Tibu Homa – Diagnosis and Management of Severe Febrile Illness

Overview and Objectives

Building on the efforts of the Tanzanian Ministry of Health and Social Welfare (MoHSW) to address the high under five morbidity and mortality rate in the Lake Zone (which is closely linked to the lack of successful child survival interventions, including malaria control efforts in the region), the USAID Diagnosis and Management of Severe Febrile Illness Project, commonly known as the Tibu Homa (Treat Fever) Project, is working with the Ministry and regional and district health teams to transform the current presumptive diagnosis and management of severe febrile illness into a system where rapid diagnostic tests play a central role.

Severe febrile illness is characterized by the sudden onset of fever and may accompany such illnesses as malaria, pneumonia, and diarrhea (the leading causes of death among children under five).

Tibu Homa’s goal is to reduce the mortality of children under five years old with severe febrile illness through improving diagnosis and treatment of febrile illness cases in the Lake Zone. This will be reached through the achievement of the following objectives:

1. Increase availability of, and accessibility to, fundamental, facility-based curative and preventive child health services.
2. Ensure sustainability of critical child-health activities.
3. Increase linkages within the community to promote healthy behaviors, thereby increasing knowledge and use of child health services.

Tibu Homa works to improve case management at facility levels, strengthen supply chain management systems, and engage communities and health providers to prevent the deaths of children under five.

• Improve case management of febrile illness at the facility level through continuous quality improvement approaches and on-the-job training and mentoring, based on the MoHSW updated Integrated Management of Childhood Illness (IMCI) protocol, which now promotes treatment based on evidence from rapid malaria diagnostic tests, or mRDTs/microscopy.
• Strengthen supply chain systems in public and private health facilities to ensure the continuous availability of medicines for febrile illness.
• Engage communities and develop linkages and referral systems between health providers and community members to: (1) teach parents when to seek services for their children; and (2) ensure that appropriate referrals and services are available when a child is brought in for health care services.

Reduce morbidity and mortality from severe febrile illness in the lake zone region of Tanzania by assisting the Ministry of Health to improve the diagnosis and treatment of fevers among children under five in their facilities.

Achievements

Objective One: To increase availability of, and accessibility to, fundamental facility-based curative and preventive child-health services.

• Updated MoHSW IMCI guidelines, which were made available with the project’s technical support.
• Contributed to the increase in the number of children under the age of five with fever and laboratory-confirmed malaria who received the correct malaria treatment. Over 90% of malaria-positive children now receive the correct anti-malarial therapy.
• Contributed to the improvement in compliance to IMCI algorithm. Clinicians now have access to and are using the differential diagnosis protocols for management of all major causes of severe febrile illness, including malaria, pneumonia, and diarrhea, as per the adapted IMCI algorithm.
• Mwanza, Mara, and Kagera Regions now have six trainers of trainers in case management who have subsequently trained the health facility’s pediatric quality-improvement teams.
• 1,167 health care workers from 416 health facilities in 29 districts trained in case management (eight in Mwanza, eight in Kagera, six in Mara, two in Shinyanga, three in Simiyu, and two in Geita regions).
• Regional and council health management teams from 28 districts and hospital management teams from 41 hospitals trained in supportive supervision and in mentorship (213 members trained in comprehensive supportive supervision and 138 members in clinical mentorship).
• Lessons learned from the previously conducted intensive logistic mentorship are now being used to address key supply chain management issues at the facility level.
• Trained a total of 1,119 health care workers in supply chain management, with a special focus on documentation of consumption data, proper filling and timely submission of report and request forms, good storage of medicines and supplies, and use of logistics management tools.
• Improved availability of essential febrile illness related medicines: facilities with more than 10 tracer medicines increased from 42% in January 2012 to 96% in September 2014.
• Improved availability of key commodities (ACTs for uncomplicated malaria and rapid malaria diagnostic tests, or mRDTs): facilities with key commodities in stock increased from 32% in March 2013 to 79% in September 2014.
• Improved malaria testing rate (mRDT/microscopy), from 75% in February 2012 to 94% in September 2014.
• Revitalized 39 hospital-based medicines and therapeutics committees and 36 primary health care medicines and therapeutics committees to oversee medicines and supplies.
• Average IMCI compliance in the Lake Zone has improved from 3% in January 2013 to 39% in September 2014.

Objective Two: To ensure sustainability of critical child-health activities

• The Muleba District council health management team (CHMT) secured funding to construct a boat to be used for supportive supervision in hard-to-reach islands.
• Four Hospital Medicines and Therapeutic Committees were revitalized/formed in Shinyanga and Simiyu.
• Trained seven CHMTs in financial management to build their capacity in planning, budgeting, and resource mobilization using the I-TECH MoHSW approved curriculum.
• Currently supporting three CHMTs in strengthening community-based health Financing in Musoma Rural, Missenyi, and Sengerema districts in the Mara region.
• Assisted two CHMTs (Missenyi and Musoma Rural) in mobilizing communities to enroll with the community health fund.
• Engaged 30 health managers and policy makers from four Mwanza districts (Chato, Ilemela, Kwimba, and Ukerewe) in a quarterly implementation progress workshop to discuss project implementation.

Objective Three: To increase linkages within the community to promote healthy behaviors thereby increasing knowledge and use of child health services

• 598 children under the age of five with fever were referred to the health facility by community health workers in the seven districts where the project implements community activities.
• A network of 94 organizations supporting orphans and vulnerable children was developed and an agreement was reached in working with them to identify orphans and vulnerable children under the age of five with fever and refer them to respective community based organizations and civil society organizations for other core services.
• Health care workers and community leaders increased the number of identified and documented orphans and vulnerable children to 3,896 in two years (above the target of 500 per year) who accessed services at Tibu Homa supported health facilities.
• 24 orphans and vulnerable children were identified by health care workers and referred to partner organizations for other core support services.
• Assisted in disseminating 3,250 information, education, and communication materials (fliers and posters), initially generated by MoHSW and COMMIT, in 14 Wards (Mwanza, Mara, and Kagera Regions).
• In collaboration with district officials (DIMFP, DSWO, DHO, and CDO), trained 166 community health workers on Integrated Community Maternal, Newborn, and Child Health (ICMNCH).
• Conducted 24 meetings with village/street government leaders, resulting in an agreement to improve health facility management and monitoring and the referral of children under the age of five to a health facility within 24 hours of onset of fever.
• Contributed to updating a Joint Pediatric Continuum of Care Framework, developed by USAID-funded partners, for implementation of community health activities.
• Initiated community-supportive supervision to all community health workers in all 32 catchments health facilities.
• Introduced an alternative community model, Community Health System Strengthening, in the spread regions of Shinyanga and Simiyu.
• Added pediatric quality-improvement teams to the outreach services teams in the catchments health facilities in Geita, Sengerema, Butiama, Missenyi, Muleba and Nyamagana Districts.
• Involved catchments health facilities’ pediatric quality-improvement teams in quarterly Village Health Days in Geita, Sengerema, Butiama, Missenyi, Muleba and Nyamagana Districts.