PMI VectorLink, PSI, Washington DC, USA.
PMI VectorLink, PSI, Accra, Ghana.
Malar J. 2023 Aug 2;22(1):222. doi: 10.1186/s12936-023-04626-y.
Continuous distribution channels are effective methods to deliver malaria interventions such as insecticide treated nets (ITNs) to pregnant women attending antenatal care clinics and children under five attending immunization visits. Facility-based and provider-based checklists were used during supportive supervision visits to measure the quality of facility-based services and interventions. This study looks at ITN distributions at health facilities in Ghana, with the aim of providing insights on how quality can be measured and monitored.
Various quality improvement approaches for malaria services occur in Ghana. Selected indicators were analysed to highlight the similarities and differences of how the approaches measured how well the channel was doing. Generally, the approaches assessed (1) service data management, (2) logistics data management, and (3) observation of service provision (ITN issuance, malaria education, ITN use and care education). Two approaches used a binary (Yes/No) scale, and one used a Likert scale.
Results showed that most data reported to the national HMIS is accurate. Logistics data management remained an issue at health facilities, as results showed scores below average across facility stores, antenatal care, and immunization. Though the supervision approaches differed, overall results indicated that almost all eligible clients received ITNs, data were recorded accurately and reported on-time, and logistics was the largest challenge to optimal distribution through health facilities.
The supervision approaches provided valuable insights into the quality of facility-based ITN distribution. Ghana should continue to implement supportive supervision in their malaria agenda, with additional steps needed to improve reporting of collected data and increase the number of facilities visited for supportive supervision and the frequency. There were various supervision approaches used with no clear guidance on how to measure quality of facility-based ITN distribution, so there is also need for the global community to agree on standardized indicators and approaches to measuring quality of facility-based ITN distribution. Additionally, future studies can review the effect of multiple rounds of supervision visits on the quality of ITN distribution as well as understand the facilitators and barriers to scaling up supervision of facility-based ITN distribution.
连续的分发渠道是向接受产前保健的孕妇和接受免疫接种的五岁以下儿童提供驱虫蚊帐（ITN）等疟疾干预措施的有效方法。在支持性监督访问期间，使用基于设施和基于提供者的清单来衡量基于设施服务和干预措施的质量。本研究着眼于加纳卫生设施的 ITN 分发情况，旨在提供有关如何衡量和监测质量的见解。
加纳发生了各种疟疾服务质量改进方法。分析了选定的指标，以突出这些方法在衡量渠道运作情况方面的相似之处和不同之处。一般来说，所评估的方法包括：（1）服务数据管理，（2）物流数据管理，（3）服务提供观察（ITN 发放、疟疾教育、ITN 使用和护理教育）。两种方法使用二进制（是/否）尺度，一种方法使用李克特量表。
结果表明，向国家 HMIS 报告的大多数数据是准确的。物流数据管理仍然是卫生设施的一个问题，因为结果显示，设施仓库、产前保健和免疫接种的分数均低于平均水平。尽管监督方法不同，但总体结果表明，几乎所有符合条件的客户都收到了 ITN，数据准确记录并按时报告，物流是通过卫生设施进行最佳分发的最大挑战。
监督方法为基于设施的 ITN 分发质量提供了有价值的见解。加纳应继续在其疟疾议程中实施支持性监督，并采取额外措施改进收集数据的报告，增加支持性监督的设施数量和频率。使用了各种监督方法，但没有明确的指导如何衡量基于设施的 ITN 分发质量，因此全球社区还需要就衡量基于设施的 ITN 分发质量的标准化指标和方法达成一致。此外，未来的研究可以审查多次监督访问对 ITN 分发质量的影响，并了解扩大基于设施的 ITN 分发监督的促进因素和障碍。
