Translating health policy into practice:Successes and challenges at implementation in Bungoma south district, western Kenya
Background: Malaria is one of the most common infectious diseases in the world with more than 40 percent of the world's population at risk and one of the greatest public health concerns especially in sub Saharan Africa. In Bungoma South district, malaria is the leading cause of morbidity, accounting for 49 percent of the top ten diseases in the district. In 2006, Kenya implemented a new malaria treatment policy recommending the use of Artemether-Lumefantrine (AL) as the first line of treatment. National guidelines on the diagnosis, treatment and prevention and job aids were developed and disseminated to health workers alongside in-service training. The survey investigated whether the treatment of uncomplicated malaria conformed to the national treatment guidelines on diagnosis, treatment and prevention of malaria in Kenya. Methods: In September 2009, 17 in face to face interviews were conducted in 17 health facilities in Bungoma South, with 31 health workers who routinely performed consultations at the out patient departments in their facilities as well as with 3 representatives of the District Health Management Team. Data on health facility inventory control practices and stock status was retrospectively collected from the records available. The main outcome measures were: availability of antimalarial drugs on the survey day, stock-outs in past six months, presence of AL wall charts, and health worker's exposure to in-service training on AL and access to new national malaria treatment guidelines Results: Only 35 percent of the health facilities had access to job aids and current treatment guidelines and that 76 percent of the health workers had been trained on malaria case management. AL was almost universally available in all the health facilities on the day of survey, all facilities had recorded stock outs of AL six months prior to the survey and the duration of the stock outs was substantial lasting two months on average. Amodiaquine was not readily available in the health facilities. Conclusion: These results offered evidence that treatment practices in uncomplicated malaria after policy change, do not fully conform to the national treatment guidelines on diagnosis, treatment and prevention of malaria in Kenya. The targets set for key implementation indicators by the division of malaria control, in terms of availability of recommended drug and training of health workers, have not been fully achieved. If the government does not ensure uninterrupted supply of recommended treatment, high quality focused training and appropriate patient education enhanced, and if provider prescription practices do not fully conform to the recommended treatment guidelines, the major potential public health benefits of AL may not be realized. These findings are important in providing evidence for decision making in future policy review.