The implementation of a new Malaria Treatment Protocol in Timor-Leste

Challenges and constraints

João Soares Martins, Anthony B. Zwi, Karen Hobday, Fernando Bonaparte, Paul M. Kelly

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)677-686
Number of pages10
JournalHealth Policy and Planning
Volume27
Issue number8
DOIs
Publication statusPublished - Dec 2012

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Clinical Protocols
Malaria
Pyrimethamine
Routine Diagnostic Tests
Private Sector
Indonesia
District Hospitals
Pharmaceutical Preparations
Health Services
Names
Guidelines
Interviews
lumefantrine
Timor-Leste
artemether

Cite this

Martins, João Soares ; Zwi, Anthony B. ; Hobday, Karen ; Bonaparte, Fernando ; Kelly, Paul M. / The implementation of a new Malaria Treatment Protocol in Timor-Leste : Challenges and constraints. In: Health Policy and Planning. 2012 ; Vol. 27, No. 8. pp. 677-686.
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abstract = "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.",
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The implementation of a new Malaria Treatment Protocol in Timor-Leste : Challenges and constraints. / Martins, João Soares; Zwi, Anthony B.; Hobday, Karen; Bonaparte, Fernando; Kelly, Paul M.

In: Health Policy and Planning, Vol. 27, No. 8, 12.2012, p. 677-686.

Research output: Contribution to journalArticleResearchpeer-review

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T2 - Challenges and constraints

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AU - Hobday, Karen

AU - Bonaparte, Fernando

AU - Kelly, Paul M.

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