A comparative analysis of malaria control programmes targeting delivery of over-the-counter anti-malarial drugs in Kenya.

Abstract

Background: The retail sector is an important channel for increasing access to adequate treatment of fevers in Africa. The objectives of the thesis were to assess the performance of three malaria control programmes targeting private medicine retailers (PMRs) by addressing coverage, utilisation, impact on PMRs' knowledge, practices and implementation processes in Kisii central, Kwale and Bungoma districts of Kenya. Methods: The thesis used mixed methods including retail audits, surrogate client surveys based on post intervention cross sectional surveys in intervention and controls and mapping of outlets in intervention areas. Qualitative methods including record reviews, in-depth interviews and focus group discussions with programme stakeholders were analysed using thematic framework and policy analysis. Results: There was a significant impact on PMR knowledge and practice of an NGO-led participatory training programme in Kisii-central district with 60.5% of trained PMRs selling AQ medicines adequately compared to 2.8% in the untrained ones (OR; 53.5: 95% CI 6.7, 428.3). There was some evidence of a limited impact for the MoH-led participatory training programme in the Kwale district, where 18.8% of trained PMRs sold AQ medicines adequately compared to 2.3% of control PMRs (OR; 9.4: 95% CI 1.1, 83.7). This study was unable to show evidence of impact in the social marketing programme in Bungoma district. In terms of coverage, Kisii central covered 27.1% of all outlets in the study sites, compared to 14.1% and 16.7% in Kwale and Bungoma districts, respectively. Policy analysis indicated that, deliberate and careful management of the implementation process, actors involved and establishing a transparent management system with a flexible decision-making processes, is key to successful uptake and impact at retailer level. Conclusions: PMR interventions operationalised through various institutions in the district level settings at moderate scale are likely to impact on PMR knowledge and practices and lead to increased coverage of appropriate treatment to target populations. Implementation management play a major role in determining programme impact, and should be areas of focus in planning and managing public health programmes.