The last year has been a very active one for Malaria Consortium. As the new Chief Executive, arriving at the organisation at the end of February, I have been impressed by both the depth of Malaria Consortium in our expertise in fields in which we work and the breadth of the ways in which that work is implemented for maximising impact and sustainability. Some examples of this are covered here.
We continue to develop and implement improved approaches to delivery of prevention and case management for control of communicable diseases, especially malaria, childhood illnesses and neglected tropical diseases (NTDs).
In the area of prevention of malaria, we expanded the use of the NetCALC tool, which estimates the number of long-lasting insecticide treated nets (LLINs) needed under different scenarios of distribution approaches and uptake rates to allow countries to develop better continuous distribution plans, especially in Nigeria and Ghana. In addition, we supported LLIN distributions directly and, by doing so, we have increased our learning on how to improve them. For diagnosis of malaria, we have further developed approaches for the introduction of rapid diagnostic tests (RDTs) into the private sector, so as to support the emergence of multiple channels of supply and increase access.
In the continuing growth of our work on NTDs, two particular points are worthy of note. We undertook an assessment in South Sudan to document our work to date there and supported the development of the next national strategy, and in the UK we became chair of the Influencing Group in the UK Coalition on NTDs.
Those who have followed Malaria Consortium for a time will be aware that we were an early proponent of, and advocate for, integrated community case management (ICCM). This integrates the diagnosis and treatment of malaria with that of pneumonia and diarrhoea and, in some cases, malnutrition, particularly for children under the age of five years. Through training community-based workers, interventions are possible soon after onset of fever, close to the homes of those who cannot access a health centre quickly. For more please see our website. This year we completed a three-year Canadian International Development Agency supported ICCM project, resulting in the training of over 10,000 community health workers across four countries, who together performed more than one million diagnoses and treatments for malaria and over 660,000 treatments for pneumonia. We received follow‐up grants in Mozambique, South Sudan (including treatment for children with malnutrition) and for six months in Zambia.
Linked to ICCM in Uganda and Mozambique is the Bill & Melinda Gates Foundation (BMGF) funded inSCALE programme. This programme is now at the stage of evaluating the effectiveness, in terms of the retention and motivation of ICCM health workers, of the use of technological interventions in the diagnosis and data gathering elements of community case management. As part of our DFID/UKaid COMDIS HSD Research Programme Consortium grant with Leeds University we have completed field work and analysis of a study comparing rural and peri‐urban ICCM in Uganda and a study on improving rational use of antibiotics for treatment of pneumonia in Zambia.
Very high on the agenda, for all involved in the control and elimination of infectious diseases, is the containment of resistance. In the case of malaria this has two particular aspects; the resistance of mosquitoes to current insecticides and the resistance of the malaria parasite to the current drug treatments. Each, in its own right, is a significant challenge and demands continuous vigilance and ongoing innovation. As a member of the newly created WHO Drug Resistance Containment Technical Expert Group, we are guiding global strategies on containment. We have also continued extensive work in Cambodia, Thailand and Myanmar on implementing containment strategies. We are actively involved in the Asia Pacific Malaria Elimination Net Work (APMEN), and our work on the joint strategy for response to artemisinin resistance in the Greater Mekong Sub region was widely disseminated, forming a basis for the new Emergency Response to Artemisinin Resistance.
The countries in which we work find themselves at different stages along the path to elimination of malaria. Though many of the key components of intervention are common, each needs a targeted approach and combination of activities, relevant to its respective setting. As part of our objective to ‘spearhead innovative approaches for monitoring, evaluation and surveillance systems, and to undertake high quality operational research’, we have set up a major long term research programme in Uganda, Ethiopia and Cambodia, called ‘Beyond Garki’ . This study is designed to obtain a deeper understanding of factors influencing malaria in light of the different epidemiological settings, climatic effects and the control efforts in each of the settings. Funded by the BMGF, we have begun work in to assess the feasibility and acceptability of a newly recommended intervention for the Sahel region of Africa - seasonal malaria chemoprevention. This approach gives oral, preventive treatment to children under the age of five years only during the peak transmission season for malaria. In Myanmar, we have been exploring potential innovations to provide protection from mosquitoes for rubber tappers working outdoors at night time.
Part of our task is to communicate new learning and successes for continuous programme improvement. In light of that, for World Malaria Day we supported a workshop in Brussels for European Parliament and Commission members to encourage funding commitment for 2014‐2020; additionally, we hosted an ICCM policy forum in London with key EU stakeholders and donors and launched an online publications database on our website, including four new learning papers. In partnership with the UK’s Guardian newspaper, we also launched Malaria Consortium’s partnerzone through our sponsorship of the Guardian’s new development hub on malaria and infectious diseases. We also saw a very successful six month run for our Malaria: blood, sweat, and tears exhibition by Adam Nadel at the Chicago Field Museum, which received nearly 200,000 visitors.
Malaria Consortium continues to grow and we believe we have a strategic role in the areas in which we operate. In order to maintain leadership of thought, technical and operational research leadership and to be in a position to provide critical implementation support in some of our key countries, as well as ensuring financial sustainability, we must continue to invest in the strengthening of our organisation. There is significant activity in our areas of focus, and, as we move towards the end of the timeframe for the Millennium Development Goals, it is important that opportunities are not missed. So this year we recruited an in-house business development team and we are building a wider cadre of Trustees to provide insight to, and oversight for, the organisation.
We thank all our partners for their continued support.
Chief Executive, Malaria Consortium