title: Impact of pharmacy worker training and deployment on access to essential medicines and health outcomes in Malawi: protocol for a cluster quasi-experimental evaluation.
abstract: BACKGROUND
  Access to essential medicines is core to saving lives and improving health outcomes of people worldwide, particularly in the low- and middle-income countries. Having a trained pharmacy workforce to manage the supply chain and safely dispense medicines is critical to ensuring timely access to quality pharmaceuticals and improving child health outcomes.
  
  
  METHODS
  This study measures the impact of an innovative pharmacy assistant training program in the low-income country of Malawi on access to medicines and health outcomes. We employ a cluster quasi-experimental design with pre-and post-samples and decision analytic modeling to examine access to and the use of medicines for malaria, pneumonia, and diarrhea for children less than 5 years of age. Two intervention districts, with newly trained and deployed pharmacy assistants, and two usual care comparison districts, matched on socio-economic, geographic, and health-care utilization indicators, were selected for the study. A baseline household survey was conducted in March 2014, prior to the deployment of pharmacy assistants to the intervention district health centers. Follow-up surveys are planned at 12- and 24-months post-deployment. In addition, interviews are planned with caregivers, and time-motion studies will be conducted with health-care providers at the health centers to estimate costs and resources use.
  
  
  CONCLUSIONS
  This impact evaluation is designed to provide data on the effects of a novel pharmacy assistant program on pharmaceutical systems performance, and morbidity and mortality for the most common causes of death for children under five. The results of this study should contribute to policy decisions about whether and how to scale up the health systems strengthening workforce development program to have the greatest impact on the supply chain and health outcomes in Malawi.
authors.affiliation: Global Medicines Program, Department of Global Health, University of Washington, Harris Hydraulics Building, 1510 NE San Juan Road, Seattle 98195-7965, WA, USA. slubinga@uw.edu.
authors.forename: Solomon J
authors.initials: SJ
authors.lastname: Lubinga
authors.forename: Alisa M
authors.initials: AM
authors.lastname: Jenny
authors.forename: Erin
authors.initials: E
authors.lastname: Larsen-Cooper
authors.forename: Jessica
authors.initials: J
authors.lastname: Crawford
authors.forename: Charles
authors.initials: C
authors.lastname: Matemba
authors.forename: Andy
authors.initials: A
authors.lastname: Stergachis
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Babigumira
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D004512:Education, Pharmacy; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D004364:Pharmaceutical Preparations / Q000600:supply & distribution*; D010595:Pharmacists / Q000458:organization & administration*; D011787:Quality of Health Care; D012107:Research Design
chemical_list: D004364:Pharmaceutical Preparations