Who moved my antimalarial?

Bill Okaka

Knowledge Management & Communications Officer, ASSIST Kenya

Dr. Abiud Machuki (center) of Khunyangu facility explains to clients new directives on dealing with malaria cases. Sign reads: Attention! Anti-malarials will be issued strictly with confirmed RDT/BS results except prophylaxis for ANC mothers. All other drugs will be issued on prescription from a qualified health worker. (Bill Okaka)

“Since 1991, I have enjoyed free malaria treatment with full prescription of antimalarial. I have noticed, and with concern, that this has stopped. As much as I am made to understand that it is the new directive, I am not happy with it. I really want the old system back,” stated a concerned mother who had brought her daughter for treatment, while her counterpart stood by to confirm their position.

As I interviewed two women from the Khunyangu sub-County health facility catchment, their strong position reminded me of the book, “Who Moved My Cheese” by Spencer Johnson. The book uses a simple parabel to illustrate dealing with change. Metaphorically, these women can be seen as the protagonists, ‘sniff’ and ‘scurry,’ who are used to the free flow of anti-malaria pills. On the other hand, a new ASSIST-initiated Work Improvement Team (WIT) represents a push for a new strategy.

Located in the western part of Kenya, in Busia County, Khunyangu is considered a high malaria transmission zone.  As medical anthropologists put it, there is a way health and illness are shaped, experienced, and understood in light of global, historical, and political forces – in essence, there are social determinants of health that cannot be wished away.

It goes without saying that my borrowed characters (i.e. woman 1 - ‘sniff’ and woman 2 - ‘scurry’) have likely experienced deaths of loved ones caused by malarial outbreaks that were not responded to. In return, and with dare need to save lives, the ‘dishing’ of pills by health workers became a norm.

In accelerating the effort to improve health outcomes, a turnaround was achieved after a Quality Improvement (QI) training by ASSIST project, facilitated by USAID – giving life to a new theory of change. The QI packaged encompassed increasing malaria case management through the 3Ts: Test, Treat and Track.

Rational use of ACTs saves 58.8% of yearly supply

Specifically, it strategically inducted the WIT to increase testing of every suspected malaria patient through malaria rapid diagnostic tests (mRDTs) and microscopy, and increase treatment of confirmed malaria cases by providing anti-malarial based on National Malaria Guide-lines. In addition, the WIT improved tracking of malaria case management through national surveillance systems, and fostered malaria commodity management through essential commodity management in the focus counties.

The WIT acknowledged that rational use of anti-malarial ensures availability of commodities for treatment and prevention of malaria, and that, appropriate and effective use of these commodities produces efficiency in service delivery. The WIT also defined dispensing of ACTs regardless of malaria diagnostic test results as irrational.

To reach patients, the WIT at Khunyangu now involve them in understanding the changes and how beneficial it is to them. At the frontline is the health talks and posters on the wall on keeping safe, testing for malaria and treatment adherence – all patients at the outpatient department are reached, while internally, continuous medical education to health workers reinforces aspects of the 3Ts.

Also, borrowing from a Centre of Excellence (i.e. Bumala B Health Center), Khunyangu will start using the ‘magic stamp’ – as a strategy of ensuring that patients are entered in the register at registry, where they receive a ‘magic stamp’ to signify that their final diagnosis has been recorded before going to the pharmacy.

Khunyangu continues to explore possibilities of reaching communities to change the long-standing perception through health days and other public forums by extending the WIT arm through community health volunteers. ‘Cheese Station N,’ as in the book, is finally here for Khunyangu’s ‘sniff’ and ‘scurry’ characters who now enjoy a better life. 

Contributing writers: Samwel Otieno Owuor (Project Officer), and Dr. Abiud Machuki (Busia Sub-County Pharmacist). 

Read more: This case study narrates how Khunyangu Sub-County Hospital saved 58.8% of their yearly supply of ACTs as a result of rational use.

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