title: Parasite-based malaria diagnosis: are health systems in Uganda equipped enough to implement the policy?
abstract: BACKGROUND
  Malaria case management is a key strategy for malaria control. Effective coverage of parasite-based malaria diagnosis (PMD) remains limited in malaria endemic countries. This study assessed the health system's capacity to absorb PMD at primary health care facilities in Uganda.
  
  
  METHODS
  In a cross sectional survey, using multi-stage cluster sampling, lower level health facilities (LLHF) in 11 districts in Uganda were assessed for 1) tools, 2) skills, 3) staff and infrastructure, and 4) structures, systems and roles necessary for the implementing of PMD.
  
  
  RESULTS
  Tools for PMD (microscopy and/or RDTs) were available at 30 (24%) of the 125 LLHF. All LLHF had patient registers and 15% had functional in-patient facilities. Three months' long stock-out periods were reported for oral and parenteral quinine at 39% and 47% of LLHF respectively. Out of 131 health workers interviewed, 86 (66%) were nursing assistants; 56 (43%) had received on-job training on malaria case management and 47 (36%) had adequate knowledge in malaria case management. Overall, only 18% (131/730) Ministry of Health approved staff positions were filled by qualified personnel and 12% were recruited or transferred within six months preceding the survey. Of 186 patients that received referrals from LLHF, 130(70%) had received pre-referral anti-malarial drugs, none received pre-referral rectal artesunate and 35% had been referred due to poor response to antimalarial drugs.
  
  
  CONCLUSIONS
  Primary health care facilities had inadequate human and infrastructural capacity to effectively implement universal parasite-based malaria diagnosis. The priority capacity building needs identified were: 1) recruitment and retention of qualified staff, 2) comprehensive training of health workers in fever management, 3) malaria diagnosis quality control systems and 4) strengthening of supply chain, stock management and referral systems.
authors.affiliation: Malaria Consortium, Upper Naguru East Road, P,O, Box 8045, Kampala, Uganda. drdjkyabayinze@yahoo.com
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Kyabayinze
authors.forename: Jane
authors.initials: J
authors.lastname: Achan
authors.forename: Damalie
authors.initials: D
authors.lastname: Nakanjako
authors.forename: Betty
authors.initials: B
authors.lastname: Mpeka
authors.forename: Henry
authors.initials: H
authors.lastname: Mawejje
authors.forename: Rukaaka
authors.initials: R
authors.lastname: Mugizi
authors.forename: Joan N
authors.initials: JN
authors.lastname: Kalyango
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
authors.forename: Ambrose
authors.initials: A
authors.lastname: Talisuna
authors.forename: Van geertruyden
authors.initials: Vg
authors.lastname: Jean-Pierre
mesh_terms: D057191:Capacity Building / Q000592:standards; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D019468:Disease Management; D006291:Health Policy; D006801:Humans; D008288:Malaria / Q000175:diagnosis*; D011320:Primary Health Care; D014454:Uganda