Strengthening of Health Systems for Effective Scale up of Malaria Control and Other Communicable Diseases in east and southern Africa (CLOVER): Uganda, Ethiopia, Zambia, Mozambique & Tanzania

Situation:

Strengthened health systems are vital to ensure that many of the interventions required to prevent and treat malaria reach those who need them most. The Irish Government’s official programme of assistance to developing countries is managed by Irish Aid, a division within the Department of Foreign Affairs. The objective of Irish Aid is to reduce poverty, inequality and exclusion in developing countries. The aim of the CLOVER project is to address the dual challenge of supporting countries in east and southern Africa to rapidly scale up malaria control interventions while at the same time supporting the development of sustainable health systems. More precisely it is to improve the delivery of preventive and curative interventions for a scaled up response by strengthening health systems (e.g. planning, health management information systems (HMIS), drug delivery systems, and support supervision systems), at various levels including central level; sub national level and district level. This will lead to improvements in district’s capability to plan, implement and evaluate malaria control and communicable disease interventions and; strengthen systems at district level to scale up implementation of case management malaria in pregnancy control interventions such as intermittent preventive treatment (IPT) and insecticidal-treated nets (ITNs).

Response:

In Zambia, the 11 districts in the southern Province have been given support in planning for malaria control as part of their annual plans of action. In addition, malaria focal persons, whose responsibility it is to coordinate malaria control activities within their districts, have been given a thorough technical update on malaria control to ensure they are implementing cost effective sound interventions. District and Provincial Malaria Task-forces has been established to oversee implementation of malaria business plans, coordination of the response to malaria at district and provincial levels and further mobilization of resources.

In Uganda we have been working on strengthening information systems in 4 districts to ensure that the districts and the Ministry of Health are able to measure progress in implementation of malaria interventions. In the same districts, a mentoring system to improve the treatment and prevention of malaria during pregnancy has been set up and is already showing evidence of improved quality of service to these pregnant women including an increased coverage for IPT. Activities are on track and include developing a national strategic plan for malaria control, case management training materials, supporting the monitoring of community medicine distributors and supporting data and information management.

In Ethiopia, we have provided motorcycles, computers and printers to key people in each of our 5 target districts in order to assist them in the areas of support supervision for improved treatment of malaria as well as improved record keeping relating to the number of cases of malaria treated and other information that is vital to planning future services. We have developed training materials, a communication strategy and a proposal to the GFATM. At National level, the whole system of malaria control organization at different levels of the health system was reviewed. Recommendations to improve the system for improved malaria control at all levels were made and are currently being taken up in the Federal Ministry of Health restructuring exercise. The Malaria Consortium assisted Zanzibar island by adapting a system for re-treating mosquito nets that had been developed in Uganda. A total of 37,000 mosquito nets were treated during the campaign.

In Sudan, we carried out an assessment of management structures both at Federal and State level, identifying capacity deficiencies. We then ran targeted training of staff from the National and State programs. In accordance with the recommendations from the assessments, the structure of the National programme has been changed to better reflect the workload and to group similar activities into single departments. In Mozambique, planning for focal point training and material development are underway as well as support for diagnostics in Inhambane region.

Points to note:

For Roll Back Malaria to be a success the challenge of rapidly scaling up the coverage of malaria control interventions needs to occur within the context of building sustainable health systems. Without a health systems perspective there is a risk of building unsustainable, vertical, project-based malaria control initiatives that undermine the long-term development of health systems in eastern and southern Africa.

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Photo: Malaria Consortium