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Top Five Strategies for Starting Up PMI Impact Malaria

February 2019 saw PMI Impact Malaria celebrate its first official year as the U.S. President’s Malaria Initiative’s (PMI) flagship global service delivery project. As of today, World Malaria Day 2019, we are running offices and implementing activities in ten countries, with more coming on board all the time.

Following a delayed start, PMI Impact Malaria (IM) kicked off in April 2018. With the end of MalariaCare and the pending completion of the Maternal and Child Survival Program (MCSP), many PMI focus countries were experiencing a gap in service delivery support for malaria case management and the prevention and treatment of malaria in pregnancy (MIP). With no time to lose, a tiny but growing IM headquarters (HQ) team sprang into action to fill those gaps by collaborating with National Malaria Control Programs (NMCPs) and maternal and child health divisions of Ministries of Health (MOH) to design and implement prioritized activities. One year and a few months later, we are in various stages of carrying out key on-the-ground activities, including revising and updating national malaria control strategies and guidelines, conducting baseline assessments, developing trainings for facility-based and community-based health workers, and microplanning for seasonal malaria chemoprevention (SMC) campaigns. This list goes on, all happening on a daily basis.

The lessons learned during project start-up are fresh in our minds. These are the top five strategies we used to get this global health project up and running:

Building on solid foundations

From the outset, IM understood that we were not starting from scratch. With the crucial support of PMI and other global malaria partners such as the Global Fund, UNICEF, and the Bill & Melinda Gates Foundation, the NMCPs in our focus countries have achieved remarkable progress in driving down the burden of malaria. Members of the IM consortium have the advantage of having been a part of previous PMI-funded service delivery projects, and therefore were able to bring the technical expertise, institutional memory, and established relationships into this new contract.

For malaria service delivery in each country, IM has worked with NMCPs to dig under the surface to identify the systems already in place, understand key strengths and challenges, and recognize the opportunities that exist to push the needle further in bringing these countries towards malaria elimination.

We have built our country offices based on IM consortium partners who already had a country presence and relationships on the ground. For example, in Mali, PSI had supported the NMCP under the MalariaCare project to address malaria case management. They have been able to recruit the technical experts who successfully led those previous interventions and can take them to the next level, while utilizing PSI’s existing offices in Bamako as well as the Mopti region to quickly establish a robust program.

Listening and learning

While IM has drawn on lessons from the past, we have been intentional about not just replicating previous projects. During start-up, IM took the time to listen and learn from our in-country counterparts. In most countries, we started off by conducting scoping visits of 1-2 weeks. During these visits, IM held conversations with NMCPs and other MOH stakeholders from national to district level; met with nurses, midwives, and clinical officers at health facilities; went into communities to speak with community health workers; and talked with technicians in laboratories. IM staff also met with key stakeholders, including PMI, other partners working on malaria in-country, and multiple governmental counterparts.

Following these exchanges, we emerged with an understanding of not just what the needs were, but also a clear picture of the different channels available to meet those needs. For example, in Cote d’Ivoire, the NMCP expressed a pressing need to reinvigorate and accelerate their community-based malaria case management. IM collaborated with the NCMP, the Department of Community Health, UNICEF, and other community partners to re-mobilize 545 community health workers from four districts within the first six months of implementation. These workers are leading community-based malaria prevention and treatment services as IM continues to scale-up in additional districts.

Maintaining a “can do” philosophy

During start-up, there was so much to accomplish in a condensed period of time. At HQ and in countries, we needed to find office space, recruit and hire staff, procure basic office equipment, create templates for everything, and develop detailed annual work plans and budgets for our core activities and each country. While our team was energized by working on a new project, we also experienced times when we felt overwhelmed and impatient. But we supported each other during these moments and maintained a teamwide “can do” philosophy throughout this first year. We critically thought through all of the project’s needs, and then prioritized and tackled them.

For example, Niger’s NMCP needed IM to support the roll out of their annual seasonal malaria chemoprevention (SMC) campaign in the regions of Dosso and Tahoua approximately one month before the campaign. Despite the lack of staff and other logistical challenges, IM realized the critical importance of ensuring that a successful campaign took place. With funding from PMI and help from PSI staff in Niger, we were able to make it happen. Borrowing staff from other projects, bringing in technical assistance from HQ, and working closely with the NMCP to execute detailed plans, IM was able to reach 90% or more of the targeted number of children during each of the four rounds of the campaign. The flexibility and agility that IM displayed in Niger is being translated to our other programs globally as we continually take the approach that we “can do” it!

Finding the right people for the job

At IM, the number one criterion for all employees—whether they are Chiefs of Party, Technical Advisors, M&E Officers, Finance Managers, Administrative Assistants, or Drivers—is a passion for the elimination of malaria in the countries where we are working. In some of our countries, like Ghana and Mali, IM was fortunate to recruit staff who had previous experience with the PMI-funded MalariaCare project. But in other countries, especially those new to PMI, there were few candidates who had previous experience working on malaria service delivery projects.

IM developed numerous job descriptions to meet the varying needs for each country and then actively recruited candidates through open advertisements and wide dissemination of opportunities via country-level networks. IM HQ and consortium partner staff conducted a rigorous interview process to identify high quality managers and technical advisors who not only met the required qualifications, but also embodied the dedication and drive that will lead the project to success. Between July-December 2018, IM recruited and onboarded more than 50 new staff.

Establishing clear systems and processes

Managing a complex and multi-faceted global health project with multiple consortium partners requires the creation, socialization, and utilization of clear systems and processes that enable each of us to carry out our work as effectively as possible. At HQ we focused extensively during the start-up period on thinking through these processes in order to efficiently deliver project interventions while staying compliant with the IM contract. We have developed checklists, templates, guidance documents, roles and responsibility matrices, and more. Results of these processes include work plan, budget and reporting templates, travel request and approval checklists, procurement guidance, new hire and biodata review checklists, and many, many trackers and project guidance briefs. While these systems will continue to evolve as the project grows, they helped enormously to set the stage for clarity in how to “get things done.”

In summary

Overall, the start-up period of any global health project is an incredibly and unavoidably hectic time. But IM’s shared vision for open communication among all partners, finding efficiency and innovation within regulations, and dedication to quality service delivery has set the stage for continued success in the months and years to come.

PMI Impact Malaria is 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. The group photo is from our 2018 IMPACT global meeting.

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