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The first in a series of 2008 World Malaria Day updates about Jhpiego's efforts to protect people from malaria. Jhpiego reaches across borders to fight a disease that has no borders.
Jhpiego supports ACT rollout for improved malaria case management in Kenya
April 2008
 Kenyan mother brings her child to a clinic where health care providers have been updated on malaria prevention and treatment. Each year, an estimated 26,000 children—a staggering 72 children per day—die from direct consequences of malaria infection in Kenya. Prompt and appropriate treatment can save many of their lives.
In Kenya, Jhpiego partners with the national government on their initiative to disseminate the artemisinin-based combination therapy (ACT) regimen as the first line of treatment against malaria. ACT has proven to be effective and is recommended for all cases of uncomplicated falciparum malaria for infants (>5kg), people living with HIV/AIDS, pregnant women in the second and third trimesters, and generally in home-based management of malaria.
In 2007, the Division of Malaria Control (DOMC) revised the nation's case management guidelines for diagnosis, treatment and prevention of malaria. They developed a training focused on the new treatment policy, major aspects of malaria case management and the creation of a forum for service providers to discuss issues arising from the implementation of the new policy. With funding from a variety of sources, only 9,000 service providers were trained, leaving over 11,000 service providers untrained.
The Cascade-Echo Approach
The cascade-echo approach allows programs to reach a greater number of providers en masse compared to traditional training because trained providers are given the tools to
"orient" their colleagues. This is followed by support supervision to address gaps in programming and ensure continued mentoring of providers. The cascade-echo approach was independently assessed by Family Health International and proven to improve quality of care and access, change provider knowledge and performance, and
was also shown to be cost-effective.
Source:
Stanback J., Lynam P., Ruto C., Cummings S. Improving Adherence to Family Planning Guidelines in Kenya. International Journal for Quality in Health Care. 2007.
To bridge this gap, the DOMC requested the technical support of Jhpiego to assist in orienting additional providers in seven districts in the Coast province. Jhpiego, in collaboration with DOMC, developed an orientation package entitled Malaria Case Management Orientation Package for Service Providers. The package was designed for front-line providers with information from Kenya’s new malaria policy guidelines. Using the proven and successful cascade-echo approach, Jhpiego and DOMC trained nearly 1,000 service providers on the new ACT treatment regimen, including prevention and control of malaria in pregnancy.
After the training, more than 300 randomly selected service providers participated in a program evaluation. Of that number, 97 percent responded that their practice had improved as a result of training in the use of ACT. The evaluation also proved the effectiveness of the cascade-echo approach with nearly 90 percent of those who attended the training stating that they introduced the information to their colleagues.
About Jhpiego
For nearly 40 years, Jhpiego, (pronounced "ja-pie-go"), has empowered front-line health
workers by designing and implementing simple, low-cost, hands-on solutions that
strengthen the delivery of health care services, following the
household-to-hospital continuum of care. We partner with community- to
national-level organizations to build sustainable, local capacity through
advocacy, policy and guidelines development, and quality and performance
improvement approaches.
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