Finding Solutions
What is being done in my region and how can my company get involved?
I would like guidance on how our company can support malaria control efforts
At what level are you interested in being involved?
Ensuring our policies and practices are appropriate and in line with regional and international standards Joining business coalitions and other advocay groups Providing financial support regionally / nationally Developing a malaria control corporate social responsibility programme in our direct area of influence Help me decide
Ensuring our policies and practices are appropriate and in line with regional and international standards Joining business coalitions and other advocay groups Providing financial support regionally / nationally Developing a malaria control corporate social responsibility programme in our direct area of influence Help me decide
Understanding and adhering to national policy and international guidelines
International guidelines for malaria control are developed by the World Health Organization (WHO). Links to their guidelines for prevention, diagnosis, treatment, communications, surveillance and monitoring and evaluation aspects of malaria control programmes are included in the additional resources section.
National malaria control programmes use these international guidelines to develop their own national malaria policies and strategies for malaria control within their country. These typically include detailed guidelines for prevention approaches that should be supported, diagnosis approaches to be used, and treatment guidelines for uncomplicated and severe malaria of different types and in different patient categories. These detailed national guidelines often include specific instructions for variation within the country depending on epidemiology and context.
All malaria control activities should adhere to international guidelines. In addition, it is good practice to adhere to national guidelines. These should almost certainly be adhered to where community-wide activities are undertaken, and should generally also be adhered to for interventions targeting employees, unless there are compelling reasons otherwise.
Reasons for adhering to national guidelines include:
- Improving the likelihood that activities will be sustainable by building capacity relating to national approaches in the local health system or local organizations.
- Improving the likelihood that company activities can be used to leverage additional or continuing funding from the government or other regional donors.
- Responsibility to support the goals and plans of the host government.
Compelling reasons to veer from national guidelines when considering employee health may include:
- If national policies are not in-line with international best practice.
- If national policies are based on a context of insufficient funding, and the company is able to commit to supporting higher cost but more effective interventions.
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International guidelines for malaria control interventions
Prevention
- Malaria Vector Control and Personal Protection, WHO.
- A toolkit for mass distribution campaigns to increase coverage and use of long-lasting insecticide-treated nets, AMP.
- Manual for Indoor Residual Spraying (IRS): Application of Residual Sprays for Vector Control, WHO.
- Indoor Residual Spraying (IRS) Toolkit, MACEPA/PATH.
Insecticide resistance
Case Management
Diagnosis
- Universal access to malaria diagnostic testing – An operational manual, WHO, 2011 (rev 2013).
- Diagnosis Guidance from the Centers for Disease Control and Prevention, CDC.
- Good practices for selecting and procuring rapid diagnostic tests for malaria, WHO.
- Use of Malaria Rapid Diagnostic Tests (RDT), WHO.
- Interactive guide for malaria RDT selection, FIND.
- Guidelines for the transport, storage and handling of RDTs, FIND. Appropriate for use in health clinics.
- Malaria microscopy quality assurance manual: version 1. WHO, 2009. Designed for use for those overseeing national programmes but includes useful information on the steps needed.
Treatment
- Guidelines for the treatment of malaria. Second edition. WHO, 2010.
- Treatment guidelines for clinicians. CDC.
Drug resistance
- Update on artemisinin resistance, WHO, 2014.
- Issue brief: The status of drug-resistant malaria along the Thailand-Myanmar border. WHO, 2012.
- Global plan for artemisinin resistance containment (GPARC)
Anti-malarial drug policies
- Country anti-malarial drug policies in South East Asia, WHO.
- Country anti-malaria drug policies in Western Pacific, WHO.
Communications
- The US President’s Malaria Initiative Communication and social mobilization guidelines and primer.
Community Implementation
Surveillance, Monitoring and Evaluation
- Disease surveillance for malaria control: operational manual. April 2012, WHO.
- Surveillance systems to facilitate malaria elimination. Background paper for the Bill & Melinda Gates Foundation, January 2014.
- LiST: The Lives Saved Tool.
- Methods for surveillance of antimalarial drug efficacy. November 2009, WHO.
- T3: Test. Treat. Track. Scaling up diagnostic testing, treatment and surveillance for malaria. April 2012, WHO.
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Engaging in Advocacy and Business Coalitions
Recognizing that the private sector can have an important influence on malaria control there are a number of coalitions that have formed to bring together the voice of the private sector. These groups lobby for and provide guidance on good practice and work to leverage the voice and influence of this sector in the support of progress on malaria globally or within specific regions.
Engaging in this way can also raise the profile of a company’s support for an engagement in malaria.
Examples of advocacy groups and coalitions which companies could consider getting involved with include:
- Roll Back Malaria (RBM) Partnership The RBM Partnership mobilises for action and resources on malaria and forges consensus among partners. A founding member of the Partnership, Malaria Consortium, is a key contributor to the global framework to implement coordinated action against malaria. The Partnership comprises more than 500 members, including those from malaria endemic countries, international donors and foundations, the private sector, non-governmental and community-based organisations, and research and academic institutions.
- World Malaria Day Website In 2009 Malaria Consortium launched the World Malaria Day website bringing together malaria activists, practitioners and stakeholders from all over the world to encourage collaboration, resource and information sharing
- GBCHealth (Global Business Coalition on Health) serves as a hub for private sector engagement on the world's most pressing global health issues. Since 2001, GBCHealth has worked with hundreds of members -- individually and in partnership with one another to tackle the challenges of HIV/AIDS, Tuberculosis, Malaria, Diabetes and other health issues facing the workplace and communities where business is conducted.
- APMEN (The Asia Pacific Malaria Elimination Network) is composed of 15 Asia-Pacific Country Partners as well as regional partners from academia, development, NGOs, the private sector and global agencies, including WHO. APMEN’s mission is to collaboratively address the unique challenges of malaria elimination in the region through leadership, advocacy, capacity building, knowledge exchange and by building the evidence base.
Click here to see a successful advocacy example
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Co-ordination and/or advocacy groups
- Asia-Pacific Malaria Elimination Network
- Asia-Pacific Malaria Leaders Alliance formed in October 2013
- GBC Health coalition for private sector engagement in global health issues.
- International Council on Mining and Metals
- OPG-IPIECA Health Committee. The health committee of OPG, the Association of Oil and Gas Producers (OPG) and IPIECA, the Global Oil and Gas Industry Association for Environmental and Social issues.
- HANSHEP: Harnessing non-state actors for better health for the poor
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Providing financial support regionally / nationally
Rather than taking an active role in designing and managing malaria control programmes, the private sector could consider providing direct funding to the government or non-State actors to support unfunded malaria control needs in the region as a whole or a specific area of interest. Exxon Mobile, for example have funded clinical trials of new malaria drugs in Papua New Guinea. No good examples are found of businesses providing direct financial support to National Malaria Control Programmes but this is a route that could be considered. Most countries have up to date and fully costed malaria control strategies with clear gap analyses. Approaching the Ministry of Health or National Malaria Control Programme to discuss out-standing gaps and opportunities for the company to provide support is an approach that could be considered.
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Developing a malaria control corporate social responsibility programme in our direct area of influence
Many companies opt for the approach of moving beyond the fence to support wider malaria control programmes in surrounding communities or the country as a whole. In areas where malaria is a major health issue CSR programmes focusing on this can be an appropriate choice. The additional benefit to the company is that such programmes can also have direct benefits to the health of your workforce: the workforce may be drawn from and live in surrounding communities, and disease transmission will be fluid between sites and nearby communities. Some of our case studies give good examples of how companies have supported malaria as part of their CSR activities:
Elimination of Taxes and Tariffs, Papua New Guinea
Exxonmobil, Papua New Guinea
Newmont, Batu Hijau, Indonesia
Shell, Palawan, Philippines
Oil Search, Southern Highlands Province, Papua New Guinea
For further information on how to design such a programme you can follow the guidance provided here.
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What approach to take will depend largely on the resources you are prepared to commit. It is important first to remember the impact that malaria may have on your business, to help consider what resources you are prepared to commit to supporting malaria control.
Impact of malaria on Business
As the World Economic forum states¹ : ‘Malaria is bad for business’! It impacts on company profits through employee absenteeism, reduced productivity and escalating benefit costs. It can also have negative reputational impacts.
In 2006 the World Economic Forum conducted a review of business attitudes and approaches to malaria, detailing businesses’ estimates of the impact of malaria on their operations, including financial impact. This document can be accessed here and its key messages are summarized below.
Attempts have been made to estimate the financial returns on investing in malaria control. Marathon Oil estimates 4:1 returns on its investments in malaria control² , though this is the in the African setting. Firm estimates of the financial impact of malaria on companies in the Asia-Pacific are not available. However it is known that malaria can impact on business in a number of ways:
Directly: through impact on workforces, increased spend on healthcare and corporate reputational effects. Specifically through:
- Absenteeism of employees who fall ill with malaria or take time off to care for family members who fall ill. Around 1 – 5 days can be expected to be lost for each malaria case.
- High healthcare costs for companies that provide health services to their employees.
- Costs of pay-out packages in the case of a death, as well as related recruitment and retraining costs for replacements.
- Poor company morale when cases and/or deaths are high.
- Corporate reputational risks where companies are seen to either make malaria worse or to engage insufficiently in what is seen to be a priority local problem.
Indirectly: through impacting on the economic climate in which the business is operating, for example:
- By damaging children’s educational prospects.
- Weakening labour productivity.
- Influencing decisions on savings and investments.
- Impacting on household solvency and ability to be economically active.
- Altering a countries demographic structure.
¹ http://www.k4health.org/sites/default/files/What%20is%20the%20Economic%20Impact%20of%20Malaria.pdf
² http://www.gbchealth.org/our-work/health_focus_areas/malaria/
Click these links for more information on the impact of malaria on specific industries: the extractive industry, agri-business industry, infrastructure Industry.
Impact of Businesses on malaria
Business activities can have both positive and negative impacts on malaria.
Some company activities can lead to increased malaria transmission by for example:
- Bringing people into unpopulated areas with high malaria transmission potential.
- Moving non-immune employees into malaria endemic areas.
- Requiring employees to work outside during peak transmission times (e.g. night-time shift work).
- Increasing the size/number of mosquito breeding sites as a result of construction work, leading to increased transmission (e.g. by the creation of trenches alongside new roads which may collect rain water).
- Causing long-term changes in land-use leading to a long-term increase in transmission potential (e.g. through irrigation projects).
Other company activities can result in reduced malaria transmission by for example:
- Reducing the size/number of mosquito breeding sites through construction work (e.g. improving drainage through the strategic use of culverts, drains and soakaways).
- Making high quality malaria treatment facilities available to employees and the wider community. This can have a particularly profound impact where companies are working in remote populated areas beyond the reach of national health services.
Private companies, perhaps more in the Asia-Pacific than in any other region, have the potential to effect major transformational impact on malaria control. The extensive presence of large scale private companies working in malarious areas, often in remote locations, provides an opportunity to bring high quality malaria control to areas that Government may be unable to reach.
There are various options available to companies interested in becoming in ivolved in malaria. Learn more about them here:
Protecting employees without community-wide programmes
It may be that the decision is made to focus malaria control measures on the workforce alone, without expansion to local communities. (Though, click here to read more about why expanding control measures to the local communities may be useful.
If a strategy of focusing only on the workforce is chosen then vector control efforts may be in place within but not outside the fence; yet local employees may be on rotation and returning regularly to home communities outside the fence. Measures to limit the malaria risk in employees at all times could include:
- Providing employees with malaria prevention measures that they can take with them to use when returning to home communities. This could include any of the personnel protection measures considered appropriate to the context, such as insecticide treated nets, insecticide treated traditional clothing and repellents. If this approach is taken it is highly recommended that the employees are given sufficient commodities to provide protection for their whole family. Aside from the clear ethical impetus for this approach, it also improves the likelihood that the employee will receive the protection from malaria which the company intends; rather than, for example, ensuring his/her children or other family members are protected by the one ITN provided.
- Ensuring high quality case management services are available, for prompt diagnosis and treatment should the employee fall sick with malaria. Employees should be able to access on site clinics regardless of whether they are currently on rotation on site; and the company may also consider reviewing and, where appropriate, supporting clinical services available in some of the major communities from which the workforce is drawn.
Building a community-wide malaria programme as part of a CSR strategy
Many companies opt for the approach of moving beyond the fence to support wider malaria control programmes in surrounding communities or the country as a whole. In areas where malaria is a major health issue CSR programmes focusing on this can be an appropriate choice. The additional benefit to the company is that such programmes can also have direct benefits to the health of your workforce: the workforce may be drawn from and live in surrounding communities, and disease transmission will be fluid between sites and nearby communities. Some of our case studies give good examples of how companies have supported malaria as part of their CSR activities:
Elimination of Taxes and Tariffs, Papua New Guinea
Exxonmobil, Papua New Guinea
Newmont, Batu Hijau, Indonesia
Shell, Palawan, Philippines
Oil Search, Southern Highlands Province, Papua New Guinea
For further information on how to design such a programme you can follow the guidance provided here.
Engaging in Advocacy and Business Coalitions
Recognizing that the private sector can have an important influence on malaria control there are a number of coalitions that have formed to bring together the voice of the private sector. These groups lobby for and provide guidance on good practice and work to leverage the voice and influence of this sector in the support of progress on malaria globally or within specific regions.
Engaging in this way can also raise the profile of a company’s support for an engagement in malaria.
Examples of advocacy groups and coalitions which companies could consider getting involved with include:
- Roll Back Malaria (RBM) Partnership The RBM Partnership mobilises for action and resources on malaria and forges consensus among partners. A founding member of the Partnership, Malaria Consortium, is a key contributor to the global framework to implement coordinated action against malaria. The Partnership comprises more than 500 members, including those from malaria endemic countries, international donors and foundations, the private sector, non-governmental and community-based organisations, and research and academic institutions.
- World Malaria Day Website In 2009 Malaria Consortium launched the World Malaria Day website bringing together malaria activists, practitioners and stakeholders from all over the world to encourage collaboration, resource and information sharing
- GBCHealth (Global Business Coalition on Health) serves as a hub for private sector engagement on the world's most pressing global health issues. Since 2001, GBCHealth has worked with hundreds of members -- individually and in partnership with one another to tackle the challenges of HIV/AIDS, Tuberculosis, Malaria, Diabetes and other health issues facing the workplace and communities where business is conducted.
- APMEN (The Asia Pacific Malaria Elimination Network) is composed of 15 Asia-Pacific Country Partners as well as regional partners from academia, development, NGOs, the private sector and global agencies, including WHO. APMEN’s mission is to collaboratively address the unique challenges of malaria elimination in the region through leadership, advocacy, capacity building, knowledge exchange and by building the evidence base.
Providing financial support regionally / nationally
Rather than taking an active role in designing and managing malaria control programmes, the private sector could consider providing direct funding to the government or non-State actors to support unfunded malaria control needs in the region as a whole or a specific area of interest. Exxon Mobile, for example have funded clinical trials of new malaria drugs in Papua New Guinea. No good examples are found of businesses providing direct financial support to National Malaria Control Programmes but this is a route that could be considered. Most countries have up to date and fully costed malaria control strategies with clear gap analyses. Approaching the Ministry of Health or National Malaria Control Programme to discuss out-standing gaps and opportunities for the company to provide support is an approach that could be considered.
Examples
Examples of successful industry malaria control programmes including summary table of levels of involvement
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Elimination of Taxes and Tariffs, Papua New Guinea
In 2011, the Malaria Taxes and Tariffs Advocacy Project (M-TAP) reported that only six countries worldwide had completely removed tariffs on products used to fight the disease despite agreement to do so ten years ago. Dropping taxes and tariffs can play a key role in cutting costs because the vast majority of medicines and other products used to fight malaria are imported. These are: LLINs, ACTs, RDTs, insecticides for indoor spraying, and insecticide spray pumps.
M-TAP, which has been gathering evidence from nearly 80 malarious countries over the two year project, found that taxes and tariffs on anti-malarial products provide only minimal revenues, and these gains are often offset by health costs and lost productivity from preventable malaria illnesses. In Cambodia, M-TAP found that non-tariff barriers present more obstacles for importation than existing taxes and tariffs, for example, in issues of procurement and supply management. Private sector providers continue to play a critical role in supplying access to malaria treatment and prevention despite the huge increase in donor commitments over the past five years, so removal of taxes and tariffs are another way to ensure that cost does not pose a significant barrier to access
Affordable Medicines Facility for Malaria (AMFM), Cambodia
Despite efforts to assure quality of care in the provision of ACTs, an alarming resistance to artesunate (an active derivative of artemisinin) was documented in western Cambodia. The poorly regulated private sector, where approximately 70 per cent of fever-sufferers seek treatment, is believed to have contributed to this resistance development by dispensing artemisinin based monotherapies (AMTs) and sub-therapeutic doses of artemisinin.
The government reconsidered its use of the private sector in its battle against malaria. International support programs offered new opportunities to test market-based incentives that compel the private sector to provide optimal malaria care. The AMFm, hosted and managed by the Global Fund, invited Cambodia (and six other countries) to participate in its plan to flood their markets with highly subsidised formulations of ACTs that are so inexpensive that private sector providers can sell them as profitably as AMTs and other ineffective treatments. The AMFm program required participating countries to partner with the private sector for the distribution of ACTs.
The AMFm enables private importers to pay up to 80 per cent less than they did in 2008-2009. It pays most of this reduced price (a ‘buyer co-payment’) directly to the manufacturers to further lower the cost to eligible first-line buyers of ACTs. Unfortunately, low cost ACTs procured through AMFm arrived late in country and so it was not possible to show impact in the ACTwatch evaluations in Cambodia.
Net Bundling Strategy, Cambodia
A bundling strategy was devised as an interim measure to address the issue of high demand for untreated nets. The strategy aimed to make use of the huge cost efficiencies of using the existing private sector net retail channels to supply long-lasting insecticide treatment kits bundled with untreated nets. This was possible because Cambodia has relatively few net importers and a highly centralised retail distribution system, with one major wholesale market as the hub through which most products flow out to provincial markets.
Population Services International (PSI) was identified as the partner to work with to implement the strategy due to their significant experience of working in the private sector. PSI approached and gained buy-in from the existing net traders (importers and wholesalers) operating in Phnom Penh. Conventional nets were bundled at the top of the supply chain where possible. A mass communications strategy encouraged buying a bundled net and dipping the net in the insecticide. The evaluation found 72 per cent of outlets were selling bundled nets (according to PSI MAP Survey data).
It was learnt that it is not efficient to segment the retail market and limit it to cater only to the high transmission areas of the country without incurring huge cost inefficiencies; therefore the program was designed to bundle all nets, reaching all areas of the country. It was considered that as there is migration around the country, nets would be assured to reach migrant populations via this method before they moved to the at-risk areas.
Social Franchising – Sun Quality Health (PSI) Myanmar
Launched in Myanmar in 2001, the social franchise network consists of a first tier of private licensed General Practitioners (GPs) called Sun Quality Health (SQH). SQH clinics offer services in malaria and also reproductive health, TB, pneumonia, diarrhoea, and HIV including STIs. In 2008 a Sun Primary Health (SPH) channel was launched to reach poor and vulnerable rural communities within a 3 hour radius of the SQH clinic. SPH are a second tier of the network and are trained in a range of health areas for which they sell subsidised products. Currently SPH is being scaled up. Payment sources are 99 per cent out-of-pocket expenditure and 1 per cent free. Malaria disability adjusted life years (DALYs) averted in 2010 were 18,523 rising to 46,567 in 2011. This significant increase was attributable to the SPH community health workers.
Private Provider Alliances, the Myanmar Medical Association
The Myanmar Medical Association (MMA) is the only professional body of medically qualified doctors in Myanmar, with over 8,000 members and a total of 74 branches throughout the country. In 2009 MMA was funded to implement the Quality Diagnosis and Standard Treatment of Malaria by Private General Medical Practitioners (QDSTM) Project.
MMA’s QDSTM project aims to provide quality assured diagnosis and treatment of malaria by the private medical GPs in selected townships. It is a continuation of a Three Diseases Fund project that empowered 173 GPs in 46 townships and provided quality assured diagnosis and treatment of malaria. Two fixed clinics extend the services to the village level through setting up mobile teams and trained volunteers. The mobile teams and volunteers provide health education and case management of malaria. The volunteers are provided with essential medicines and RDTs to manage malaria in between the visits of mobile teams. The mobile team visits one/two villages per week and also supervises the activities of trained volunteers. The implementation is regularly supervised and provides feedback to MMA technical staff, central supervisors and the WHO malaria unit.
In year 3 and 4, the project will further expand to 14 new project townships and train 50 more GPs to deliver malaria case management in accordance with the National Malaria Treatment Guidelines. In addition, the project management, in consultation with WHO, will open fixed and mobile clinics in two remote townships (Kachin and Rakhine) where malaria is highly endemic and access to health services is very limited. The project will focus on strengthening in-house capacities; ensuring participating GPs follow the QDSTM Project Standard Operating Procedures; and improving monitoring and evaluation.
Exxonmobil, Papua New Guinea
ExxonMobil is implementing ‘inside’ and ‘outside’ the fence initiatives at its operations in PNG. Inside the fence, the Malaria Control Programme covers both employees and contractors working in malaria-prone areas. It includes awareness campaigns, mosquito bite prevention tools, and anti-malarial medication, and promotes early diagnosis and treatment to fight malaria. Outside the fence, ExxonMobil, through its Malaria Initiative, has collaborated with the Rotarians Against Malaria Program on logistics, planning and bed net distribution. Plans are under development for enhanced malaria diagnostics at relevant community clinics. More than 1,000 community members have been tested for malaria and were treated if positive. ExxonMobil is also working with the Medicines for Malaria Venture to fund clinical trials of new antimalarial medicines in PNG.
Newcrest Mining Ltd., Gosowong, Indonesia
Newcrest Mining Ltd is implementing an ‘inside the fence’ employee protection malaria control program at the Gosowong gold mine in Indonesia. Education, counselling, prevention, risk-control and treatment programs are available to all workers and treatment is also provided to workers’ families. Employees are given safety inductions to learn about the dangers of malaria and can obtain further information from or report cases of malaria to the safety officer, malaria control officer or site doctor. Prevention and risk-control methods include reporting of potential malaria hazards, fogging, IRS, and sanitation. Malaria cases are treated at the site clinic or the local hospital where employees are covered by health insurance.
Newmont, Batu Hijau, Indonesia
Since 1996, Newmont has been contracting International SOS to operate an integrated broad-based health service at its Batu Hijau mine. The program involves prevention and treatment activities both inside and outside the fence including larviciding, screening of military personnel for malaria before entering the control zone, distribution of mosquito nets, space spraying, training of community members on diagnosis of malaria, capacity building of government health workers, screening and treatment of children in surrounding villages, case management in the site clinic and first aid posts and medical evacuation if necessary. Malaria prevalence reduced in community school children from 47.3 per cent in 1999 to 1.5 per cent in 2007. In addition, the malaria incidence rate in the mine workforce dropped from 53 per 1,000 employees in 1998 to 5 per 1,000 in 2007.
Shell, Palawan, Philippines
In 1999, the Pilipinas Shell Foundation launched the Movement Against Malaria social investment program. The foundation worked with the provincial government and the Department of Health to set up 344 malaria village laboratories in the Palawan province, with trained local staff to detect the malaria parasite in blood smears. The program provides leaflets and holds village meetings to raise awareness of malaria prevention. It encourages people to sleep under mosquito nets, clear breeding areas and keep themselves covered in the evening. In 2006, the program received a US$14 million five-year grant from Global Fund to expand to four more provinces. Another grant in 2010 provided US$31.4 million and increased the total number of provinces covered to 40. The program has reduced malaria deaths by nearly 97 per cent from 99 deaths a year in 1999 to three in 2011.
Oil Search, Southern Highlands Province, Papua New Guinea
Since 1998, Oil Search has been implementing the Marasin Stoa program, a village malaria treatment initiative at its Hides gas field project area in the Southern Highlands Province. The program entails training a community member, usually a woman, in basic malaria diagnosis using a Rapid Diagnostic Kit and supplying pre-packaged (dosage for weight category) malaria medication. The village treatment providers also collect malaria blood slides from each case for laboratory analysis in the Oil Search laboratory in order. The treatment providers charge a nominal fee and can sell additional ‘over the counter’ health products to supplement their income. This ensures sustainability of the program and addresses other social development issues such as poverty and gender equity. The program has seen a steady decline in the incidence and prevalence of malaria in all affected communities. Direct management has been taken over by a local church health service provider, with technical support provided by the Oil Search Health Foundation. The National Department of Health (NDOH) has endorsed the program and the model is being trialled in other parts of the country. Additionally, Oil Search has been appointed the new principal recipient (PR) of funding from the Global Fund replacing the NDOH as PR.
mhealth Management Information Systems, Philippines, Indonesia
EpiSurveyor is a free mobile phone- and web-based data collection system. It is used for the collection of information regarding clinic supervision, vaccination coverage or outbreak response, and it helps to identify and manage important public health issues including HIV/AIDS, malaria, and measles. As of April 2012, EpiSurveyor, based in Kenya, has nearly 8,000 users in more than 170 countries worldwide including the Philippines and Indonesia, making it the most widely used mHealth software. Partners include: Datadyne, United Nations Foundation, Vodafone Foundation, and Knight Foundation.
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In 2011, the Malaria Taxes and Tariffs Advocacy Project (M-TAP) reported that only six countries worldwide had completely removed tariffs on products used to fight the disease despite agreement to do so ten years ago. Dropping taxes and tariffs can play a key role in cutting costs because the vast majority of medicines and other products used to fight malaria are imported. These are: LLINs, ACTs, RDTs, insecticides for indoor spraying, and insecticide spray pumps.
M-TAP, which has been gathering evidence from nearly 80 malarious countries over the two year project, found that taxes and tariffs on anti-malarial products provide only minimal revenues, and these gains are often offset by health costs and lost productivity from preventable malaria illnesses. In Cambodia, M-TAP found that non-tariff barriers present more obstacles for importation than existing taxes and tariffs, for example, in issues of procurement and supply management. Private sector providers continue to play a critical role in supplying access to malaria treatment and prevention despite the huge increase in donor commitments over the past five years, so removal of taxes and tariffs are another way to ensure that cost does not pose a significant barrier to access
Affordable Medicines Facility for Malaria (AMFM), Cambodia
Despite efforts to assure quality of care in the provision of ACTs, an alarming resistance to artesunate (an active derivative of artemisinin) was documented in western Cambodia. The poorly regulated private sector, where approximately 70 per cent of fever-sufferers seek treatment, is believed to have contributed to this resistance development by dispensing artemisinin based monotherapies (AMTs) and sub-therapeutic doses of artemisinin.
The government reconsidered its use of the private sector in its battle against malaria. International support programs offered new opportunities to test market-based incentives that compel the private sector to provide optimal malaria care. The AMFm, hosted and managed by the Global Fund, invited Cambodia (and six other countries) to participate in its plan to flood their markets with highly subsidised formulations of ACTs that are so inexpensive that private sector providers can sell them as profitably as AMTs and other ineffective treatments. The AMFm program required participating countries to partner with the private sector for the distribution of ACTs.
The AMFm enables private importers to pay up to 80 per cent less than they did in 2008-2009. It pays most of this reduced price (a ‘buyer co-payment’) directly to the manufacturers to further lower the cost to eligible first-line buyers of ACTs. Unfortunately, low cost ACTs procured through AMFm arrived late in country and so it was not possible to show impact in the ACTwatch evaluations in Cambodia.
Net Bundling Strategy, Cambodia
A bundling strategy was devised as an interim measure to address the issue of high demand for untreated nets. The strategy aimed to make use of the huge cost efficiencies of using the existing private sector net retail channels to supply long-lasting insecticide treatment kits bundled with untreated nets. This was possible because Cambodia has relatively few net importers and a highly centralised retail distribution system, with one major wholesale market as the hub through which most products flow out to provincial markets.
Population Services International (PSI) was identified as the partner to work with to implement the strategy due to their significant experience of working in the private sector. PSI approached and gained buy-in from the existing net traders (importers and wholesalers) operating in Phnom Penh. Conventional nets were bundled at the top of the supply chain where possible. A mass communications strategy encouraged buying a bundled net and dipping the net in the insecticide. The evaluation found 72 per cent of outlets were selling bundled nets (according to PSI MAP Survey data).
It was learnt that it is not efficient to segment the retail market and limit it to cater only to the high transmission areas of the country without incurring huge cost inefficiencies; therefore the program was designed to bundle all nets, reaching all areas of the country. It was considered that as there is migration around the country, nets would be assured to reach migrant populations via this method before they moved to the at-risk areas.
Social Franchising – Sun Quality Health (PSI) Myanmar
Launched in Myanmar in 2001, the social franchise network consists of a first tier of private licensed General Practitioners (GPs) called Sun Quality Health (SQH). SQH clinics offer services in malaria and also reproductive health, TB, pneumonia, diarrhoea, and HIV including STIs. In 2008 a Sun Primary Health (SPH) channel was launched to reach poor and vulnerable rural communities within a 3 hour radius of the SQH clinic. SPH are a second tier of the network and are trained in a range of health areas for which they sell subsidised products. Currently SPH is being scaled up. Payment sources are 99 per cent out-of-pocket expenditure and 1 per cent free. Malaria disability adjusted life years (DALYs) averted in 2010 were 18,523 rising to 46,567 in 2011. This significant increase was attributable to the SPH community health workers.
Private Provider Alliances, the Myanmar Medical Association
The Myanmar Medical Association (MMA) is the only professional body of medically qualified doctors in Myanmar, with over 8,000 members and a total of 74 branches throughout the country. In 2009 MMA was funded to implement the Quality Diagnosis and Standard Treatment of Malaria by Private General Medical Practitioners (QDSTM) Project.
MMA’s QDSTM project aims to provide quality assured diagnosis and treatment of malaria by the private medical GPs in selected townships. It is a continuation of a Three Diseases Fund project that empowered 173 GPs in 46 townships and provided quality assured diagnosis and treatment of malaria. Two fixed clinics extend the services to the village level through setting up mobile teams and trained volunteers. The mobile teams and volunteers provide health education and case management of malaria. The volunteers are provided with essential medicines and RDTs to manage malaria in between the visits of mobile teams. The mobile team visits one/two villages per week and also supervises the activities of trained volunteers. The implementation is regularly supervised and provides feedback to MMA technical staff, central supervisors and the WHO malaria unit.
In year 3 and 4, the project will further expand to 14 new project townships and train 50 more GPs to deliver malaria case management in accordance with the National Malaria Treatment Guidelines. In addition, the project management, in consultation with WHO, will open fixed and mobile clinics in two remote townships (Kachin and Rakhine) where malaria is highly endemic and access to health services is very limited. The project will focus on strengthening in-house capacities; ensuring participating GPs follow the QDSTM Project Standard Operating Procedures; and improving monitoring and evaluation.
Exxonmobil, Papua New Guinea
ExxonMobil is implementing ‘inside’ and ‘outside’ the fence initiatives at its operations in PNG. Inside the fence, the Malaria Control Programme covers both employees and contractors working in malaria-prone areas. It includes awareness campaigns, mosquito bite prevention tools, and anti-malarial medication, and promotes early diagnosis and treatment to fight malaria. Outside the fence, ExxonMobil, through its Malaria Initiative, has collaborated with the Rotarians Against Malaria Program on logistics, planning and bed net distribution. Plans are under development for enhanced malaria diagnostics at relevant community clinics. More than 1,000 community members have been tested for malaria and were treated if positive. ExxonMobil is also working with the Medicines for Malaria Venture to fund clinical trials of new antimalarial medicines in PNG.
Newcrest Mining Ltd., Gosowong, Indonesia
Newcrest Mining Ltd is implementing an ‘inside the fence’ employee protection malaria control program at the Gosowong gold mine in Indonesia. Education, counselling, prevention, risk-control and treatment programs are available to all workers and treatment is also provided to workers’ families. Employees are given safety inductions to learn about the dangers of malaria and can obtain further information from or report cases of malaria to the safety officer, malaria control officer or site doctor. Prevention and risk-control methods include reporting of potential malaria hazards, fogging, IRS, and sanitation. Malaria cases are treated at the site clinic or the local hospital where employees are covered by health insurance.
Newmont, Batu Hijau, Indonesia
Since 1996, Newmont has been contracting International SOS to operate an integrated broad-based health service at its Batu Hijau mine. The program involves prevention and treatment activities both inside and outside the fence including larviciding, screening of military personnel for malaria before entering the control zone, distribution of mosquito nets, space spraying, training of community members on diagnosis of malaria, capacity building of government health workers, screening and treatment of children in surrounding villages, case management in the site clinic and first aid posts and medical evacuation if necessary. Malaria prevalence reduced in community school children from 47.3 per cent in 1999 to 1.5 per cent in 2007. In addition, the malaria incidence rate in the mine workforce dropped from 53 per 1,000 employees in 1998 to 5 per 1,000 in 2007.
Shell, Palawan, Philippines
In 1999, the Pilipinas Shell Foundation launched the Movement Against Malaria social investment program. The foundation worked with the provincial government and the Department of Health to set up 344 malaria village laboratories in the Palawan province, with trained local staff to detect the malaria parasite in blood smears. The program provides leaflets and holds village meetings to raise awareness of malaria prevention. It encourages people to sleep under mosquito nets, clear breeding areas and keep themselves covered in the evening. In 2006, the program received a US$14 million five-year grant from Global Fund to expand to four more provinces. Another grant in 2010 provided US$31.4 million and increased the total number of provinces covered to 40. The program has reduced malaria deaths by nearly 97 per cent from 99 deaths a year in 1999 to three in 2011.
Oil Search, Southern Highlands Province, Papua New Guinea
Since 1998, Oil Search has been implementing the Marasin Stoa program, a village malaria treatment initiative at its Hides gas field project area in the Southern Highlands Province. The program entails training a community member, usually a woman, in basic malaria diagnosis using a Rapid Diagnostic Kit and supplying pre-packaged (dosage for weight category) malaria medication. The village treatment providers also collect malaria blood slides from each case for laboratory analysis in the Oil Search laboratory in order. The treatment providers charge a nominal fee and can sell additional ‘over the counter’ health products to supplement their income. This ensures sustainability of the program and addresses other social development issues such as poverty and gender equity. The program has seen a steady decline in the incidence and prevalence of malaria in all affected communities. Direct management has been taken over by a local church health service provider, with technical support provided by the Oil Search Health Foundation. The National Department of Health (NDOH) has endorsed the program and the model is being trialled in other parts of the country. Additionally, Oil Search has been appointed the new principal recipient (PR) of funding from the Global Fund replacing the NDOH as PR.
mhealth Management Information Systems, Philippines, Indonesia
EpiSurveyor is a free mobile phone- and web-based data collection system. It is used for the collection of information regarding clinic supervision, vaccination coverage or outbreak response, and it helps to identify and manage important public health issues including HIV/AIDS, malaria, and measles. As of April 2012, EpiSurveyor, based in Kenya, has nearly 8,000 users in more than 170 countries worldwide including the Philippines and Indonesia, making it the most widely used mHealth software. Partners include: Datadyne, United Nations Foundation, Vodafone Foundation, and Knight Foundation.
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Engaging in national forums
All malarious countries in this region have forums focusing on malaria in which a wide range of stakeholder groups take part. Where malaria specific forums are not established, malaria stakeholders meet as part of health or child health forums.
These forums are a way of ensuring that all potential and current partners involved in the national malaria control effort remain up to date both on national policy and on the activities being undertaken by others. Joint strategizing and planning is often a feature.
These meetings are a good opportunity to find out who is working on malaria in your area and to start the process of looking for partners. Taking part in these meetings can also be an excellent way to show that your company is taking the issue of malaria seriously, as well as showcasing your activities and achievements.
Common national forums include:
- Health partners meetings,
- Malaria stakeholders meetings,
- Working group meetings for specific malaria control areas such as vector control and case management.
Sources of information on appropriate stakeholder forums in which your company could take part are:
- The Ministry of Health or National Malaria Control Programme website,
- The local health authority office,
- The WHO country office / website.
- The Country Coordinating Mechanism (for grantees of funds from the Global Fund to fight AIDS, TB and Malaria). These groups typically work across AIDS, TB and Malaria. From the list of contacts you can find the most relevant groups to approach. To access contact information, choose a country location from the drop down box on this webpage and, on the right, click ‘Country Coordinating Mechanism’ to access the list for malaria specific contacts).
What would you like to do now
Get guidance on another issue Find out more about malaria Find out where to access more information Find out how to access advice and assistance
Get guidance on another issue Find out more about malaria Find out where to access more information Find out how to access advice and assistance