Effective SBCC begins with a thorough understanding of the problem or issue that you want to influence.
Developing a communication strategy to address substandard and falsified malaria medicines is no different. What is a bit different from other health issues are the sources of information, the types of information you need, the partners you may want to work with and the questions you need to ask. In addition to information concerning media access, literacy levels and preferred channels of communication, a strong situation analysis of SSFFC malaria medicines provides the following information:
- The pervasiveness of substandard and falsified malaria medicines in your country or community, and geographic prevalence
- A description of existing malaria medicine manufacturing, importation, distribution and quality control systems – listing any differences between geographic areas
- An understanding of the laws, policies, regulations and enforcement systems in place to protect the public from substandard and falsified malaria medicines
- Prescription and dispensing practices of health workers, pharmacists, and other official and unofficial sellers or distributors of malaria medicines
- Malaria treatment knowledge, beliefs, attitudes and practices among the public, health workers, pharmacists and drug vendors
- Regulatory efforts that are in place to prevent SSFFC malaria medicines, and how knowledgeable the public is about these efforts
- Stakeholders involved in efforts to ensure quality of malaria medicines, their roles and what they are currently doing to address SSFFC malaria medicines
Why is a Situation Analysis Important?
A situation analysis provides a detailed picture of the current state of the malaria medicine supply chain from manufacturer to user, including prescribing and treatment practices of health workers, vendors, pharmacists and consumers/clients. This understanding will inform the overall vision and the objectives of your communication strategy, as well as implementation decisions, and will ultimately contribute to its success.
HC3 conducted a desk review, Global Landscaping of SSFFC Malarial Medicines in 2015. The document focuses on the global SSFFC situation and efforts to address substandard and falsified ACT and other malaria medicines, but also highlights activities that have helped prevent or improve the quality and availability of malaria medicines. These countries are Nigeria, Tanzania and Rwanda.
The best way to start is to conduct a desk review of available research reports, policy documents and media reports. One organization that works with regulatory authorities in several countries to conduct drug quality surveys is the United States Pharmacopeial Convention (USP). Through the USP website you can check the Medicines Quality Database for a report on the quality of medicines in your country. See the Resources page for links to other helpful sources of information.
Conduct interviews with key informants in the National Malaria Control Programme, the national drug regulatory body, professional councils of pharmacists and health workers, pharmaceutical trade associations and major pharmaceutical companies to learn more about the situation. Often, these interviews will lead to more contacts, reports and research.
To learn more about the knowledge, attitudes, beliefs and practices surrounding malaria medicines access and use, conduct interviews with clients, health workers, pharmacists, regulators and drug vendors. These interviews may be quantitative or qualitative – quantitative research provides numerical data and can help us understand how many people believe or act a certain way, or determine the strength of relationships, while qualitative research provides more detail, and can explain why a person believes something or acts a certain way. One quick and inexpensive way to get quantitative information is to purchase questions on commercial omnibus surveys conducted periodically by marketing research companies.
What Key Questions Should I Ask?
The situation analysis will have three main sections:
The malaria context and extent of SSFFC malaria medicines in your country.
You will want to know about the malaria situation—the type and source of the problem, its prevalence, which populations are most affected and the current malaria case management recommendations. What is the recommended first line medicine for malaria management? What is the policy regarding malaria diagnosis? What is the prevalence of substandard and falsified malaria medicines? What are the most common sources of SSFFC malaria medicines?
The factors influencing SSFFC malaria medicines prevalence and use.
SBCC campaigns usually target factors or behaviors that influence a defined problem. With this in mind, it is important to gain an understanding of the many factors influencing SSFFC malaria medicines prevalence and use. For example, it will be helpful to learn how malaria medicines are manufactured and distributed. Are malaria medicines imported or manufactured locally? How is the quality of malaria medicines monitored? What regulatory body is responsible for setting drug standards, registering manufacturers and distributors and enforcing laws concerning medicine quality? Who is licensed to sell and dispense malaria medicines and what is the system for training and licensing them? What laws and penalties exist to deter improper importation, manufacturing and dispensing of malaria medicines? What are the variations in costs for customers purchasing malaria medicines?
It will be helpful to know about the public’s treatment seeking and malaria medicine purchasing practices, as well as their attitudes and knowledge concerning substandard and falsified malaria medicines. Who in the household usually treats malaria and buys medicines? How do they usually diagnose malaria? Where do they most commonly get malaria medicines? What do they know about substandard and falsified malaria medicines?
See examples of survey questions here.
Key partners and activities in the fight against SSFFC malaria medicines.
Health practitioners will also want to know what organizations and individuals are involved in ensuring the quality of malaria medicines and enlightening the public about it. What organizations or institutions are involved in monitoring the quality of medicines? What organizations or institutions are communicating with the public about drug quality and malaria treatment? What organizations or institutions train pharmacists, health workers and drug vendors concerning malaria medicine storage, dispensing and quality control? What advocacy efforts are taking place that influence the quality of malaria medicines?
Many actors are involved in efforts to protect malaria patients from poor quality ACTs and monotherapies. Each group has their own perspectives, roles and resources. You will meet many potential partners who can help shape and implement your communication strategy when conducting the situation analysis. It will be very beneficial to involve as many as possible and as early as possible.
Most partners come from one of five groups:
- Medicine regulatory and policy bodies and professional associations
- Pharmaceutical manufacturers, importers, distributors, and trade associations
- Government malaria control program and its civil society partners
- Criminal investigation and law enforcement agencies
- Media and communication specialists
Involving as many of these partners as possible will strengthen your understanding of the issue. You may want to get these partners together again when you develop your communication strategy.