PMI Impact Malaria (IM) is the flagship global service delivery project of the U.S. President's Malaria Initiative (PMI), providing global technical leadership to fight malaria and save lives. IM supports countries in their efforts to strengthen malaria diagnosis, treatment, and drug-based prevention in health facility and community settings through implementation and technical support, as well as operational research.  

This year, IM operated in 18 countries across Africa and Asia, including our newest partnership with Myanmar (Burma), and supported USAID’s Bureau for Latin America and the Caribbean and the Africa Regional Bureau. We closed out and transitioned activities in Lao, Tanzania, and Zambia.  

This year’s World Malaria Report shows that although global progress towards malaria eradication continued to be impacted by COVID and humanitarian disruptions, there has been notable impact. Endemic countries continue to hold the line against further setbacks by demonstrating leadership and resilience, especially by using data for impact and informed decision-making. Further, country-led impact saw expanded access to seasonal malaria chemoprevention (SMC), from 22 million in 2019 to 33 million in 2020 to 45 million in 2021; stable coverage of IPTp3 coverage for pregnant women; and an increase from 33 to 35 countries with less than 1,000 new cases of malaria, moving closer to WHO’s global strategy goals for national elimination targets. Further, the 11 high-burden to high-impact countries, seven of which are supported by IM, held the line showcasing a slight but significant decrease in deaths. 

IM-supported countries contributed to this global impact by applying lessons learned and adjusting programs where appropriate, continuing to train health providers with a focus on data-informed decision-making to improve the quality of malaria services, supporting efforts to curb the impact of antimalarial resistance, and more as highlighted below. 

Patrick Raharinandrasana from the DIANA region, is one of 12 technicians now certified to WHO standards through training supported by USAID through IM. Photo credit: IM Madagascar 

This is a snapshot of country-driven achievements that IM supported in 2022:  

• Supported national malaria programs (NMPs) in Burkina Faso, Cameroon, Niger, and Mali to reach more than four million children through seasonal malaria chemoprevention campaigns (SMC) ahead of and during the heavy rainy season when malaria transmission is highest. We also published our first peer-reviewed publication focused on learnings about adherence practices to providing medicine to children during the 2020 SMC campaign in the Dosso Region of Niger. The results from this publication show high adherence, and where actions can be taken to improve adherence and achieve greater impact in future campaigns.  

• Continued to support NMPs to close gaps in the quality of malaria diagnosis and treatment, and the prevention and treatment of MIP, through the IM quality improvement model. This included conducting OTSS+ visits in 4,507 health facilities across the 11 countries we partner on this approach to adopt up-to-date policies, guidelines, and tools for diagnosing and treating malaria and for program monitoring and quality improvement and train 4,663 health workers with the most up-to-date global and national guidelines. Trainings included the prevention and treatment of malaria in pregnancy (MIP), clinical case management of fever, performance, and interpretation of malaria rapid diagnostic tests (mRDTs), recognizing danger signs in patients, and making an appropriate referral for severe illness. As the OTSS+ approach is built into an electronic tool, IM collected and analyzed service quality data in real time, allowing supervisors to provide targeted on-the-job training and coaching and to develop action plans to address identified weaknesses.  

• Provided a comprehensive package of support to six countries (Cameroon, Mali, Niger, Rwanda, Sierra Leone, and Malawi) to scale up and improve the quality of integrated community case management (iCCM) services. IM support has built on these country efforts made over previous years to establish iCCM policies and systems that align with WHO/UNICEF guidance and are integrated into their national health care delivery systems at central, subnational, and local levels for coordination, service delivery, capacity building, supply chain support, and data reporting. This included training 6,469 community health workers in four of the six target countries, regular supervision, and facility check-ins, supply of necessary equipment, materials, and iCCM commodities and drugs for Cameroon, Mali, Niger, Rwanda, Sierra Leone. In the reporting period, a total of 4,825 CHW visits were conducted; and 708,651 fever cases were seen by CHWs in IM-supported areas.   

• Supported quality improvement for malaria microscopy and mRDTs, proficiency testing, and quality assurance. IM also supported strengthening of competency for microscopy and mRDTs through malaria diagnostic refresher trainings and OTSS+ visits to improve the malaria microscopy skills and ability of laboratory technicians to accurately read malaria rapid diagnostics tests in 12 countries. These trainings help expand the network of experts that can quickly and accurately diagnose malaria from a lab sample so that health providers can provide the right treatment at the right time to their patients.  

• Towards our operational research, IM completed a study on the accuracy and reliability of a new point-of-care test for G6PD deficiency in Cambodia; an assessment of the 1-3-7 surveillance system in Laos to achieve the national elimination strategy; oversaw the implementation of mass drug administration (MDA) in moderate-to-low transmission areas in Senegal which showed that MDA in this setting was a effective, safe, and effective intervention for further burden reduction; monitored the effectiveness of Group Antenatal Care (ANC) and ANC surveillance in Benin and Enhanced ANC services in Mali; and supported the planning and implementation of Therapeutic Efficacy Studies (TES) to better understand regional resistance to Plasmodium falciparum (p.falciprum) in nine countries in Africa and for radical cure treatment of Plasmodium vivax (p.vivax) in Latin America and the Caribbean.   

• At IM Headquarters, we’ve produced a Malaria in Pregnancy (MIP) Technical Working Group (TWG) Quick Start guide with tools and materials to assist countries to establish and re-establish impactful MIP TWGs; we continue to develop several resources across project activity including an Operational Manual on OTSS+ to provide a comprehensive overview of the evidence and rationale for implementing OTSS+, an internship curriculum for community health workers to implement quality improvement approaches, and collaborate to produce the WHO Handbook for Improving Malaria Case Management in the Private Sector. We continue to migrate IM training materials to e-learning to streamline training and supervision, which includes an introductory module on the Health Network Quality Improvement System as well as e-learning modules for introducing OTSS+; preparation for supportive supervision visits and developing action plans; and to improve community health worker ability to identify severe malaria danger signs, administer rectal artesunate, and refer patients to a higher care level.   

Sam Agbor Enow (left) goes over malaria supervision notes with Nurse Samira Adamou at Madaka Health Centre, Far North Region, Cameroon. Sam has been trained to provide OTSS+ to ensure that healthcare providers know and can follow national guidelines for correctly diagnosing and treating malaria. Photo Credit: Mwangi Kirubi, IM 

Header photo caption: A young girl shows her vaccination card after receiving antimalarial medicine during a seasonal malaria chemoprevention campaign in Mali. Photo Credit: IM Mali 

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with Jhpiego, MCD Global Health, and the Malaria Elimination Initiative (MEI) at the University of California, San Francisco.