Factors influencing the behaviour of retail providers of Malaria treatment: the case of selected retail pharmacy outlets in Mombasa County, Kenya
Oruta, James A
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In low income countries the majority of health care is sought in the private sector, often through retail pharmacy providers. Prompt access to effective malaria treatment is central to the success of malaria control worldwide. One of the three main dimensions of access is the behavior of retail providers of malaria treatment. There are very few studies on the factors influencing the behavior of retail providers of malaria treatment. This study addressed this research gap by examining the effect of retail competition, physician practice, knowledge and clinical skills of malaria treatment and regulation on the behavior of retail providers of malaria treatment in Mombasa County. The study employed the descriptive survey research design. It utilized both primary and secondary data. The study targeted retail pharmacy outlets in Mombasa County. The study subjects were all retail pharmacy dispensing staff. A sample size of 113 retail providers' selected using stratified random sampling was used. Data collection was done using questionnaires and interviews and the data collected was entered into Microsoft Access tables which were then exported into STATA for analysis. It was noted that 83% of retail outlets had a business license with 53% of the dispensing staff having a PPB license. Only 24% of the retail outlets flouted health related regulations. The knowledge and clinical skills of malaria\ treatment was low with 56% of the respondents failing to state the correct ACT dose for an adult and a 2 year old child. 67% of the respondents lacked an idea of the national malaria treatment guidelines. There was a positive correlation between experience and knowledge and clinical skills of malaria treatment with an odds ratio of 0.89 at 95% confidence level. Over 53% of the retail providers were influenced by the physician's prescribing habits. Competition positively influenced the behavior of retailers in several ways. For instance 88% of all retail outlets interviewed were open during weekends and over lunch hour, while 61 % of the retail outlets offered credit facilities to clients thereby increasing malaria treatment coverage. Inspection visits by drug inspectors were common with 85% of the respondents remembering a recent visit. There was a 48% prevalence of collusion between inspectors and retailers to flout regulations. From these findings, it was concluded that, the retail providers had limited knowledge and clinical skills of malaria treatment, retail pharmacy competition increased the relative accessibility of care, Government failure in regulation contributed to the sale of inappropriate medicines and packaging, and unregistered products of unknown quality and that most of the retail providers of malaria treatment were unduly influenced by the physician practice or prescribing behavior. In conclusion, to improve the majority of treatment for many common health problems such as malaria/fever, the government has to look beyond the public sector and facilities, acknowledge the reality of widespread retail sector use, and address the ways in which government policy intentionally and unintentionally influence private sector behavior. If policy makers are to design effective strategies, they need to comprehend the determinants of provider behavior in the retail sector and design intervention strategies to improve positive behavior in order to make prompt access to effective malaria treatment a reality to all.