Monitoring and Evaluating Availability, Stocking and Dispensing of Childhood Pneumonia Treatments in Tanzania

PROJECT OVERVIEW

Globally, pneumonia kills close to one million children each year, roughly equivalent to 16% of all deaths of children under five years old, (WHO, 2016). Less than one third of children with suspected pneumonia receive antibiotic treatment, despite their low cost and high effectiveness (Stop Pneumonia, 2012). In response to this, R4D launched a global initiative in 2014 funded by the Bill & Melinda Gates Foundation to scale-up access to amoxicillin dispersible tablets (Amox-DT), the World Health Organization recommended treatment for childhood pneumonia, in selected high-burden countries.

Tanzania was selected as one of the countries and this study focuses on the availability, stocking, and dispensing of childhood pneumonia treatments in District Hospitals, Health Centres, Public Dispensaries, and Accredited Drug Dispensing Outlets (ADDOs) across Tanzania. To this effect, R4D, IDinsight, the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) and the National Institute for Medical Research (NIMR) among other partners, have been working with EDI to collect high quality, reliable data from a nationally representative sample of public health facilities and a subsample of ADDOs on the current state of pneumonia-related treatments. The intended outcome of this partnership is to increase access to effective treatment in the public sector, thereby helping to reduce pneumonia mortality among children in Tanzania.

EDI conducted three rounds of data collection, all taking place in 2017. The total sample of health facilities involved 53 district hospitals, 50 health centers and 521 public dispensaries across all 26 mainland regions in Tanzania and a sample of 135 ADDOs in 3 sentinel regions. Data collection involved administering five separate questionnaires: An overview of the facility and its facilities, information about the Dispensing Outlets and the medicines dispensed to patients, information about the Stock Rooms and the medicines in stock, information about the patients diagnosed and treated, and a separate questionnaire for ADDOs. 

This year, R4D and EDI Global have been working on a follow-up survey to understand trends around the availability and stocking of amox DT and other essential medicines at frontline public health facilities. The survey, which began in March 2020, was retooled to be fully remote as result of the COVID-19 pandemic. 

Between September 2017 and January 2018 EDI conducted two side stream projects on behalf of R4D.

Intervention

The Intervention project contained three separate strands, each designed to improve awareness and knowledge of the diagnosis and treatment of childhood pneumonia. The three intervention strands were: (1) Mobile Messaging – involving sending informative messages to healthcare providers; (2) Visual Aids – containing information and pictures and supplied to Health Facilities and ADDOs, and; (3) Clinical Mentoring – conducted by trained mentoring professionals to individual healthcare providers. EDI was responsible for managing the different interventions and for collecting data to help evaluate their effectiveness.

Misdiagnosis

The Misdiagnosis project is an observational study using portable ultrasound machines to determine the rate of under and over diagnosis of childhood pneumonia in Tanzania. EDI worked with R4D, the Ministry of Health Community Development, Gender, Elderly, and Children, the National Institute of Medical Research, the President’s Office – Regional Administration and Local Government and IDinsight to collect high quality, reliable data from a sample of District Hospitals, Dispensaries and Health Centres in three regions of Tanzania. This study consisted of a single observational round comparing diagnosis from providers without ultrasound machines to diagnoses from examinations performed with ultrasound machines.

PROJECT UPDATE

EDI Global has been the data collection partner on this project since 2017 and in March 2020 we were one week into the latest round of data collection when fieldwork was discontinued. Together with R4D, we quickly changed gears, adapting and bringing forward planned phones surveys.  In June 2020, we launched the first of seven rounds of phone surveys of 251 sample health facilities, in which we obtained an overall response rate of 98.8%. The lessons learned during this transition will benefit the subsequent rounds of data collection, which will take place every three months, with the next round starting in late August. You can read more about our experience with remote surveying for this project here. 

EDI has received positive feedback from the client and partners about the work conducted:

“Thanks so much for all of the hard work and persistence. We appreciate all of the efforts of the entire EDI team.”

“Congratulations on finishing fieldwork! I’d like to send a huge thank you to all of the field staff who persisted through the rain, bumpy roads, and mud to complete the sample. It’s been a great partnership with EDI.”

“Congrats on wrapping up the fieldwork and thanks for the great partnership.”

“We have also thoroughly enjoyed working with EDI…I really want to say thank you to EDI for your commitment, professionalism and quality of work…”

WHO (2016). Pneumonia Fact sheet Available at: http://www.who.int/mediacentre/factsheets/fs331/en/ Accessed: 9 May 2017

Stop Pneumonia (2012). Leading International Child Health Agencies Join Forces to Increase Access to the Most Effective Antibiotic Treatment for Children with Pneumonia Available at: http://stoppneumonia.org/leading-international-child-health-agencies-join-forces/ Accessed: 9 May 2017

“Thanks so much for all of the hard work and persistence. We appreciate all of the efforts of the entire EDI team.”

 

“Congratulations on finishing fieldwork! I’d like to send a huge thank you to all of the field staff who persisted through the rain, bumpy roads, and mud to complete the sample. It’s been a great partnership with EDI.”

 

“Congrats on wrapping up the fieldwork and thanks for the great partnership.”

 

“We have also thoroughly enjoyed working with EDI…I really want to say thank you to EDI for your commitment, professionalism and quality of work…”

WHO (2016). Pneumonia Fact sheet Available at: http://www.who.int/mediacentre/factsheets/fs331/en/ Accessed: 9 May 2017

Stop Pneumonia (2012). Leading International Child Health Agencies Join Forces to Increase Access to the Most Effective Antibiotic Treatment for Children with Pneumonia Available at: http://stoppneumonia.org/leading-international-child-health-agencies-join-forces/ Accessed: 9 May 2017