Empowering Teachers To Handle Public Health Interventions - PowerPoint Presentation

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Empowering Teachers To Handle Public Health Interventions

Pickmore Swira; Malawi

School based malaria control

Coastlands Hotel – Durban, South Africa

22-24 November 2016

Presentation Outline

A description of the programme or policyAchievementsChallengesOpportunities/Emerging IssuesKey lessons learnt

What is the Learner Treatment Kit?

A first-aid kit available

to all school children during schools hours for:

Uncomplicated malaria (mRDTs & ACTs (Artemisinin Combination therapy)

for malaria diagnosis and treatment) Basic illnesses (diarrhoea, eye infection etc.)Basic injuries

(minor wounds and burns

)

At

each school between

2-4 teachers

trained

to use LTK.

Schools collect supplies from the local health facility

What does the LTK include?

Achievement: Usage of Learner Treatment Kit:

32,193 individual learner consultations conducted

92 trained teachers in

29 primary schools

(33,943

enrolled

learners) implemented the

LTK

from December 2013 to March 2015:

22,481 learners tested for malaria using an

mRDT

16,642 learners with malaria treated using an ACT

Increased access to prompt treatment

For many the LTK was reported as a preferential choice for sick children due to perceived convenience and reliability in comparison to the health facility. Some parents reported they felt

relieved of the economic burden of treating their children.District and national level policy makers saw the programme as

consistent with the Government’s School Health and Nutrition (SHN) 2008-2018 strategic plan

“What you should know is that our schools are in the remote area, for a child to go to the health centre, the distance which is there, no wonder that we had so many children be absent from school, dropping out etc. So this was a relief to us we are doing it instantly at a school campus”.

(IDI, MOEST official)

Perception of reduced absenteeism

Reported by multiple groups that the programme has contributed to areduction

in school absenteeism, number of school drop outs

number of cases of children being kept at home by the parent until very sick

“In the past a lot of learners used to be absent and this used to affect their work in class, this is no longer the case because even if they fall sick at home,

they still come at school because they know that they will get medical attention at school

”

(IDI, head teacher)

In line with

MoEST

: healthy schoolchildren

Providing a service for children in schools

Bolstering the current SHN curriculum guidelines

So what did we learn?

Hugely popular intervention

32,193 learner consultations during the period

Parents wanting access to the service for other children

Control schools kept requesting the intervention

In line with

MoH

: Universal Access

Providing prompt effective treatment for a group who have been the least likely to be taken for treatment

Supporting the CCM for the under 5s in the community

Accessed more frequently by girls

Up to age of 15 girls sought nearly twice as many consultations as boys

No difference in the range or frequency of symptoms

Will explore the equity of the LTK further

I

mpact on absenteeism?

No significant difference between groups

Reported

illness accounted for 6% of absenteeism

The reason behind 80% of the absenteeism was unknown

Feasible & acceptable to teachers

Teachers were capable providers of the services

Despite the calls for more teachers trained and incentives teachers were very active and very low drop out

Challenge: Burden of work

Concern that programme would add extra burden on teachers and distract from core duty of teachingEspecially a problem in wet seasons when consultation numbers higherUniversal suggestion was that more teachers per school should be trained e.g. At least 4 per school plus head teacher

“LTK dispensers do not rest .

We do not have time to rest

.The moment you have gone to LTK room to treat learners you do not have time to rest because sick learners come one after the other. (FGD, LTK dispenser)

Challenge: Health facility linkage

Initial tensions between teachers and health workers as not enough communication. Teachers did not always receive feedback from referrals Occasional stock-outs at the facility

Sometimes the linked facility was several km away and it can take a long time to get there, and transport was not provided

“It

may take time for us to collect [supplies] because they are put at the health

center

, [but] when

you go there and you want some

mRDTs

, when they tell us

no [that supplies have stocked-out]…

that

means that everything stops because we were advised not to treat any child with malaria without doing

mRDT”. (IDI, head teacher)

Future challenge: supply chain

Need to ensure supply chain properly managedSCI currently supplying at Health centresHow will district level supply be managed to the health centres?

Taking to scale: how to scale it oversight and accountability to be

consideredWho is to procure Will Govt manage; Cost of intervention

National dissemination:

Attendees agreed on the following action points:Dissemination meeting at district level

Dissemination to other MinistriesTo consider perspectives on scale-up, resources and support required.

Generate and collate further information on feasibilityCompile knowledge gained during implementation into ‘how-to’ manual.

Finalise data analysis & report writing

Final report July 2016.

To

continue collaboration between

MoH

&

MoEST

Established

LTK Taskforce

To review final report and next steps how to move forward…

LTK Partners

National Malaria Control Programme (NMCP) at MoHSchool Health Nutrition Programme (SHN) at MoESTHealth Technical Support Services (HTSS) at MoHThe

Zomba district health and education officesMalawi Institute of Education (MIE)

Save the ChildrenMalaria Alert Centre (MAC) at College of MedicineLondon School of Hygiene & Tropical Medicine

Others

Social Innovation in Health Initiative (SIHI)

PSI and Millennium villages

Special thanks to the

communities of TA

Chikowi

– The teachers, children, parents, HSAs, health facility support staff and field officers!

R. R. W. & Florence Berglund Family Foundation

Funded by

International Initiative for Impact Evaluation (3ie)

Save the Children Sponsorship funds

Berglund Family Foundation

Acknowledgements

THANK YOU

FOR LISTENING