The Role of the Pharmaceutical Sector in Malaria Control in Ghana (original) (raw)

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Background: Malaria is endemic in Ghana, and contributes significantly to infant and maternal deaths, as well as to loss of disability adjusted life years. The pharmaceutical sector and in particular the medicine outlets has been identified as accessible units in the health system, where public health initiatives could be targeted to facilitate greater access to interventions for prevention and control of malaria. This study was aimed at assessing medicine outlets and their staff in both public and private sector facilities in Ghana, and how their activities conformed to global and national initiatives for malaria control. Materials and Methods: A preliminary study on the appropriateness of self care and health facilities based management of malaria, and the role played by medicine outlets staff in the supply and utilisation of anti-malarials, was done in a well resourced rural hospital and a city based polyclinic in Southern Ghana. After which an indicator-based assessment of the infrastructure and settings for pharmaceutical services, the staff and material resources and practices for malaria control was done, in a cross section of medicine outlets (n=130) selected from hospitals/clinics and community-based retail outlets in Northern and Southern Ghana. The study indicators were based on international and national standards for pharmaceutical services, as well as the roll back malaria and national policy initiatives for malaria control. Results: The preliminary study indicated high prevalence of inappropriate use of anti-malarials among those who attempted self care before visiting the health facilities, consequently resulting in severe and complicated malaria conditions that were managed appropriately in the health facilities. The later study showed that the infrastructure and practice settings assessed were satisfactory, but could be further improved and utilized as supplementary or alternative channels to facilitate access to effective interventions for malaria control. On the availability and supply of medicines for malaria therapy; nonpolicy recommended and mostly ineffective anti-malarials were observed to be highly available and often supplied for malaria therapy, particularly in the retail outlets. The availability of policy-recommended medicines and in particular the artemisinin-based combination products, were rather poor. In addition very few of the outlets (less than 10%) strictly adhered to policy recommendations for the selection and supply of medicines for malaria therapy. On the staff resources; greater than 55% had no professional training as pharmaceutical service providers. The hospitals/clinics had more professional staff per outlet than those in the retail sector. Majority of the staff assessed (over 80%), which included both professionals and non professionals could recognise malaria illness and also advice clients on how to avoid further infections. However, very few (20%) and mainly professionals were adequately skilled to both recognise and manage the malaria cases as recommended by national guidelines. Conclusions: The infrastructure and settings in most of the outlets were satisfactory for pharmaceutical services. However, there were significant shortfalls, regarding the availability and supply of effective medicines for malaria control. Also majority of the staff assessed were inadequately skilled to appropriately manage malaria cases. Pragmatic education and regulatory interventions should be directed CONTENTS 1 INTRODUCTION 2 BACKGROUND 2.1 Health and health care challenges in sub-Saharan Africa 2.2 Pharmaceutical services and health in Societies in sub-Saharan Africa 2.3 Health policy of Ghana 2.4 Health systems in Ghana and organisation of health services 2.5 Regulation of health and pharmaceutical services 2.6 The pharmaceutical sector and services in medicine outlets 2.7 Medicines supply management chain 2.8 Pharmacy education and manpower issues 3 MALARIA AS A PUBLIC HEALTH PROBLEM 3.1 Life cycle of malaria infection 3.2 Symptoms of malaria 3.3 Global burden of malaria and malaria in sub-Saharan Africa 3.4 Impact of malaria on well-being and socioeconomic development 3.5 Global strategies for prevention and control of malaria 3.6 Malaria control in Ghana and the role of medicine outlet practitioners 4 AIMS AND OBJECTIVES OF THE STUDY 5 MATERIALS AND METHODS 5.1 Context of the study 5.2 Overview of methods used and study design 5.3 Self care and health facilities-based management of malaria (I) 5.3.1 Study setting and participants 5.3.2 Data collection and analysis 5.4 Assessments of the pharmaceutical settings and practices for malaria control (IIIV) 5.4.1 Sampling of facilities 5.4.2 Indicators for assessments of the pharmaceutical settings and malaria control practices 5.5 Data collection (II-IV) 5.5.1 Infrastructure and settings for pharmaceutical services 5.5.2 Availability and supply of medicines for chemotherapy and malaria prevention in pregnancy (IPTp) 5.5.3 Human resources in the outlets, their knowledge, skills and practices for malaria control 5.6 Coding of data and data analysis 6 RESULTS 6.1 Self care and the health facilities-based management of malaria (I) 6.1.1 Self-care for malaria and appropriateness of use of anti-malarials 6.1.2 Malaria therapy at the health facilities and therapeutic outcomes 6.2 Assessment of the infrastructure and settings for pharmaceutical services (IV) 6.2.1 Diagnostics, dispensing tools and packaging of anti-malarials 6.2.2 Medicine outlet records, tools for communication and reference literature 6.3 The availability of medicines for malaria chemotherapy and IPTp (II) 6.3.1 Non policy recommended medicines and anti-malarials not registered with FDB 6.3.2 Policy recommended medicines 6.3.3 Other commodities stocked for mosquito control in the outlets 6.3.4 Adherence to policy recommendations when supplying medicines 6.4 The staff resources, their knowledge and practices for malaria therapy (III) 6.4.1 Staff resources in the outlets and their professional status 6.4.2 Knowledge, skills and practices of staff for malaria therapy 7 DISCUSSION 7.1 Appropriateness of self-care and the role of medicine outlets 7.2 Infrastructure and the settings for pharmaceutical services (IV) 7.2.1 Packaging and dispensing of anti-malarials 7.2.2 Tools to aid the identification of malaria cases and optimization of anti-malaria therapy 7.2.3 Records maintained in medicine outlets and tools for communication 7.2.4 Reference materials and its relevance to pharmaceutical services 7.3 Availability and accessibility of medicines and other commodities 87 7.3.1 Malaria prevention 7.3.2 Malaria treatment 7.3.3 Adherence to policy when choosing anti-malarials for chemotherapy or IPTp 7.4 Staff resources and their training as pharmaceutical service providers 7.4.1 Knowledge, skills and practices of staff for malaria control 7.5 Methodological considerations and limitations 8 CONCLUSIONS 8.1 Policy implications and applicability of study findings 9 RECOMMENDATIONS FOR FURTHER RESEARCH 100