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

From: Factors influencing implementation of the Ministry of Health-led private medicine retailer programmes on malaria in Kenya

Reported impacts 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
  1. * No change especially reported by mothers in Kwale
  2. † This perception was reported by mothers
  3. ‡ Trainers and managers not interviewed in Kwale
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