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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 selfsustaining 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
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 proactive 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.
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
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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
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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
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.
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.
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.
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.
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.
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.
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.