Implementation report for the Test and Treat communication campaign
Of the Stop Malaria Project November 2012- June 2014.
Submitted by : Lillian Nakato Kyadondo
Project Manager -Test and Treat campaign
Submission date: June 20th, 2014
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1.0
Background to the Test and Treat Campaign
The Test and Treat communication campaign was designed and implemented by JHU/CCP
through the Stop malaria Project on behalf of the National malaria control Program of the
Ministry of Health Uganda. The campaign was supported by the United States Agency for
International Development (USAID).
Given the high prevalence of malaria over many years, especially among pregnant women and
children below the age of 5, the Ministry of Health in 2002 instituted a policy to treat every
fever as malaria. Uganda stepped up national efforts to address the problem over the last 10
years which yielded good results of declining prevalence as reflected in the 2009 malaria
indicator survey. With the advent of rapid and reliable tests and the changing epidemiology of
malaria, the Ministry of Health and World Health Organization recently revised their policies for
the control and management of malaria. They now recommend that all suspected cases be
tested for malaria and should be only treated if for malaria confirmed positive.
The Test and Treat communication campaign was then designed to address the existing gaps at
service delivery and community levels. It is important to note that this initiative followed
systematically, the whole strategic communication process from the design stage,
implementation to evaluation.
At the service delivery level, campaign efforts targeted public health providers with
Interpersonal Communication skills and orientation on differential diagnosis. This was done as
part of efforts to strengthen the enabling environment for care givers of children aged five and
below to demand for malaria diagnostic services, trust test results and adhere to treatment
guidelines. The mass media campaign targeted the care givers of children aged five and below as
the primary audience with communication on the importance of testing before treating malaria,
effectiveness of existing testing methods in detecting malaria as well as adherence to testing
and treatment guidelines. Evaluation of the campaign is scheduled for July 2014.
1.1
Goal and objectives of the campaign
The implementation of the test and Treat communication campaign was intended to
increase uptake malaria diagnostic and treatment services in Uganda.
Campaign objectives:
a) Empower care of children aged five and below to:
 Know that there are other possible causes of fever other than malaria.
 Seek malaria – testing services before they get their children treated for
malaria and within 24 hours of onset of fever.
 Believe in negative test results for malaria and follow the health provider’s
instructions for managing other possible causes of fever.
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b) Empower private and public health providers to:
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1.2
Trust malaria diagnostic methods (especially RDTS).
Communicate to caregivers about the importance of testing for malaria before
treating any fever with malaria drugs.
Test for malaria before they treat with any malaria drugs.
Treat malaria only if the test results are positive.
Counsel care giver to trust malaria testing methods and adhere to negative test
results.
Campaign target audiences
The campaign targeted two main audiences namely:
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Care givers of children aged five and below in the 18 SMP supported districts of
the Central Region of Uganda.
Health workers at Health Center II, III, IV and hospitals in the campaign districts.
1.3
Scope of the campaign.
The campaign is being implemented in 18 districts of Central region namely;
Nakasongola, Nakaseke, Luwero, Rakai, Masaka, Lwengo, Kalungu, Bukomansimbi,
Ssembabule, Mpigi, Mukono, Butambala, Gomba, Mityana, Mubende, Buikwe, Kayunga
and Buvuma Island.
1.4
Campaign implementation partners
The campaign was implemented by JHU/CCP through the Stop Malaria Project on behalf
of the National Malaria Control Program. Implementing partner include; Malaria
Consortium and Uganda Health Marketing Group (UHMG).
Malaria Consortium provided technical support for the design of the health provider
training manuals, the pre-test of the manuals as well as development of the CME guide.
They developed the following training materials.
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The National Trainers Interpersonal Communication guide for managing
children with fever.
The District Trainers Interpersonal Communication guide for managing children
with fever.
The Health Providers’ work book on IPC skills for managing children with fever.
Checklist for diagnosis of fever among children aged five and below
Guide for conducting Continuing Medical Education (CME sessions).
UHMG supported the campaign to design the media communication materials to
include print and radio materials.
Communication materials developed with support from UHMG include;
Posters, Billboards and radio spots.
The project however, hired technical services from CDFU to redesign radio drama
segments aired before the radio talk shows. A media agency (MAAD) was contracted to
implement the communication campaign.
2.0
Campaign implementation activities
2.1
Field support sessions
The Stop Malaria project conducted support sessions with some public health workers
to identify key communication issues which would hinder the adoption of testing before
treating children for malaria. It was observed that for many years, the MOH had
recommended treating every fever as malaria due to the high prevalence among
children at the time and scarcity of malaria diagnostic services especially in the rural
areas of Uganda.
It was observed that due that, many health workers believed that fever most commonly
means presence of malaria. They also had problem trusting the malaria testing methods
particularly RDTS. As a result it was difficult for them to effectively explain to the
mothers whose children tested negative to malaria but had a high fever. It was the
apparent that they need information on malaria and diagnosis among children with
fever. The support sessions were conducted at HC II, III, and IV in the districts of
Mukono, Soroti and Masindi.
Discussions were also conducted with VHTS and care givers of children aged five and
below in the mentioned districts. These indicated similar gaps that include:
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All fever is due to malaria
Mistrust of negative test results.
Low adherence to management instructions of not treating fevers with malaria
drugs unless child is positive for malaria. These findings were utilized to design
the communication campaign.
Strategy development and dissemination
A communication strategy was designed in December 2012 through a consultative
process that involved many partners. These include; UHMG, Malaria Consortium. CDFU,
NMCP, district health staff among others.
The strategy was finalized later in March 2013 due to the delays in the design of the
monitoring and evaluation framework which had to be incorporated into the strategy
document.
2.3
Communication materials development and pretesting
Stop Malaria Project contracted UHMG to design the media communication materials
that include; posters, billboards, and radio spots. These were pretested with
participation of SMP and NMCP after which final copies were produced.
The following materials were produced and posted or aired.
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5,000 posters with the message “ Take to the health center for a test before
you give me malaria medicine, Not every fever is due to malaria” in English
5,000 posters with the same message Luganda
2,500 posters with the same message in Runyoro-Rutooro.
5,830 radio spots aired on 7 FM stations in Luganda.
420 radio talk shows conducted on 7 FM stations.
15 bill boards posted on entry into campaign districts.
2.4
Development of the training materials
SMP worked with Malaria Consortium to develop the training materials which was done
through a highly participative process. Several review meetings were conducted in
participation of partners that include IDI , JHU, NMCP to make input to the materials.
Malaria Consortium also conducted the training pretests and used the data to make
final production. The development of the training materials took place from May to June
2013. The pretesting trainings were conducted in August and September 2014.
2.5
District orientation meetings
After the materials were ready, project staff in the BCC department conducted district
orientation meetings to introduce the campaign and discuss district campaign roles. The
meetings were conducted in 17 of the 18 districts. The district health staff were
appreciative of the campaign and pledged to work with SMP meet the campaign goal.
The Malaria focal person coordinates campaign activities in the district but the DHO
oversees all activities. The districts had a responsibility for conducting CME, support
supervision and training of health workers in IPC skills for managing children with fever.
2.6
Health provider trainings in IPC skills
A cascade approach to was utilize to strengthen health worker PIC skills to effectively
implement the campaign.
2.6.1
Training of the Master Trainers
13 Master trainers were trained in IPC skills for managing children with fever. The
trainers were drawn from NMCP pool of trainers as well as from campaign
implementing partners that include Malaria Consortium and IDI.
2.6.2
Training of District Trainers
The master trainers were supported to train 68 district trainers. An average of 4 trainers
were selected from each of the campaign districts. District personnel who were already
working as trainers or supervisors were selected to make learning easier. It was also
intended to sustain district technical capacities since they were already interacting with
the health facilities during field support visits and other exercises. At the district level,
trainers include the malaria focal person, the district Lab Coordinator, the district Health
Educator and senior clinical officers.
2.6.3
Training of Health workers in IPC skills for managing fever among children
As of June 2014, 414 health workers from HC II, HC III, HC IV and hospitals had been
trained. The trainings were most useful to HC II staff where most staff had just been
exposed to RDTS but lacked the IPC and diagnostic skills required to effectively observe
adherence to testing and treatment guidelines.
2.7
Conducting of Continuing Medical Education sessions
Three – four weeks after training, health workers were followed up through CMES at
their health facilities. The CMES were conducted by a team that include; One national
trainer and two district trainers. A guide was developed with technical assistance from
Malaria Consortium to direct CME sessions and ensure uniformity of standards. The
CMEs were very useful in support the health workers who had not attended the
trainings to get on board and appreciate the Test and Treat campaign.
As of June 2014, CMEs had been conducted to 213 health facilities.
3.0
Monitoring and evaluation of campaign activities
Campaign monitoring activities include; The CME sessions at health facilities, partner review
meetings at national level, media progress review meetings as well as integrated Support
Supervision field visits by SMP.
4.0
Lessons learnt
 The trainings have been most effective at HC II because all staff are involved in the provision
of malaria diagnostic services. It is easier for the same health workers to support care givers
from patient assessment, diagnosis to, management. They are able to use the care givers’
guideline effectively.
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The CME sessions have been so useful in extending technical support to health workers who
did not participate in the trainings.
5.0
Key achievements
 District capacity was built so training and CME activities can continue beyond the project life
span. Each campaign district has at least three trainers who are supervisors at the same
time.
 Health workers reported that they are realizing improvement in stocks for malaria drugs
since they started to adhere to treatment guidelines. Because they only treat when test
results are positive, the drugs are available and used when the people actually have malaria.
 Misdiagnosis and its likely effects has reduced.
6.0
Challenges
A few challenges to the project have been encountered. These include:
 HC IV and hospital staff find the CME session difficult to attend due to overwhelming
clients/patients as well as the segmentation of malaria diagnostic and management
services.
 Staff transfers to some extent have affected continuity of expertise as trained staff left
the health facilities soon after the training.
 The campaign was delayed for almost three months due to delays in completion of
procurement process for media agency.
7.0
Next steps
Expand health facility trainings and CMES to maximize impact.
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