Highlights from the C-DMCI Assessment in Senegal

As a follow-on to the 2001 DMCI assessment, which focused primarily on the public sector health facilities, the MoH of Senegal, in collaboration with RPM Plus and the BASICS project, conducted an assessment using a newly developed Community Drug Management for Childhood Illness (C-DMCI) assessment tool.

Although the questionnaires had been field-tested, the sampling and survey methodology was being used for the first time. The survey took place between August and October 2002 in Kaolack and Thiès districts.

Some key findings include—

• ORS, which is recommended as the first-line treatment for diarrhea by the Senegal IMCI guidelines, was not available in private pharmacies and was poorly available in the public sector.
  
  
• Only 56 percent of the children with fever took the first-line antimalarial medicine, and fewer than 20 percent of children with pneumonia or diarrhea took the appropriate first-line treatment (co-trimoxazole and ORS, respectively).
  
  
• In general, the medicines were not correctly administered in the home, even when instructions were given to caregivers at the time of purchase; only about 60 percent of patients took chloroquine for three days and fewer than 10 percent took chloroquine once a day for three days, as recommended.
  
  
• Only around 30 percent of caregivers took children with symptoms of pneumonia for care on the same day symptoms started.

The results of both these surveys were discussed in strategy planning workshops in May 2002 (for the DMCI survey) and February 2003 (for the C-DMCI) with key stakeholders in country.

Action plans resulted and a selection of interventions was designed and is being implemented by the MoH in collaboration with other partners and with technical assistance from RPM Plus.

The interventions resulting from these planning sessions are—

• Inventory Management
  In cooperation with BASICS and the MoH, RPM Plus worked to incorporate training in the principles of store management into IMCI training for head nurses at the health posts.
  
  A more simplified training module on store management was also developed for the training of storekeepers at health posts and health huts (case de santé).
  
  In collaboration with various sections of the MoH, RPM Plus facilitated a consultative meeting of a variety of stakeholders in 2003 to standardize and validate a set of stock management tools.
  
  
• Private sector
  Responding to the finding of the surveys that ORS were not available in private pharmacies, a ministerial decree was issued allowing the sale of ORS and other key generic medicines to private wholesalers through the central medical stores (PNA).
  
  Additionally, RPM Plus has worked with the MoH and the association of private pharmacists to provide pharmacists working outside the public sector with additional training in rational use of medicines for childhood illnesses and general IMCI strategies, as outlined in the national treatment guidelines.
  
  Through meetings and discussions, private pharmacists also identified the need to inform their sales assistants of these strategies. In response, RPM Plus collaborated with the MoH Direction de pharmacie et laboratoire (DPL), and the Division d'alimentation et survie de l'enfant (DANSE), the syndicate, and BASICS to develop a training manual for sales assistants in private pharmacies on rational medicine use for childhood illness in the USAID intervention areas. Training has been completed in all USAID districts and a total of 685 out of 723 (or 95%) assistants were trained. Work is underway with the DPL and the syndicate of private pharmacists to develop the monitoring mechanism.
  
  
• Community level
  Findings from the 2001 DMCI survey demonstrated that antibiotics, although not authorized at the health hut level, were widely available and not being used appropriately.
  
  As a result, operational research on the community case management of pneumonia [PDF - 62 KB] by the agents de santé communautaires (ASC) (community health workers) using co-trimoxazole was commissioned by the MoH. In support of this operations research conducted by a partnership of MoH, BASICS, and UNICEF, RPM Plus developed a training manual in store management, facilitated at the training sessions, and offered guidance on the supervision tools.
  

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