Sustainability and Cost of Home-Based Management of Malaria in Children Under Five Years in Ejisu-Juaben Municipality, Ghana.

Abstract

Malaria, one of the world's most common and serious tropical diseases, causes at least one million deaths every year. This proportion increases each year because of deteriorating health systems, growing drug and insecticide resistance, climate change, natural disasters and armed conflicts. In Ghana however, statistics shows that one in five childhood deaths is as a result of malaria. The cost of treatment of malaria alone is crippling the health budget, in that in 2007 alone the cost of treating malaria amounted to about US $772 million. HBMM was introduced to ensure prompt and effective treatment of malaria at the household level. The potency of HBMM has been established but little was known about the cost and sustainability of HBMM. A cross sectional study involving the use of quantitative and qualitative surveys with caregivers, community medicine distributors (CMDs) was designed and implemented from July-September 2010. The study involved a population sample of 500 people. Questionnaires were administered for data collection. Data was entered and analyzed with SPSS. Female CMDs dominated and affordability of HBMM was associated with the type of occupation; traders could afford price range of GHp10 to GHp20 while majority of the farmers could afford it at GHp5. Supplies and incentives to CMDs were the two key factors influencing cost of HBMM. Cost incurred in accessing HBMM was less as compared to the one sought from the health facilities. The study revealed that the sustainability of HBMM is bleak as the upkeep of volunteers; their kits, incentives, communal support and ownership remained unknown. Perceptions about who owns HBMM were mixed. There is attrition among CMDs and could affect smooth implementation of HBMM. Delays in supplies, unattractive CMDs’ incentives and cost were the barriers to the implementation and sustainability of the HBMM. The monthly allowances giving to the CMDs compared to the national salary wage was far less. The CMDs lose more money for being on HBMM programme than they would have received if they were working elsewhere. Efforts should be made to increase community ownership of HBMM, supervisory visit, improve CMDs incentives, and early supplies of medicines and logistics in HBMM.