Adherence to the Test, Treat and Track malaria policy among selected health facilities in Ghana: The clients’ perspective

Introduction The World Health Organization in 2012 introduced the test, treat and track (T3) policy to standardize the process of malaria management in endemic settings. All malaria suspected conditions are expected to be confirmed by test and treatment initiated with recommended artemisinin-based combination therapy (ACTs) and treatment outcomes monitored over the course of the illness. This study evaluated the adherence to the T3 policy in selected health facilities within three malaria epidemiological zones in Ghana. Methods This crossectional study was conducted in November 2019 involving thirty health facilities comprising one district hospital, one Health Centre and 3 Community Health and Planning Services (CHPS) randomly selected from six districts in the 3 malaria epidemiological zones. In addition, Clients exit interviews were conducted from each facility. Frequency charts highlighted facility characteristics. Factors associated with the test , treat and track defined outcomes were assessed using chi square and multivariable logistic regression models at 5% level of significance and 95% confidence interval. Data were classified according to facility and clients’ perspectives. Results Overall, 590 patients and 30 health facility managers were interviewed from 30 facilities in 6 districts across the three zones. CHPS compounds formed 18 (60.0%) of facilities assessed. Twenty-nine out of 30 health facilities had Rapid Diagnostic Test (RDT) kits and antimalarials. In all, adherence to the T3 policy was 31.9%, whiles 30% of facility managers in the North and Middle zones indicated inadequate training on the T3 policy. The study showed that 90% and 98% of patients were tested and treated respectively for malaria. However only 35% (range 22% − 44%) of patients were tracked according to the T3 policy across all zones. Health facilities in the southern zone of Ghana had almost three-fold increased odds of adhering to the T3 policy compared to the middle zone [aOR = 2.87 (1.7, 4.8): p < 0.001]. Males were more likely not to return to the health facility for review [aOR = 0.6 (0.3, 0.9): p = 0.018]. Conclusion Testing and treating for malaria were high among health facilities in the three epidemiological zones. However, tracking of patients was very low across the zones. Adherence from clients’ perspective was low especially for males, who were more likely to default on health facility return for review, even though facility prescribers informed participants on the need to return for review. The hurdle for one to adhere to the policy was to return to facility for review. Recommendations The National Maria Elimination Program (NMEP) should ensure periodic trainings of health facility staff especially those within the Northern and Middle zones of Ghana and strengthen monitoring and supervision of health facilities to enhance adherence to the T3 policy. The NMEP could also intensify Client sensitization programs especially targeting male clients to help understand the need to return to health facilities for review in line with the T3 policy. There is also the need for implementation research to explore strategies to improve the tracking component of the policy at the client and health facilities levels within the T3 policy framework.