Sustainability of Intervention for Home Management of Malaria: The Nigerian Experience

Abstract

Background: An important challenge to community-based intervention is sustainability. This study evaluated sustainability of an intervention to improve Home Management of Malaria (HMM) in Ona-Ara Local Government Area of Oyo State, Nigeria two years after end of intervention. Methods: A total of 13 FGDs was conducted among trained Community Medicine Distributors (CMDs), mothers of children aged 0-5 years and community members; 14 Key Informant Interviews were held with community leaders, Primary Health Care (PHC) Coordinator and Rollback Malaria Manager.Observation was carried out on 13 CMDs to check AL stock and registers. Thematic approach was used to analysed the data. Results: Utilization of CMDs was said to be high when the project started but dwindled after the researchers left the community. Some of the CMDs have not had drug to distribute in the two years preceding this study. Thus, majority of the caregivers sought care at other alternative care providers or used herbs. While some CMDs have abandoned the assignment, a few continued to provide care to febrile children as their own contribution to the good of the community. The functioning CMDs prescribed paracetamol, sulfadoxine-pyrimethamine, amoxycillin and chloroquine when out of AL stock or referto PHC center. Source of AL was still the nearest government health facilitiesbut supply was irregular and hindered by incessant transfer of trained health workers. All the CMDs mentioned they did not receive any support from the community as promised and this wascorroborated by community members/leaders and health facility workers. None of the CMDs observed had AL in stock orrecord of patronage in the last one year. They mentioned that health centres have not had AL stockedin recent times. Conclusion: Mechanisms to draw unflinching commitments from the government and community to sustain community-based intervention, the major sustainability challenge identified in this study, should be explored.