TECHNICAL SESSION for Drug Shop Vendors

TECHNICAL SESSION FOR Drug Shop Vendors

Introduction

We are here today to provide technical support to you to communicate with community members on malaria. We would like to learn about and address some of your questions and concerns, particularly with regard to you and your community members’ understanding of the use of Rapid Diagnostic Tests (or RDTs)to diagnose malaria. We also want to share with you recent Ministry of Health (MOH) recommendations on malaria diagnosis and treatments.

In the next few months MOH will carry out a campaign to strongly promote malariatestingbefore getting treatment. In the past, here in Uganda all fevers have been treated as malaria, but as you know, all fevers are certainly not malaria. There are many other illnesses you see in your clinics that cause fevers.

Our practice of treating all fevers as malaria, has meant that in some cases health workers or drug shops have prescribed anti-malarial drugs even when patients did not have malaria. This practice has allowed malaria parasites to develop resistance to the antimalarial drugs, and since we have overused these drugs we have had to switch to new anti-malarial drugs. It is expensive and takes a long time to develop new drugs, and it is not easy.

Also, if we continue providing anti-malarials to patients with a fever who do not have malaria, not only will we wasting expensive medicines and creating more resistance, but patients will likely suffer more by not receiving the correct treatment needed for their illnesses.

I.Activity: Understanding Drug Shop Vendors Beliefs and Attitudes

To get started, may we ask you to share your views and opinions on a few issues about malaria testing and treatment. There are no right or wrong answers. We only want to better understand your own views and beliefs.

Note to SMP team: Most likely you will only be interviewing an individual drug shop vendor. Ask him/her the question and make sure he/she understands you are not asking him/her to state whether the statement is correct or incorrect, but to state what he/she BELIEVES and whyhe/she agree or disagree with the statement.

Document the reasons they provide, as this information will help us to gain a better understanding of drug shop vendors’ beliefs.

‘I agree’or‘I disagree.’

1.I believe that malaria can be diagnosed without a blood test.

Why:

2.Drug shop vendors should sell anti-malarials to any community member

who demands them.

Why:

3.Malaria tests are a waste of time and money.

Why:

4.Most people in my community go to drugs shops for treatment of malaria.

Why:

5.I believe that promoting malaria tests would decrease my profits from

sales of ACTs.

Why:

6.Recognition of malaria symptoms is mostimportant in determining the use

of antimalarial drugs rather than the result of a malaria test.

Why:

7.INSERT one or two other issues we want to learn about from drug shop

vendors.

Why:

8.INSERT:

Why:

II.Discussion: Soliciting information about Community Responses

to Malaria Testing and Treatment

Now, we would like to talk with you more specifically about what happens to people in your community who get a fever and go for malaria testing or treatment.

1. Community Access toMalaria Testing

1. Where to most people in your community go for malaria testing?

(If different responses, include all, and see if the drug shop vendor can identify who specifically goes to drug shops, who tends to go to health centers or hospitals, private clinics – and WHY? Try to solicit their views on the main reasons people choose one place over another.)

2.What kind of malaria testing is available in your community?

3.Are RDTs available in your community?

If yes: Where are they available?

4. Do you or any other drug shop vendors use RDTs?

If yes: Ask follow-up questions about using RDTs in drug shops. (i.e. positive and negative results, what do they do?)

B. Community views on RDTs

1. What do you think of the RDT test? (Elicit positive and negative opinions.)
2. What do people in your community think about RDTs? (Elicit positive and negative opinions and probe for specific audiences. Be sure to document who specifically they are talking about –caretakers views, drug shop owners, health workers, leaders, etc.)

Explain to Drug Shop Vendors:

• The use of RDTs across Africa is increasing. Extensive research has shown that RDTs are a very reliable and accurate method of testing for malaria.
• RDTs are very useful because they are easy to use and results can be determined very quickly.

• Uganda has already been using RDTs in some private clinics and drugs shops as well as in some government facilities. In the very near future, our MOH will receive many RDT kits to supply to local government Health Center III and IVs who do not have access to testing using a microscope.
• MOH will promote the use of these malaria tests and will work to ensure that clients trust the RDT results and that health workers in these centers know how to use the RDTs correctly.

3.What do you think your community needs to be able to useand trust

RDTs?

(May need to probe further to get specific responses. What do the health workers need? What to the clients need?What do drug shop vendors need? Etc.)

1. Current community behaviors and reactions to malaria testing

1.Doesprescribing an antimalarial when the results are negative happen a

lot in your community? If so, why do you think this happens?

And by whom? (e.g. private clinics, drug shops, public health facilities)

Try to get at the most frequent or common reasons.

2.How do caregivers usually react to malaria tests? (positive,

negative).

3. What kind of support or information do you think would help you to

convince or help caretakers to accept negative results?

(Probe for specific answers.)

4.If a caretaker tells you he/she had a malaria test that was negative but

still wants anti-malarials, would you sell them to him/her? Why? Why not?

1. Feedback on Job Aids and Messages

End the session by briefly reviewing the key messages MOH will promote in their campaign, highlighting the emphasis now being on testing before treating, versus the message to date (which has been ‘to treat within 24 hours’).

Insert Key Messages:

Use the finalized Key Messages from the Radio Scripts….

1.What information and support do you needin order to promote these

messages?

2.What, in your view, do caretakers need to know and understand in order

to follow these messages….

(Try to get at the question of whether patients understand RDTs – fear them? Confused by them? If fear, why and what can we do to help patients overcome fears? If confused, what sort of simple information will help them not be confused? etc. )