Improving child health through informed policy decisions and targeted interventions to strengthen medicine management in the community: The example of Senegal

To reduce child mortality, communities must have access to appropriate treatment with quality medicines. The Rational Pharmaceutical Management (RPM) Plus Program's indicator-based Community Drug Management of Childhood Illnesses (C-DMCI) assessment tool helps inform national policy change and guide interventions to improve medicine management and child health. The C-DMCI comprises two complementary questionnaires: one evaluates knowledge, services, and products of medicine providers, and one evaluates the medicine use practices of household caregivers of sick children.RPM Plus's survey of 263 medicine providers and 300 caregivers resulted in a series of policy changes and related interventions in Senegal. C-DMCI results indicated the wide availability and inappropriate use of antibiotics in the community; consequently, the government introduced a policy permitting community health workers with special training and close supervision to treat cases of childhood pneumonia. Results also showed that caregivers frequently bought inappropriate treatment from private pharmacies. In response, these private providers were included in child health interventions, and RPM Plus designed a training and supervision package for sales assistants to improve their management of childhood illnesses. In addition, the C-DMCI indicated that importation restrictions kept private pharmacies from obtaining oral rehydration salts (ORS), so the policy was changed to permit private wholesalers to purchase ORS and other generic medicines from the public-sector source, thereby allowing the medicines to be stocked in private pharmacies. The C-DMCI assessment in Senegal identified problems in community-level management of medicines for childhood illnesses that shaped national policies and guided interventions targeting private pharmacies and community health providers.