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  • HOW CAN MOSQUITOES BE CONTROLLED?

    Mosquitoes around the home can be reduced significantly by minimizing the amount of standing water available for mosquito breeding. Residents are urged to reduce standing water around the home in a variety of ways.

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    The best way is to avoid being bitten by mosquitoes.This can be accomplished using personal protecting  while outdoors when mosquitoes are present. Treated bed nets should be used sleeping. Mosquito repellent should be used when outdoor.

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    Nearly half of the world’s population is at risk of getting malaria. Pregnant women are particularly at risk of malaria. Children under 5 years are at high risk of malaria.
     

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OUT OF STOCK

Imagine you have malaria and reported to a health facility, only to realise that there is no antimalarial available at the facility  for your  treatment.  A  serious problem with dire consequences, without
a doubt!

But sadly, this is the situation bedevilling some health facilities in Africa as a result of stock-outs of malaria medicines. There is an absence of information on stock-outs in Africa  and this is potentially a large problem and the surveys that collect this information are  not  done  frequently, according to experts.

“The problem is that  we actually  don't measure the stock-outs. Even when we do, we find out there are a lot of stock-outs. And we are not documenting the availability of drugs, whether it is malaria drugs or any other drug. So if you do a study across Africa to try to find out what is the stock-out rate of drugs, you can't really find any information. Just five or six countries in the last four or five years have published any information about  stock-outs of essential medicines in Africa” says Don de Savigny, a  Professor of Health Systems  and  Policies  Research at  the Swiss Tropical and Public Health Institute.

Not only is this the problem, but according to  Prof de Savigny, there  is even a difficulty with the  definition  of “stock- out”.

“There is no standard  way to  measure stock-outs  to  compare  across time  or across places.  We really don't know the magnitude of the problem of stock-outs of  antimalarials and of other  essential health commodities,” he added.

In order to address this problem, there is a new initiative known as SMS for Life where a few African countries have put in place stock tracking  systems  using  mobile phones which record every week the stock situations for malarial drugs. This has been  piloted in Tanzania, Kenya, Ghana, Democratic  Republic  of Congo  and Cameroon.

In  Ghana the  pilot  took place in  five districts. And there is talk about the Ghana Health Service scaling it up.  In Tanzania, the pilot is completed and the Tanzania Ministry of Health and  Social Welfare implemented the system at full national scale across over 5,000 health facilities.

“SMS for life was an idea to exploit the revolution of ICT technology through the use of mobile phones to try to find a way to make real time reporting and visualisation of  information. So we have maps, tables,  graphics to  communicate  the meaning easily but the most  important thing is that it is in real time. So, like in Tanzania, we can know exactly how many doses of drugs are in a health facility last week, not six months ago, and then you have a chance to act” says Prof de Savigny.

He said Tanzania is doing a nation-wide coverage involving every health facility in the country sending reports every week on antimalarial stocks.

The government and private sectors have been doing so for over two  years and documenting important stock-out rates, which show that from a current 10 per cent to  an  original 40  per cent of the health facilities have no antimalarial drugs at different points of times of the year.

In the parts of the country where there is the highest prevalence of malaria, these have the most stock-outs and the longest stock-outs.

“So stock-outs may last from a few weeks to as long as 10 to 12 weeks during which time there is no treatment available for anyone with malaria at that health facility. That is a serious problem and we didn't know  it was that  big  until we started measuring it and unfortunately, routinely health  systems  don't  measure  these things” he explained.

He said the  Global Fund for  example which pays for most of the HIV, Tuberculosis and malaria drugs until recently did not  actually  require  the  countries  to report on stock-out rate.

Asked  why there  is  such  infrequent documentation  of  stock-outs,  Prof de Savigny said “well I think it is a neglected health system issue. We have neglected diseases but in the health system we also have neglected issues.”

He explained that drugs and salaries were what most of the money goes into at the Ministry of Health and so if it is the largest cost centre of the  system, there  is the need to  track  what  happens to  those drugs.

“Do drugs reach the  people who  need them  most?  Where and when  do they need them? That's the best indicator of your health system.”

Prof de  Savigny  likened  the  health systems  to  patients  and  said  health systems are like patients – they also have illnesses  and  interventions  that  are needed”.

He said one of the problems is stock and flow – how to  manage  procurement supply chains that  work in the  public sector. He said the private sector does a good job in supply chain because if not, they will  go out of business but “when public sector supply chain fails, business goes  on;  patients  are  not  served and health workers are not provided for, and that  erodes the  confidence of  both the public and the system itself.”

“If you need a life-saving drug and when you go, it should be there but it's not there – that's a system failure and we have to understand  why that  system has  failed and fix it because it doesn't matter how well a health worker is trained or how nice the building is, if you don't have the tools to work then there is a serious problem.”

He said it was important for governments to  determine what  percentage  of the health  budget  should be for drugs and what percentage should be spent to make sure the drugs are where they should be; that the supply chains are working and are not broken and continue to take care of the needs of the population.

“Even the international community has never sat down to say let's make a well- defined indicator and track it. If you don't measure something, you can't manage it. This is something we are not measuring and, therefore,  not  managing,  even though  it is a  big piece of the  health system,” he said.

Asked if there was any success story to share since the SMS for Life project took off, Prof de Savigny said  unfortunately there was none to tell  at the  moment. Stock-outs continue.

“The first stage is to measure and then to act. So measurements  are starting  and action has not  really kicked in  because stock-outs  have continued;  we know more  about  them  and  they continue, which  suggests that  the  problem is  a complex problem.  In each country the problem may have many different causes and different solutions, so it's a big issue. We need to put this on the table and start thinking  seriously  both  nationally  and globally,” he added.

The  Director  of the  Dodowa  Health Research Centre, Dr Margaret Gyapong, shares Prof De Savigny's sentiments. She said maintaining adequate supply of anti-malarial medicines at health facilities in Ghana  has  been  a  major  barrier  to effective management of the disease.

“Stock-out of malaria drugs is a problem at  the  health  facility level  in Ghana especially in remote areas which makes patients have limited access to the life-saving drug” she noted.
 
The effect she said was that patients may lose confidence in the  health  system's ability to meet their needs and this may account  for higher  number of patients self-treating malaria.
 
According to Dr Gyapong, the SMS for Life demonstrates  the  visibility of  weekly stock levels of ACT, RDT and amoxicillin at the health facilities in communities and will promote  action to eliminate stock-outs or a meliorate them, thereby significantly improving access to essential medicines.  Sharing  her  experience,  Dr Gyapong, said the  SMS for Life  is  an initiative of NOVARTIS and following the Tanzania experience, it was implemented in six pilot districts in Ghana by the three Health  Research  Centres  located  inDodowa, Kintampo and Navrongo.

“The main aim was to help tackle the anti- malaria  supply chain  challenges and improve the in-country supply, planning and access to ACTs by harnessing everyday electronic communication tools and  mapping technology to  improve information  exchange  and  to  bring visibility to stock levels of ACTs in the pilot health facilities” she said.

Dr Gyapong said the participating health facilities underwent the processes to send out weekly SMS on their drug stock levels. “There was a registration of health facility mobile  phones  and  locations  at  a live training sessions, as well as weekly stock level request SMS sent to all participating health  facility  workers.  Health facility workers counted ACTs, RDTs and Amoxicillin  stock  levels and  composed stock level  SMS  and  send stock count SMS. The system sends reminder SMS to all participating health facility workers.”

“The system credits health facility mobile phones which submitted a stock level SMS correctly. The system  provides  weekly status  report to the  District Director of Health Services.”

Following the successful implementation, she said the Greater Accra region is using the system to monitor blood stock levels in blood banks in the regions. The system is yet to be scaled-up in the entire country.

BY BECKY KWEI - GHANA

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