Successful Roll Out of RDTs in Uganda

This brief discusses lessons learned by the Malaria Consortium during a three-year period of scaling up the use of rapid diagnostic tests (RDT) to detect malaria at the community level and in health facilities. Their work indicates that introducing RDTs requires a "holistic systems strengthening approach" rather than mere distribution, in order to be successful. Based on experience, the Malaria Consortium says that despite the relatively high cost of RDTs, their use is a cost-effective measure in settings currently over-treating for malaria with artemisinin combination therapy (ACTs), provided that health workers treat patients in accordance with the results.

The brief explains that if Uganda is to successfully scale up the use of RDTs and sustain the benefits achieved for the health system, there are four areas that need specific attention. Some of the communication aspects are outlined below:

“Appropriate training of health workers in case management and patient education”:

• Training all health workers involved in patient care management, not just lab technicians and doctors;
• Trainings should be arranged in a “cascade” of levels that creates trainers who can train and supervise others. Well-trained national and district trainers, health workers, and village health teams will help improve the uptake of this diagnostic tool, as well as provide enough trainers to assist in districts with less access to health coverage;
• Some qualities to consider when choosing trainers include commitment, technical, and teaching qualifications;
• Trainings should be participatory in nature and include practical sessions. The facilitator’s guide and user’s manual are resources that assist in this;
• A guide should be developed on how to manage cases with negative RDT results for health workers; and
• Interpersonal communication skills are key among health workers at all levels.

“Support supervision tailored over time to improve and sustain quality of the services”:

• ‘Long-term, integrated support’ can change "health workers’ attitudes and improve their skills and confidence” for uptake;
• Training is needed for district trainers in "methods of integrated supervision and mentoring";
• Checklists for supervision can be developed and supervision can be adapted to needs of health workers and village health teams; and
• Two follow-up visits, one right after training and one in six weeks will help to ensure that new knowledge and skills are used and that workers stock and set up their work area. Ongoing training can be provided during supervisory visits.

“Strong monitoring systems to improve disease surveillance ensure quality of the test kits and inform stock management”:

• Improved record keeping and integration of records on malaria and other febrile diseases can improve control overall of communicable diseases. E-health initiatives, such as mTrac, should be explored further.
• The use of supplies should be monitored. This data will improve “procurement and distribution of both RDT kits and drugs....”

“Sensitisation and social mobilisation to ensure uptake by the communities”:

• Raising awareness among political and religious leaders helps to “ensure the environment is favourable to health workers’ new practices.” By involving local leaders, they can help to communicate the potential benefits to their communities;
• Well-planned behaviour change communication campaigns should help to move from “presumptive to diagnosis-based treatment so that community members can understand and accept the changing practices in case management”; and
• Engaging the private sector in continuous dialogue may help to make RDTs more available at the national level.