TY - JOUR
T1 - The implementation of a new Malaria Treatment Protocol in Timor-Leste
T2 - Challenges and constraints
AU - Martins, João Soares
AU - Zwi, Anthony B.
AU - Hobday, Karen
AU - Bonaparte, Fernando
AU - Kelly, Paul M.
PY - 2012/12
Y1 - 2012/12
N2 - Background: Timor-Lestechanged its malaria treatment
protocol in 2007, replacing the first-line forfalciparum malaria from
sulphadoxine-pyrimethamine to artemether-lumefantrine.This study explored the
factors affecting the implementation of the revisedtreatment protocol, with an
emphasis on identifying key constraints.
Methods: A mixedmethod approach drew on both qualitative and
quantitative data. The studyincluded data from District Health Services in
seven districts, communityhealth centres in 14 sub-districts, four hospitals,
five private clinics, oneprivate pharmacy and the country's autonomous medical
store. In-depthinterviews with 36 key informants, five group interviews and 15
focus groupdiscussions were conducted. A survey was also undertaken at
community healthcentres and hospitals to assess the availability of a physical
copy of theMalaria Treatment Protocol, as well as the availability and
utilization ofartemether-lumefantrine and sulphadoxine-pyrimethamine.
Results: Many factorsimpeded the implementation of the new
malaria protocol. These included:inadequate introduction and training around
the revised treatment protocol;unclear phasing out of
sulphadoxine-pyrimethamine and phasing in of the revisedtreatment,
artemether-lumefantrine, and the rapid diagnostic test (RDT); lackof
supervision; lack of adherence to the revised guidelines by foreign
healthworkers; lack of access to the new drug by the private sector; obstacles
in theprocurement process; and the use of trade names rather than generic
drugdescription. Insufficient understanding of the rapid diagnostic test and
theuntimely supply of drugs further hampered implementation.
Conclusion: Toeffectively implement a revised malaria
treatment protocol, barriers should beidentified during the policy formulation
process and those emerging duringimplementation should be recognized promptly
and addressed.
AB - Background: Timor-Lestechanged its malaria treatment
protocol in 2007, replacing the first-line forfalciparum malaria from
sulphadoxine-pyrimethamine to artemether-lumefantrine.This study explored the
factors affecting the implementation of the revisedtreatment protocol, with an
emphasis on identifying key constraints.
Methods: A mixedmethod approach drew on both qualitative and
quantitative data. The studyincluded data from District Health Services in
seven districts, communityhealth centres in 14 sub-districts, four hospitals,
five private clinics, oneprivate pharmacy and the country's autonomous medical
store. In-depthinterviews with 36 key informants, five group interviews and 15
focus groupdiscussions were conducted. A survey was also undertaken at
community healthcentres and hospitals to assess the availability of a physical
copy of theMalaria Treatment Protocol, as well as the availability and
utilization ofartemether-lumefantrine and sulphadoxine-pyrimethamine.
Results: Many factorsimpeded the implementation of the new
malaria protocol. These included:inadequate introduction and training around
the revised treatment protocol;unclear phasing out of
sulphadoxine-pyrimethamine and phasing in of the revisedtreatment,
artemether-lumefantrine, and the rapid diagnostic test (RDT); lackof
supervision; lack of adherence to the revised guidelines by foreign
healthworkers; lack of access to the new drug by the private sector; obstacles
in theprocurement process; and the use of trade names rather than generic
drugdescription. Insufficient understanding of the rapid diagnostic test and
theuntimely supply of drugs further hampered implementation.
Conclusion: Toeffectively implement a revised malaria
treatment protocol, barriers should beidentified during the policy formulation
process and those emerging duringimplementation should be recognized promptly
and addressed.
KW - artemether-lumefantrine (AL)
KW - implementation science
KW - Malaria
KW - malaria treatment
KW - plasmodium falciparum
KW - policy implementation
KW - sulphadoxine-pyremethamine (SP)
KW - Timor-Leste
KW - treatment protocol
UR - http://www.scopus.com/inward/record.url?scp=84870221709&partnerID=8YFLogxK
U2 - 10.1093/heapol/czs019
DO - 10.1093/heapol/czs019
M3 - Article
C2 - 22460007
AN - SCOPUS:84870221709
SN - 0268-1080
VL - 27
SP - 677
EP - 686
JO - Health Policy and Planning
JF - Health Policy and Planning
IS - 8
ER -