The MAM program – led by FHI 360, GSMF, LSHTM and Health Partners Ghana, and funded by Pfizer – was established in 2007 to help close critical gaps in malaria prevention, treatment and education. Malaria is endemic in all parts of Ghana, with all 24.2 million people at risk. It accounts for over three million outpatient visits annually in the country and 30% of all deaths in children under five. Pregnant women are particularly susceptible to malaria, increasing the risk of severe anemia and death, as well as premature delivery, stillbirth and low birth weight in newborns.
The MAM program educates Licensed Chemical Sellers (LCSs) – the local health authority and main suppliers of medicines across communities in Ghana – on malaria symptom recognition and treatment approaches. The program also involves community mobilization to educate patients, particularly the high-risk population of pregnant women and children under five, and strengthen their demand for quality care. Over 25% of malaria in Ghana is resistant to widely-available monotherapies. Combination therapies that address resistance issues were also cost-prohibitive for most of the population prior to the program.
In addition to the barriers of cost and availability, there were also many common misconceptions held by community members and even LCSs. These included:
- The belief that malaria is a common disease, is not dangerous and does not kill
- The lack of knowledge that malaria is spread by mosquitoes
- The impression that malaria is caused by heat, house flies, dirt, hard work or eating fatty/oily foods or unripe mangoes
To address these issues in a comprehensive way, the MAM program includes health, education and even economic improvement aspects.
A Licensed Chemical Seller explains how to provide appropriate dosing of malaria drugs based on the client’s age and weight, information she learned through the MAM training course.
At the core of the program is reducing malaria-related morbidity and mortality in Ghana’s Ashanti region by improving malaria symptom recognition, treatment and referral. The program contributed to the advocacy that resulted in a declassification of combination anti-malarial drugs by the Ministry of Health. Subsequently, LCSs are now permitted to stock and dispense these drugs, bringing effective treatment into the communities. The program has reduced the time needed to obtain effective treatment by 40%. Through community mobilization, household knowledge of early signs of malaria has increased. Combination therapies are also now the most widely used treatment for malaria, increasing cure rates. The program established links so that community-level data is now being collected, analyzed and fed into the health system, helping to inform decision making at all levels and strengthening the connectivity between LCSs and the District and Regional Health Office.
Robust education programs trained 1700 LCSs in Ghana to recognize the symptoms of malaria, refer complicated cases directly to health centers, and provide proper treatment and dosage for those who do not need a referral. As a result of the trainings, participating LCSs were elevated in the community for their expertise in malaria and are now recognized as part of the health system and a source of community-level data on malaria.
A sign board on the outskirts of Kumasi alerting passer-bys to the dangers of malaria and the importance of prompt treatment.
There were economic benefits to both the program beneficiaries and the LCSs. Following training and education, participating LCSs became area experts on malaria, which increased traffic and built customer trust, often driving business growth. The increased business helps to reinforce the value of MAM training and better customer service, making the program more sustainable. Community members also benefited from the program: the MAM program and its partners worked with the National Malaria Control Program (NMCP) to apply for the Affordable Medicines Facility for malaria (AMFm) from the Global Fund for AIDS, Tuberculosis and Malaria. This approach resulted in a price reduction for combination therapy, thus making it affordable for lower-income members of the community. As a direct result, caregivers and mothers are spending less time at home caring for sick family members and more time at work or in income-generating activities.
Programs like MAM improve lives by addressing more than health. Through the MAM project, LSC program participants have gained powerful expertise and improved their businesses in the process. And program beneficiaries have gained better knowledge of the signs of the disease, while gaining improved access to and lower costs for treatment. Although MAM is a health-centered program, it would not be as successful without a more comprehensive approach.