The Malaria Fact Card Project: Empowering pharmacists for malaria prevention

1. The Malaria Fact Card Project Authors: Bell CA, Bell JA, Hoek AJM, Ondari C A Collaborative Project was undertaken by The Commonwealth Pharmaceutical Association (CPA), The International Pharmaceutical Federation (FIP), and The World Health Organization (WHO). The Malaria Task Group comprised members of the above organisations and was responsible for overall management of the Project. At the country level, the project was implemented by national pharmaceutical societies, and co-ordinated by CPA. Problem Statement: At its inaugural meeting during the FIP Congress in Vienna in August 2000, the CPA/FIP/WHO Malaria Task Group recognised that pharmacists could and should play a more pro-active and co-ordinated role in the prevention and treatment of malaria, given the alarming global statistics relating to the disease and the enormous economic burden and the tragedy of human suffering, especially in the high risk groups of children under five years of age and pregnant women. Objectives: The Malaria Task Group decided that the highest priority was prevention of malaria through provision of consumer information. Its aim, therefore, was to provide pharmacists with the skills and resources to develop, produce and implement intervention strategies which would enable them to contribute effectively to the prevention of the disease in both the rural and urban areas of malaria-endemic countries. Design: The project centred around a “mix of intervention strategies”consisting of two major communication tools which were relatively inexpensive to produce and easily adaptable to suit the local conditions: 1.Malaria Fact Cards for use in urban areas; and 2.Flip Charts or Pictograms for use in rural areas. The project has focussed to date on the Malaria Fact Card. Malaria Flip Charts will form Phase 2 of the project. The Fact Card Project was designed to work on three levels: 1. by providing easily accessible consumer health information through pharmacies and clinics; 2. by using pharmacists’skills as communicators and educators as well as medication providers; 3. by promoting the role of professional organisations within health infrastructures. The time for design, development, implementation and evaluation in each country was estimated at two years. Project Settings: After successfully piloting the project in Zimbabwe in 2001, the Malaria Fact Card project has since been implemented by the Pharmaceutical Societies of Tanzania and Ghana. Outcome Measures: Project outcomes were evaluated on three levels: 1. Pharmacists’ Focus Group, 2. Consumer Survey, 3. Organisations Focus Group. Results revealed improved consumer understanding of the use of malaria medications, increased awareness of prevention strategies and early treatment. Pharmacists reported greater patient/pharmacist interaction and greater recognition of pharmacists’ knowledge and advice. Conclusions: The project has enormous potential to develop further as a self-sustaining consumer health education program. The fact card is developed through collaboration between the research and practice arms of the profession, distributed by pharmacists and healthcare workers in pharmacies and clinics, and resourced through public/private partnerships. Study Funding: CPA, FIP

2. Background The Malaria Task Group first met in August, 2000. It consisted of representatives from: • The Commonwealth Pharmaceutical Association (CPA) • The International Pharmaceutical Federation (FIP) • The World Health Organization (WHO) The Group agreed that pharmacists should play a more pro-active role in the prevention and treatment of malaria. The chosen intervention would need to meet the following criteria: • Easy access to information at community level, • Compatibility with national Treatment Guidelines and resource constraints, • Easy integration into existing health infrastructures. The chosen intervention strategy, a consumer health education program, focused on distribution of a “Malaria Fact Card”[1], initially to a target group. The Card would be designed by pharmacist members of national professional organisations and distributed through community pharmacies and clinics. [1] Based on the Self Care Fact Card concept developed by the Pharmaceutical Society of Australia.

3. Project Aim The Group aimed to disseminate reliable and relevant consumer information on the prevention and early treatment of malaria in various malaria-endemic regions. Advantages of The Malaria Fact Card • Easily adaptable to local needs and conditions • Inexpensive to produce and amend • Easily accessible by a wide community • Easy to translate into local languages • Excellent training tool for non-qualified workers • Excellent communication tool between pharmacist and patient/consumer Advantages of Pharmacy Distribution Network • Pharmacist skills in communication • Pharmacist commitment to communities • Community respect for pharmacists & their advice • Accessibility of pharmacies and clinics to district level • Fact Cards available at no charge to consumers

4. Implementation in Zimbabwe Zimbabwe – location for pilot project The Pharmaceutical Society of Zimbabwe began work on the project in August 2000. The target group, highly literate urban dwellers, were accustomed to accessing health information through pharmacies. Collaboration at organisational level Information for the Card was researched through collaboration with the Ministry of Health. Printing and distribution of the Card was sponsored by industry and community pharmacy organisations. Promotional Events to Launch the Fact Card The card was launched by Ministry officials during Malaria Month, March 2001 and was accompanied by extensive media coverage in major urban centres. Outcomes The Card has been incorporated into the Ministry’s public awareness campaigns on malaria. The Card has become the template for consumer information leaflets on HIV/AIDS and Bilharzia.

5. Implementation in Ghana The Pharmaceutical Society of Ghana (PSGH) commenced the project in 2001, aware that malaria was a serious health concern throughout Ghana at all times of the year and in all age groups. Focus on training PSGH focused efforts and resources on training large numbers of pharmacists in the use of the Card. Pharmacists trained other healthcare workers who also distributed the Card. Focus on Access PSGH distributed the Card to pharmacies, clinics, & licensed chemical sellers to provide the greatest possible access to the Card. Official Support for the Card The Card was launched in a regional capital by the Deputy Minister of Health during Malaria Awareness Week in September 2002. Outcomes The card is now printed in six local languages.

6. Implementation in Tanzania The Pharmaceutical Society of Tanzania (PST) began the project in June 2001. Printed in Swahili, the Card was launched by the Prime Minister of Tanzania in September 2002. The Card was endorsed by the National Malaria Control Board. Focus on prevention Lack of knowledge of malaria transmission among the target group of low income urban dwellers encouraged the PST to highlight prevention methods on the Card. Focus on early treatment Cost of medications to low income families influenced the PST to include a medication dosage chart on the Card. Appropriate action should side effects occur was also included on the Card, to allay consumer fears during changes to the Government’s Treatment Guidelines. Outcomes The card is also being distributed through Care International Maternal & Child Health Clinics.

7. Evaluation of the Malaria Fact Card Project in Tanzania (1) A participatory evaluation was undertaken in January/February 2004 using a purpose designed Evaluation Manual. Method The evaluation focused on the outcomes reported by participating organisations, distributing pharmacists and consumers and consisted of: • Organisations Focus Group • Pharmacists Focus Group • Consumer Survey * *Final year students from the Muhimbili School of Pharmacy in Dar-es-Salaam assisted with the survey using it as a practical exercise in their Health Promotion studies.

8. Evaluation of the Malaria Fact Card Project in Tanzania (2) RESULTS Organisations Focus Group All five collaborating organisations, including the Ministry of Health, reported positive outcomes and recommended extending distribution of the Card. Distribution of the Card supported the Ministry’s decision to change Treatment Guidelines. Pharmacists Focus Group Pharmacists reported increased patient/pharmacist interaction and greater awareness of the role of the pharmacist. Pharmacists recommended all prescribers and dispensers receive the Card to promote more rational prescribing.

9. Evaluation of the Malaria Fact Card Project in Tanzania (3) Consumer Survey Consumers reported the card easy to read and easy to understand and 60% of consumers reported an increased knowledge of malaria prevention techniques and improved use of their medications. Survey respondents reported that improved knowledge about medication dosage, especially in children, reduced the fear of side effects associated with SP (sulfadoxine/pyrimethamine) drugs. Summary Results indicated that the Fact Card had increased awareness of the prevention and early treatment of malaria in more than 60% of survey respondents in the target group.

10. Conclusions and Recommendations The Malaria Task Group made the following observations about the project and it’s potential for further development. Needs, Objectives and Strategies • Wide ownership of the project through organisational collaboration ensured a strategic advantage on national and regional health agendas. • Increased pharmacist/patient interaction not only informed patients but also promoted the potential for real change in consumer behaviour. Sustaining Project Benefits • Direct involvement by collaborating organisations in all aspects of the project will help sustain project benefits. • Government and industry support for consumer health education will help sustain project benefits. Project Potential • The project represents a cost-effective use of resources in maximising community health benefits in diverse geographical, cultural and socio-economic settings.