirmed malaria receive first line treatment (an increase of 47%)
600+ junior doctors, nurses, lab technicians, pharmacists and surveillance officers at Connaught Hospital trained and mentored
97% of nurses and doctors surveyed were able to correctly identify first-line antimalarial medication, as a result of the SHIFT project
95% of nurses, doctors and laboratory staff that said that the impact of SHIFT project on malaria management and diagnosis was ‘positive’ or ‘very positive’