Building Local Capacity to Treat Malaria

APRIL 2009 — In Ghana many people seeking initial treatment for malaria consult a licensed chemical seller (LCS) rather than a doctor or a nurse. There are nearly 10,000 LCS shops in Ghana, and for many Ghanaians, the local LCS is the first point of call when they're sick. But shop owners may not always recognize the symptoms of malaria, or know when a case is severe enough to warrant referral to a health facility.

To build the capacity of LCS and their counter assistants to recognize malaria symptoms, FHI is partnering with Pfizer, a US-based pharmaceutical company, in a five-year initiative that began in 2006. Mobilize Against Malaria (MAM), supported by the Clinton Global Initiative, aims to improve symptom recognition, appropriate treatment within 24 hours, and referral through training, education, and awareness creation in the Ashanti and Brong Ahafo regions of Ghana. MAM supports the priorities of Ghana's National Malaria Control Program (NMCP) and includes as partners the Ghana Social Marketing Foundation (GSMF) and Health Partners Ghana (HPG). A major benefit of this initiative is the creation of strong linkages between public and private sector providers, which leads to increased trust, better cooperation, and more effective referral systems.

Raising the Bar: A Model Training Program
To help build LCS into effective national healthcare partners, FHI developed a comprehensive training program. Through group activities and role-playing exercises, participants in the training learn to use structured questions to obtain critical information from customers—such as a patient's age, symptoms and their duration—before dispensing medicines. Participants learn how to correctly dose and administer Artemisinin-based Combination Therapy (ACT), the national standard for treating uncomplicated malaria. They are also trained in the recognition of and process of referring complicated cases to the nearest health facility.

"I was skeptical about the referral system until I had a case of severe malaria in a certain little girl," says Mr. Paul Ofosuhene, an LCS in New Tafo. "I filled [out] the referral form for the mother to take her to Tafo district hospital immediately. I was amazed when the mother later came back to thank me for helping to save her daughter's life. Previously, who was I to formally refer any case to the hospital? But now thanks to MAM, I can distinguish between complicated and uncomplicated malaria and refer when necessary."

Acting Locally
LCS usually live in the communities they serve, and the MAM initiative promotes their engagement with their communities by involving them in malaria prevention. LCS are encouraged to advise pregnant women visiting their shop to sleep under insecticide-treated nets (ITN) and to refer them to the nearest health facility to receive intermittent preventive treatment (IPT). IPT is medication that protects pregnant women from malaria-related low birthweight in their babies, anemia, or possible death.

In the Ashanti region, 660 LCS have been trained, and linkages are being created and strengthened between LCS and the District Health Management Team (DHMT). A total of 1,700 LCS in the Ashanti and Brong Ahafo regions are expected to be trained by the conclusion of the project in 2011.

"LCS under the MAM project are not just businesspeople dishing out drugs for cash," says Acting FHI/Ghana Country Director Henry Narh Nagai. "They are educating patients and conducting referrals. They take pride in being part of the nucleus of health providers responding to malaria at the community level."

PHOTO: A licensed chemical seller's kiosk in Nkawie-Toase, Ghana. Mobilize Against Malaria branding on the flags along the top and nearby signage let people know that the licensed chemical seller has successfully completed the FHI-developed comprehensive training program.

Related Resources

More about FHI's work in malaria »

Learn about FHI's malaria programs in West Africa with the World Cocoa Foundation and in Cambodia »

Review the LCS malaria training manual» (PDF, 28 pages, 211 KB)