- Approaches Used and Key Accomplishments
- Challenges and Opportunities
- JUMP’s impact to date can best be demonstrated through quotes from health workers who have benefitted from the programme
The Joint Uganda Malaria Training Programme (JUMP) is an exceptional collaboration that was formed between IDI, the Uganda Malaria Surveillance Project (UMSP), the MOH Uganda National Malaria Control Programme, and the Makerere University College of Health Sciences-University of California San Francisco Malaria Research Collaboration. JUMP was established to carry out the following tasks:
- Establish an exemplary malaria training programme that is based on a team approach to strengthening management of patients with malaria/fever at the health facility level
- Build capacity for proper clinical case management of fever and malaria
- Build capacity for malaria laboratory diagnosis
- Develop a monitoring and evaluation system to demonstrate the impact of training and capacity building on case management for malaria, at the health facility level
- Improve surveillance systems and health information/data collection
Activities are implemented by the multi-disciplinary JUMP team under the guidance of two committees (management and steering) composed of members from major malaria stakeholder organizations. These two committees offer guidance to ensure that JUMP activities are in line with MOH policies.
Development of Transferable Training Modules: JUMP has developed and evaluated an exemplary malaria training programme that trains teams at the health facility level to strengthen malaria management, and focuses on reducing the use of inappropriate malaria treatment practices. These include excessive presumptive treatment (treatment without laboratory tests) and substantial over treatment with anti-malarials for patients with negative malaria tests (in the era of very expensive Artemisinin combination therapies—the most effective first line drugs for Malaria treatment).
Courses Adopted by Others:
- The Integrated Management of Malaria (IMM) course has been adopted by the USAID-funded STOP MALARIA project and the Presidential Malaria Initiative (PMI) for use in training health care workers on the laboratory diagnostic component of malaria case management.
- Management of Fever Using Rapid Diagnostic Tests (RDT) for Malaria: RDTs are tests that, using a ‘dip-stick’ technology, provide almost immediate indications of whether an individual has malaria or another cause of fever. The training manual for Management of Fever using RDTs for Malaria has been adopted by the MOH National Malaria Control Programme as the “user’s manual” for the national roll out of health worker training in management of fever using RDTs.
Linking Learning, Policy and Practice: Three members of the JUMP team serve on the national task force responsible for the nationwide roll out of the use of RDTs for malaria testing. JUMP is expected to play a quality assurance role during roll out of IMM and RDT training (under Global Fund Round 4 phase 2). JUMP also makes regular efforts to disseminate its findings. This year one manuscript entitled “Improved Malaria Case Management After Integrated Team-based Training of Health Care Workers in Uganda” was published in the American Journal of Tropical Medicine and Hygiene (November 2008).
Capacity Building for Health Care Professionals: The trainings provided by JUMP have had a positive effect on the performance of health workers at facilities where training has taken place, through improving team work and unity; increasing the utilization of laboratories for confirmation of malaria; and improving recording keeping. In addition, there are improvements in the diagnostic skills of clinicians, the diagnostic accuracy of laboratory tests and the rational use of anti-malarials—leading to a significant reduction in the inappropriate use of anti-malarials among patients who have fevers caused by other things.
This model appears to be effective, and the JUMP team hopes to roll it out more widely in coming years. If funds permit, the following activities will be undertaken:
- Establishing regional and district teams of trainers for IMM and RDT throughout Uganda, for the purpose of scaling up training and providing on-going supportive supervision; training will ideally be provided at all facilities in districts where evaluations have indicated a need
- Hiring and training additional health care workers to meet the overwhelming demand for laboratory services; while there has been an increase in confidence and trust through community awareness for malaria testing, there has also been an increase in the workload and utilization of laboratory facilities. Without an increase in manpower to serve already understaffed and poorly equipped laboratories, there will be little chance of meeting the demand for malaria tests; for confirming blood test results; and for prescribing proper treatment.
- Supporting health facilities (which have received training interventions) with laboratory equipment and supplies (e.g. microscopes and reagents)
- Testing community-based interventions which can promote increased adoption of malaria prevention practices
- Supporting MOH to implement quality assurance and quality control activities that realistically assess accuracy of laboratory diagnosis
- Exporting courses developed by JUMP to other countries in the region that are facing problems with malaria case management
“Issues highlighted during training included maintenance of teamwork among staff and from what has been observed, there is [now] good communication between laboratory staff, clinicians and records staff”.
“…before the training programme, clinicians used to doubt malaria results from the laboratory, and would treat malaria suspected cases basing on clinical assessment. Now we are sure of the high quality of our laboratory results and we trust the personnel therein.”
Health workers have been empowered through the JUMP training programme to deal with pressure to dispense unnecessary drugs.
“…we now have some cooperation with the community members especially politicians. Previously they would come demanding for antimalarials for their relatives or for themselves; but when JUMP supported us to hold a district council sensitization meeting we explained that a patient with fever had to take a blood test to confirm malaria before getting Coartem. The clients now appreciate if Coartem is not given when a patient has a negative malaria test.”
The training, through team building, has also helped health facilities improve records management and patient flow within health facilities.
“…In my department there is a fundamental change. Before training, records were incomplete but now they are complete. Staff members know that it is everyone’s responsibility to keep good records and every department has good records.”
The training programme not only addressed health care worker knowledge and skills, but also provided equipment for health facilities and helped districts to deploy staff appropriately.
“…before the training we didn’t have qualified lab personnel. The coming of JUMP helped us get lab personnel from one health unit which had no laboratory equipment. The district health team had never realized that a member of staff was redundant in that health unit until JUMP came.”
The community has also gained more confidence in the quality of services offered by the health facilities.
“Patient management has improved...because of increased utilization of the laboratory, patients’ trust in the service providers has increased. They go back to their villages and tell their colleagues about the improvement and this has attracted more patients.”
The training promoted rational use of anti-malarial drugs. There are now fewer incidents of stock outs of anti-malarials, as a result.
“Anti-malarials are no longer wasted. Now we first thoroughly examine and do laboratory investigations to decide on who deserves treatment. The consumption rate of anti-malarials is reduced, so we no longer experience stock outs.”