Translating health policy into practice: successes and challenges at implementation in Bungoma South district Western Kenya

Background: Malaria is one of the most common infectious diseases in the world with more than 40 percent of the world’s population at risk and one of the greatest public health concerns especially in sub-SaharanAfrica. InBungomaSouthdistrict,malaria is the leading cause of morbidity, accounting for 49 percent of the top ten diseases in the district. In 2006, Kenya implemented a new malaria treatment policy recommending the use of ArtemetherLumefantrine (AL) as the first line of treatment. National guidelines on the diagnosis, treatment and prevention and job aids were developedanddisseminated tohealthworkers alongside in-service training. The survey investigated if treatment of uncomplicated malaria conformed to national malaria treatment guidelines in Kenya. Methods: In September 2009, face to face interviews for 31 health workers routinely performing consultations at out-patient departments in 17 health facilities were conducted. Data on health facility inventory control practices and stock status was retrospectively collected from records available. Outcome measures: availability of antimalarial drugs on the survey day, stock-outs in past six months, presence of job aids, health worker’s exposure to in-service training on AL and access to new national malaria treatment guidelines. Results: 35 percent of the health facilities had access to job aids and current treatment guidelines, 76 percent of the health workers had been trained on malaria case management. AL was almost universally available in all the health facilities. All facilities had recorded stock outs of AL six months prior to the survey and the duration of the stock outs was substantial lasting two months on average. Conclusion: Treatment practices in uncomplicated malaria after policy change, do not fully conform to the national malaria treatment guidelines. Targets set for key implementation indicators by the division of malaria control, in terms of availability of recommended drug and training of health workers, have not been fully achieved. If the government does not ensure uninterrupted supply of recommended treatment, high quality focused training and appropriate patient education, and if provider prescription practices do not fully conform to the recommended treatment guidelines, the major potential public health benefits of AL may not be realized.