Table 2 Summary of reported impacts, and perceptions of moderating factors

ON COMMUNITY:

Positive attitudes/better relationship with PMRs

Improved use of OTC medicines/some report no change*

More likely to accept advice from PMRs

Experienced better outcomes from treatment

Positive:

Knowledge of programme (through public information or direct experience)

Availability of programme materials (act as validation of training)

Shopkeeper's knowledge, attitude and communication skills

Availability of credit

Negative:

High cost of drugs

Lack of familiarity with drugs/preferences

Side effects of drug

Inability to read instructions

Time taken in buying drugs from trained retailers

Use of proxy customers

Rapid improvements in symptoms

Contradictory messages on packaging and mass media (e.g. radio advertisements)

ON PMRs:

More knowledge about malaria and its treatment

More likely to ask customers questions, give advice on drug use and refer to hospital

Financial gains from selling more drugs and getting more customers

Financial losses if not able to sell

Improved status in community

Better relations with community and public health officers

Less likely to sell expired drugs†

Positive:

Exposure to training

Materials: support training and validate trained PMRs

Public information activities (where held)

Shopkeeper's attitude positive

Customers' attitude positive

High coverage of shops in surrounding area

Negative:

Cost of drugs

Instability of some shops and staff in shops

Proximity to hospitals, clinics and chemists (don't stock antimalarials because cannot compete on prices)

Situated in remote rural areas: often small outlets, do not stock antimalarials because expensive to stock and low turnover

Time taken in training and advising

ON TRAINERS AND MANAGERS (Busia and Makueni‡)

More knowledge and skills on malaria control, training and programme management

Improved status for trainers in community and with PMRs

Better relationship between PHOs and PMRs

PHOs supported to conduct other routine activities

Trainers feel positive - bringing about change and getting positive feedback from PMRs

Positive:

Positive attitudes in DHMT

Technical support from KEMRI

Negative:

Inadequate resources such as coverage of programme, unable to undertake monitoring and public information activities, low allowances to co-trainers, materials not adapted to current drug policy

Delays in disbursement of funds