PMI Impact Malaria
Countries in West and Central Africa are increasingly decentralizing resources and decision-making for health as part of a sustainable strategy to improve health system quality and efficiency. In Cote d’Ivoire, decentralization is part of the Ministry of Health’s (MoH) new strategic approach and is reflected in the country’s malaria planning and programming. One recent example is the National Malaria Control Program’s (NMCP) launch of a program that embeds malaria technical advisors within regional MoH offices. Each Regional Technical Advisor (TA) is based in one regional office and responsible for two regions, traveling frequently to work on malaria activities around both regions.
To help ensure a strong start, a group of stakeholders held a three-day workshop at the end of November 2018 for the launch of the new Regional TA program. Participants included the NMCP, the National Maternal and Child Health Program (PNSME), the Division on Community Health (DSC), the U.S. President’s Malaria Initiative (PMI) country office in Cote d’Ivoire, PMI Impact Malaria, other PMI implementing partners—including Breakthrough Action, Human Resources for Health 2030 (HRH2030), Integrated Health Supply Chain-Technical Assistance (IHSC-TA), and MEASURE Evaluation—UNICEF, Save the Children, and the ten new TAs.
Government stakeholders and PMI partners presented different sessions to the TAs, which covered the objectives of the TA role and key malaria technical areas, including diagnosis and treatment, malaria in pregnancy, severe malaria, stock management, and data quality. The TAs (pictured below) were given their site placements at the end of the workshop and have been in their assigned regions since then.
One of the new TAs, Dr. Hans Bahibo, explained that he is enthusiastic about his new role because he thinks the regional model will address many of the operational challenges that he experienced while working as a monitoring and evaluation specialist with the NMCP. According to Dr. Bahibo, “these difficulties limit the ability of the NMCP to achieve the objectives set in its strategic plan for the fight against malaria.” He feels strongly that the role of TAs in providing technical and operational support will be very useful for the NMCP and “there is no doubt that it will allow for improvement of national malaria control indicators.”
TAs were first tasked with supporting the rollout of a training for community health workers and a training of trainers, both centered on a new integrated community case management (iCCM) package. The daily work and activities of the TAs varies based on the needs of the regions and districts they cover, but they each play an important role in working to ensure that malaria services are accessible and high quality. The TAs receive ongoing coaching and mentoring from the NMCP and PMI Impact Malaria and participate in quarterly meetings to discuss activity updates and new initiatives for the TAs to work on.
Cote d’Ivoire’s Regional TA program is an important resource to strengthen capacity and coordination at the regional level and beyond, both across the country and in the PMI intervention districts. The lessons learned from this program will be useful from region-to-region and will inform the programming and activities of other national health systems. Stay tuned as we learn more!
Written by Kathryn Malhotra and Silue Mamadou, PMI Impact Malaria Technical Advisors
Photography credits from top to bottom: Benjamin Schilling for the first photo; PMI Impact Malaria Cote d'Ivoire for the second photo.
PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) Population Services International (PSI) in partnership with Jhpiego, Medical Care Development International (MCDI), and the Malaria Elimination Initiative (MEI) at UC San Francisco.
Ricki Orford is PMI Impact Malaria’s Senior Project Director, responsible for guiding the strategic, technical, and operational direction and delivery of the project. He brings 20 years of malaria expertise to the team. Among other experiences, Ricki worked with the World Health Organization (WHO) to provide technical support to national malaria control programs in southern Africa, led Population Service International’s (PSI) in-country Malawi team and programming, and most recently served as PSI’s Director of Malaria, Child Survival and Sanitation.
Read on to learn more about PMI Impact Malaria and hear Ricki’s perspective on the project’s role in the global fight to end malaria.
This project you’re leading, PMI Impact Malaria, is funded by the U.S. President’s Malaria Initiative (PMI) to “advance malaria service delivery.” What does that mean in practice?
All our project activities, whether taking place in countries or at the global level, are driven by our mission to save lives and reduce illness from malaria by strengthening diagnosis, treatment, and drug-based prevention. We’re focused on the populations that are most at risk, which translates to children and pregnant women in countries with a high malaria burden. To achieve our mission, we focus our work mainly around three key intervention areas: malaria in pregnancy (MiP), seasonal malaria chemoprevention (SMC), and the diagnosis and treatment of malaria.
The U.S. President’s Malaria Initiative (PMI) supports 27 countries across Africa and Asia and we currently are working closely with 12 of them. The national malaria control programs (NMCPs) in these countries lead on-the-ground activities while our team provides implementation support and technical assistance to the NMCP on behalf of PMI. We’re helping NMCPs tackle malaria service delivery challenges by working to:
We’re also focused on supporting global malaria technical leadership by harnessing our teams’ expertise across several key global malaria technical working groups. Through that involvement and our longstanding relationships with NMCPs, our team is strengthening the linkage of global dialogue with country experiences to improve malaria service delivery and accelerate the translation of country learning into international practice.
With the backdrop of the global malaria landscape, why is the focus and timing of this project so relevant?
Unfortunately, it’s clear that global progress in the fight to end malaria has stalled. The most recent World Malaria Report showed that, for the second consecutive year, cases are rising. In 2017, approximately 70% of all malaria cases (151 million) and deaths (274,000) were concentrated in 11 countries: 10 in Africa (Burkina Faso, Cameroon, DRC, Ghana, Mali, Mozambique, Niger, Nigeria, Uganda and Tanzania) and India.
To boost progress in these highest burden countries, WHO has developed a new “high burden to high impact” approach based on four key pillars:
PMI Impact Malaria is currently active in almost half of these countries and is well positioned to support WHO’s new strategy through our country-led programming and data driven approaches to achieving results, generating evidence, and distilling lessons learned. We understand that our project’s work is needed now more than ever.
A core function of public health is preventing disease. Could you tell me about a malaria prevention activity that PMI Impact Malaria is supporting?
Malaria threatens the lives of billions of people around the world and accounts for more than 400,000 deaths every year, the majority of whom are children under five. One of our project’s key interventions, Seasonal Malaria Chemoprevention (SMC), is specifically designed to prevent and treat malaria in young children. SMC involves giving an antimalarial medicine made up of two components, sulphadoxine pyrimethamine (SP) and amodiaquine (AQ), at monthly intervals for a maximum of four months during the rainy season when malaria incidence dramatically increases. The goal is twofold: 1) treat any existing malaria infections; and 2) prevent malaria by maintaining protective drug concentrations in the blood for the entire transmission season.
According to WHO, in 2017 an estimated 15.7 million children were protected through SMC campaigns, but 13.6 million children who could have benefited from this intervention were not reached. Two of the most common reasons for the coverage gap reported by countries include insufficient resource allocation and delayed disbursements of funding, which hinder the ability of countries to plan and procure medicines in time for the malaria transmission season.
Our team is currently working with NMCPs in Cameroon, Mali, and Niger to help address these and other challenges and will support this work again in these same countries in 2020, with the addition of Ghana (and potentially other countries, as well). We are also working with partners at the global level to advocate for additional resources to close this funding gap.
Based on project activities so far, do you have an example that would help someone understand how your team provides support to NMCPs as they lead work on-the-ground?
PMI Impact Malaria supports NMCPs in carrying out their malaria service delivery work more efficiently and effectively. An early example of this is the implementation support that we provided to the Niger NMCP’s 2018 SMC campaign in the regions of Dosso and Tahoua.
Our project was just getting up and running in Niger and had not yet hired in-country staff, but we recognized the time sensitive nature of SMC campaign work. Thanks to funding from PMI, we recruited substantial help from the PSI staff in Niger and worked closely with them and the NMCP to develop a budget and work plan, secure transportation for community health workers, and arrange for delivery of commodities from districts to health centers and from health centers to SMC teams. We also coordinated extensively with the NMCP to align procedures with the microplans for each region and ensure timely preparation before each SMC campaign wave.
Through our rapid mobilization of staff and resources, our team was able to help the NMCP cover two key regions during a critical malaria transmission season. The campaign resulted in a total of about a million treatment doses administered, with each of the four campaign waves reaching 90% or more of the targeted number of children. In collaboration with the NMCP, we are currently compiling lessons learned and will share these broadly to help improve future campaigns in Niger and inform the planning of SMC campaigns in other countries.
So, using this example, you can see that we promote more efficient and effective programming by “getting into the weeds” with each country, but we also do it by providing our countries with the knowledge and insights that we gain through our cross-national and global work.
How does your team stay focused on those who benefit from your project’s work and ultimately are the reason why PMI Impact Malaria exists in the first place?
With PSI leading the project (in partnership with Jhpiego, Medical Care Development International, and the Malaria Elimination Initiative (MEI) at UCSF), we employ PSI’s human-centered design approach when thinking about our malaria service delivery interventions. To help us with this, we orient all our work around “Sara”—the name we use to represent a woman of childbearing age who is striving to keep herself and her family healthy in the face of constant obstacles to affordable, high quality, respectful health care. At PMI Impact Malaria, we’re working as a team with PMI and partners to support NMCPs in enabling those most at risk to protect themselves and their families from illness and death caused by malaria.
You grew up in a small town in England, right? What prompted your earliest awareness of malaria and how did you go from that to making it the focus of your career?
During university I was fortunate enough to take part in a year-long internship with WHO in Zimbabwe. This was a life-changing experience, funded by the British government and in partnership with WHO’s emergency and humanitarian affairs program. I focused on emergency management of natural and manmade disasters and epidemics, but of course it was impossible to live and work in southern Africa without developing an understanding of malaria and its human toll, unfortunately.
When the internship ended and I returned to the UK to finish my degree, I stayed connected with WHO colleagues who later put me in touch with a new team that was coming together to reinvigorate malaria control efforts in southern Africa. They saw an opportunity to apply my training in emergency management to the role of managing malaria prevention and control efforts during malaria epidemics and acute and complex emergencies.
Working to end malaria is such a meaningful challenge and I’m still incredibly grateful to the Southern Africa Malaria Control (SAMC) team for their willingness to invest in me. Individual team members and NMCP managers welcomed me into their programs, taught me so much, and were patient with my youth and limited experience. That was my introduction and, well, the rest is history!
Written by Anne Bulchis, PMI Impact Malaria Communications Manager
Photography credits from top to bottom: Mwangi Kirubi, Kenya, 2018 for the first and third photos; Elisabeth Soumaye Djinari, Niger, 2018 for the second photo.
PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and led by Population Services International (PSI) in partnership with Jhpiego, Medical Care Development International (MCDI), and the Malaria Elimination Initiative (MEI) at UC San Francisco.
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