On the cards – literally and figuratively

The Herald of Zimbabwe reports that, “NEW vaccines for meningitis, hepatitis, malaria and diarrhea among other diseases that had no vaccines before are on the cards as the world moves to effectively reduce cases of infant mortality and morbidity in view of attaining the World Millennium Development Goals.”

The Herald’s article is using the common metaphor, “on the cards,” or as said in the US, “in the cards”, to refer to a predictable or likely future event.  In essence the article expresses expectations that new vaccines will be incorporated into national health programs in the near future.

The metaphor is likely based on the fact that cards, as in the kind used to play games or Tarot cards, have been used for centuries to divine the future. But there is another kind of card that is crucial for determining the success of health programs generally and malaria interventions specifically. That is the record card that shows the health services a client has received.

Unfortunately, malaria interventions are not always “on the cards” that one finds at public health service centers.  In Ghana, for example, the antenatal card (actually a small booklet) for pregnant women does have a place to write if she has received IPTp and the number of doses, but there is no official place to record whether she has been given an ITN.

anc-cards-sm.jpgThe ANC cards in common use in Burkina Faso do not even have a formal place to record IPTp doses.  In Nigeria many ANC cards as seen at the left, had no place to enter whether a woman was given an ITN or received IPTp doses. Several malaria in pregnancy projects had to print new ANC cards and clinic registers to make it possible to mark accurately the delivery of malaria control services. One wonders how accurate service and coverage data can be obtained to show progress toward achieving national malaria targets and indicators without such cards.

With no place to mark malaria interventions provided, health record cards are incomplete. No amount of divining will be able to give us proper information on whether we are achieving our malaria targets without these.

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