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Advancing Global Malaria Service Delivery in the Face of COVID-19

In its seven-month lifespan, COVID-19 has impacted people around the globe in widespread and unparalleled ways. As of July 23, there were 15.4 million confirmed cases and almost 632,000 confirmed deaths reported from 188 countries and regions (Johns Hopkins). The numbers are striking and the urgency to combat COVID-19 is acute.

While the global health community has achieved steady gains in reducing the incidence of malaria over the last decade, nearly half the world’s population remains at risk of malaria. The malaria death rate could nearly double if the pandemic causes ongoing commodity shortages and the disruption of essential malaria interventions (WHO). As always, it’s young children and pregnant women who are most at risk.

National malaria control programs (NMCPs) in parts of sub-Saharan Africa with a particularly high malaria burden are confronted with the challenge of continuing to deliver malaria prevention and treatment services while also protecting patients, health workers, and public health officials from COVID-19 exposure (CDC).

PMI Impact Malaria (IM) works closely with countries to improve the access, quality, and efficiency of malaria services. Prior to the pandemic, the nature of IM’s support to countries tended more towards in-person gatherings like group trainings, lessons learned workshops, and other meetings to effect improvements in malaria service delivery. Thanks to decentralization, digital technology, and a laser focus on infection prevention and control, IM has largely been able to sustain its support to country health systems during the pandemic.

The examples below highlight country-driven adaptations supported by IM that enable a continued focus on advancing malaria service delivery:

Seasonal Malaria Chemoprevention (SMC)

Cameroon, Mali, and Niger updated their SMC campaign protocols with new approaches to limit the spread of COVID-19. These include door-to-door distribution only, reduced numbers of participants in physical meetings and training sessions, mandatory use of face coverings for health workers and supervisors, maintaining social distance, increased hand hygiene, and changes to training curricula for health workers and communications strategies for communities.

With COVID-19 restrictions in mind, Ghana developed a new job aide to ensure adherence to infection, prevention, and control (IPC) protocols before, during, and after SMC administration. The tool encourages acceptance of these practices by health workers and the beneficiary population.

Diagnosis and Treatment

The Democratic Republic of the Congo is reviewing clinical and laboratory guidelines to address comorbidities between malaria and COVID-19 to confront the issue of misuse of antimalarial drugs to treat COVID-19 patients, integrate a new COVID-19 module into enhanced supportive supervision (OTSS+) visits, and train OTSS+ supervisors using a blended physical and remote approach.

Ghana is remotely supporting and mentoring health workers in peripheral health facilities. Through mentoring delivered through emails, WhatsApp messages, and phone calls, the targeted community health officers (CHOs) are showing improvement in the quality of malaria data management and the use of data for decision-making. They have also demonstrated improvement in adherence to testing and test results, referral of severe malaria, and intermittent preventive treatment in pregnancy (IPTp) coverage for malaria in pregnancy (MIP) prevention.

Malaria in Pregnancy (MIP)

In Côte d’Ivoire, malaria clinical mentors are working directly with health providers to improve the quality of MIP and case management service delivery. IM has supported mentors to redirect efforts from in-person visits to virtual mentorship to help sustain malaria service delivery quality and help health workers adapt to delivering malaria services in the COVID-19 environment. These virtual mentorship calls help prevent potential COVID-19 transmission at facilities until mentors are able to return to facilities in-person.

Similarly, in Cameroon, the training, supervision, and quality assurance (TSQ) experts supporting case management and MIP providers had to stop in-person visits in the North and Far North regions due to the spread of COVID-19. To maintain contact during this period, TSQ teams used a checklist to track and document phone calls to facilities during this time. The checklists captured information about services delivered and commodities available.

Adapting with the Pandemic

IM strictly observes the safety guidelines of each of the countries where it operates. Considering the uncertainties of COVID-19 in Africa and around the world, IM will continue to heavily use mobile and digital platforms and reduce travel where possible. As IM becomes more experienced with malaria service delivery in the context of COVID-19, we will follow this with lessons learned!

Header photo caption: Nurse Oba Dieudonne checks Tall Nafissatou, 3 years, for malaria at Mouyassue Rural Health Centre in Côte d'Ivoire. Credit: Mwangi Kirubi, PMI Impact Malaria

Written by Jaclyn Flewelling, Charlotte Eddis, Kate Wolf, Anne Bulchis, Pharath Lim, Gladys Tetteh, James Sarkodie, and Katherine Kemp—all from PMI Impact Malaria.

PMI Impact Malaria is led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and UCSF

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