In Liberia, the need for health assistance is great due to the inadequate level of services and the growing demand on existing health structures as IDPs and refugees return home following the cessation of Liberia's civil war. In conjunction with efforts by the Government of Liberia to meet the health needs of its citizens, the international community continues to support health structures and provide services in areas where the demand is greatest. IMC is proposing to introduce or scale up rapid diagnostics to effectively diagnose sexually transmitted infections (STIs), such as syphilis, and malaria. PATH has worked with private firms to develop and promote access in low-resource settings to simple tests that do not require laboratory facilities. A private sector partner will be sought for support of program implementation and the procurement and transport of the technologies.
As a pilot activity, PATH and IMC, in collaboration with the Ministry of Health, will introduce select public health technologies, accompanied by training for health workers, into stable relief settings served by IMC. In each area, many health care workers from the local communities are working to improve the health of their communities. However, the factors that have caused the crisis in their country have also had a deleterious effect on the availability and education levels of health workers. Thus, these settings are prime locations for a public/private partnership through product, financial, and technical interventions channeled via training and support to a willing but under-educated cadre of local health workers.
This pilot IMC/PATH effort will be conducted with an eye toward establishing a model program on the introduction and correct use of appropriate technologies to more effectively address health delivery and the capacity building of health workers that can be scaled up across IMC's 20 programs countries or by other implementing relief agencies.
Effective Diagnosis of Syphilis - In Liberia, the return of IDPs and refugees has increased the spread of STIs. The level of vulnerability for many returnee women remains very high. Repatriation information shows that most female returnees are single heads of households, with no source of support. Many, therefore, resort to exchanges for sex to make ends meet, thereby fuelling the transmission of HIV/AIDS, syphilis, and other STIs. Rapid syphilis diagnostic tests will allow IMC-supported clinics to offer diagnosis and treatment at the same clinic visit, ultimately reducing the loss to follow-up and improving treatment.
Prevention and Treatment of Malaria - All those who seek treatment for malaria at health facilities must first have the illness properly diagnosed, but effective diagnostic tools are often unavailable or inappropriately utilized by local staff, especially at peripheral facilities. An increase in the proper use of rapid diagnostic tests for malaria will enable the effective diagnosis of the disease for those seeking treatment at IMC-supported clinics.
Job Aid Development - PATH will develop job aids to be pilot tested and used by IMC. (November 2008)
Training - PATH will provide training to local health workers on the use of rapid diagnostic tests for syphilis and malaria. (December 2008)
Evaluation of Introduction and Training - PATH will assist IMC in evaluating the use of these two rapid diagnostics in post-conflict peripheral health facilities. The evaluation will include an examination of improved accessibility for hard-to-reach populations, improvements over current practices, acceptability to staff and beneficiaries, appropriateness for the setting, and potential appropriateness of technologies for more acute relief settings. Feedback on job aids and information education and communication materials will be solicited from health staff through informal discussions after trainings and from beneficiaries during introduction activities. A pre-post knowledge test will also be administered to health providers. (January - November 2009)
In the target area, this project will impact approximately 50,000 people, many of whom will be women and children, from among the nearly 300,000 refugees and internally displaced persons (IDPs) reached through IMC's 35 health facilities in three counties in Liberia (19 health facilities in Lofa County, ten in Cape Mount, and six in Bomi). Approximately 300 health care workers in these sites would receive training on these technologies.