Providing training and supplies to health centres not enough to improve children's health
28 July 2014
A trial in a high malaria transmission area in Uganda aimed to improve quality of care for patients with a fever. It showed small improvements in malaria case management, patient satisfaction and communication between health workers and patients, but it did not improve the health of community children.
Researchers from the PRIME trial identified barriers for good quality health care and developed an intervention which aimed to attract patients to seek care and to improve the quality of care delivered at public health centres in the Tororo region.
The intervention - one of ACT Consortium’s 25 projects - included training in health centre management, in fever case management using malaria rapid diagnostic tests (RDTs), and in patient-centred services. It also ensured supplies of these tests and antimalarial treatment. An additional study, PROCESS, was carried out alongside PRIME to help understand if and how the intervention worked.
From 2011 to 2013, the researchers delivered the intervention in 10 public health centres in the region. Ten other health centres did not receive the intervention for comparison purposes.
The results were presented at a meeting hosted by the Infectious Diseases Research Collaboration (IDRC) in the capital city, Kampala earlier this month.
Political will and better health systems needed
The PRIME intervention made small improvements in the quality of care delivered, but it made little difference to how patients seek treatment and it did not improve community children’s health.
In theory, introducing RDTs in health centres should reduce over-prescription of antimalarial treatment, improving treatment of malaria and other illnesses that cause fever. However, this theory may not apply in high transmission settings such as Tororo, where weak health systems, poverty and malaria create a cycle of poor health care.
“The PRIME intervention addresses the nightmare experienced by a manager at public health centres”, said Dr Henry Katamba from the Uganda National Malaria Control Programme at the Kampala meeting. “The manager is deployed to the health facility, and sets off to work equipped with a lot of knowledge and enthusiasm, very little supervision, very little funding and yet with a lot of expectations from the rural community.”
The Principal Investigator of the PRIME study, Dr Sarah Staedke from the London School of Hygiene & Tropical Medicine, added: “One has to have political will to improve quality of care in the public health sector. There were major gaps that we were not able to fill, such as infrastructure and staffing challenges. We were not able to increase salaries – and understaffing and absenteeism are a problem in many health centres. We feel that good political will would have gone a long way towards addressing these higher level challenges.”
Seeking feedback from health workers
There was an agreement that the attitude of health workers has a big role on the quality of the service delivered. This could be improved by providing not only training and availability of RDTs, but also supervision and mentoring.
Earlier this year in Tororo, the PRIME team also presented the results to those involved in the study, including staff from all 20 health centres.
When discussing the challenges faced during the project, they highlighted the shortage of staff and salaries, the risk of reducing RDT supply after the study, and the need to educate communities about the dangers of mosquitoes.
Photo: PRIME study team
Further information
- Watch a video and learn more about the PRIME trial
- Read the policy brief of the PRIME study
- Learn more about PROCESS, the study that evaluated the context in which the PRIME intervention took place
- Read the peer-reviewed articles published by the PRIME and PROCESS teams to date
Research Themes
Safety
Targeting
Access
quality of health care- health centre management
- health interventions
- formative research
- complex interventions