Blog

Rutoke’s key influencer sets up a village health club and ‘ambulance fund’

Posted on
Ernest (left) informing Bagonza (right) about preventive measures for malaria

Ernest Masereka, a voluntary community health worker and key influencer from Rutoke village, Uganda, introduced his community to the idea of forming a village health club in December 2017. Village health clubs provide forums at which community members can disseminate messages and address different issues, such as sanitation, health and savings. Members of the club collectively come up with action plans and local solutions for the challenges their community faces.

Club members, Ernest suggested, could also contribute 1,000 Ugandan shillings every month for the community to use to address health issues when needed. The community welcomed this idea and in January 2018 a village health club was formed and members began contributing to what they referred to as the ‘ambulance fund’.

Since 2016, USAID’s Malaria Action Program for Districts (MAPD) has been working with the key influencers to reduce the malaria burden in Uganda. Their role is to sensitize their communities on the dangers of malaria, the importance of seeking early treatment within 24 hours of symptoms, and preventive practices. This is done through monthly home visits and, when they exist, through community dialogues via the village health club. In September 2017, MAPD, implemented by Malaria Consortium in partnership, identified and trained 32 key influencers in malaria prevention, treatment and interpersonal communication and one of their deliverables was to establish village health clubs.

Bagonza (left) attending a dialogue meeting hosted by the Rutoke Tweyambe Group chairperson

Thanks to Ernest’s encouragement, his community’s village health club is already proving a success. When Bagonza’s son got sick in May 2018, he took him to a nearby health centre where he was diagnosed with malaria and received treatment. However, his condition became worse after a week and he was referred to St Paul’s hospital 10 kilometers away from his home in Kasese town. Bagonza did not have enough money at the time, so he spoke with the chairman, treasurer and secretary of the village health club in his village and managed to borrow 40,000 Ugandan shillings. With this money, Bagonza took his son to hospital and bought a few other necessary items, such as sugar, soap and food. This was officially communicated to the village health club members at the next meeting and a repayment schedule was established for Bagonza to replenish the Ambulance fund.

“My child is very well now and is back at school,” said Bagonza. “Recently, the government gave us nets and we now sleep under a mosquito net. I also know even more nets are being distributed at the facilities to pregnant mothers. We are lucky that our village was chosen [for this project]. Please do not forget us in your future plans.”

MAPD plans to increase the number of key influencers in the Kasese district from four to 10 to extend its reach in promoting behavior change and reduce the malaria burden in the district. Since key influencers and community members are accountable for the success of village health clubs, this will ensure the sustainability of MAPD’s impact even after the project ends.

This success story is published as part of a series from the USAID’s Malaria Action Program for Districts project.

For more information, see www.malariaconsortium.org/resources/publications/977/ or contact: Dr Sam Gudoi, s.gudoi@malariaconsortium.org

USAID’s Malaria Action Program for Districts aims to improve the health status of the Ugandan population by reducing childhood and maternal morbidity and mortality due to malaria. The project will support the Government of Uganda for a period of five years, focusing in particular on children under five years of age and pregnant women. This project, made possible by the generous support from the American and British people, is implemented by Malaria Consortium in partnership with Jhpiego, Banyan Global, and Communication for Development Foundation Uganda (CDFU), Deloitte Uganda and Infectious Diseases Institute (IDI).

From the field: female community health volunteers in Nepal

Posted on

Nepal is one of only five countries that have reduced under-five mortality by 50% since 1990[1], however pneumonia remains one of the primary causes of death for Nepali children (15% of under five deaths in 2015[2]). In rural areas, the government relies on the country’s 50,000 Female Health Community Volunteers (FCHVs) to provide maternal and child health care. Although 42% of these women have never been to school[3] they have been trained to diagnose a number of illnesses, including pneumonia, and provide essential care to young children on a daily basis in the most remote areas where Health Posts are hard to reach.

Guta

As part of its Acute Respiratory Infection Diagnosis Aid (ARIDA) project/study, Malaria Consortium (MC) went on a scoping mission to Nepal end of January and visited an FCHV in a valley outside Kathmandu. Guta Kunwor is 38 years old and she has been an FCHV for 12 year. Her aunt was an FCHV before her and she used to accompany her to trainings at the local Health Centre. On average, she sees three children with cough or difficulty breathing every week. When children present with those symptoms she counts their respiratory rate (RR) for 60 seconds according to the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) guidelines and refers them to the nearest Health Post if she diagnoses fast breathing.

A child wearing the ChARM device

So far, Guta has been using the ARI Timer, a device which works like a stopwatch whilst she is counting the child’s breaths by watching their stomach moving with each inhalation and exhalation. The ARIDA study is focused on testing an automated device which is strapped to the child’s belly and automatically counts the child’s breaths. It also reduces the assessment time from five minutes to merely a couple of minutes. When we told Guta about this new device, she spontaneously thought of an analogy which rang very true: she said that using the ARI Timer was a little like touching a child’s forehead and yours at the same time to check for fever, whilst using the ChARM device was more like using a thermometer to get a reliable diagnosis.

This stage of the ARIDA study is looking at the acceptability of this new automated device under a number of specific themes: affective attitude, burden, intervention coherence, perceived effectiveness and self-efficacy. The results should show whether FCHVs and health facility workers (HFWs) using an Acute Respiratory Infection Diagnostic Aid (ARIDA) can adhere to the IMNCI algorithm, and should help us better understand FCHVs’ and HFWs’ perceptions on the benefits of and barriers to using this new device.

Alice Maurel is Senior Programme Officer at Malaria Consortium. Alice visited Nepal in January 2018.

Find out more about the ARIDA study in our project brief here.

The ARIDA study is funded by the La Caixa Foundation and UNICEF in collaboration with the Federal Ministry of Health Ethiopia, Federal Ministry of Health Nepal and Ministry of Health Mozambique.

[1] P Dawson YP, R Houston, S Karki, D Poudel, S Hodgins. From research to national expansion: 20 years’ experience of community-based management of childhood pneumonia in Nepal. Bulletin of the World Health Organization, 2008

[2] Government of Nepal MoH. Annual Report, Department of Health Services, 2015–2016. 2016.

[3] Ibid.

Mozambique: A field officer developing community capacity in malaria prevention

View in: English | Portuguese
Posted on
Field officer Castélio Muwasse

Story collected by Dorca Nhaca and edited by Fernando Bambo in November 2017

Ilha de Moçambique is an idyllic island for visitors; it was once the capital of Mozambique and is now a world heritage site. But for the local population as well as for visitors, there is a threat that darkens the picture: the risk of getting malaria, a potentially deadly disease that remains the main cause of health problems in Mozambique.

Castélio Muwasse, a Field Officer for Malaria Consortium, works in the District of Ilha de Moçambique. This 31-year old technician in preventive medicine and environmental sanitation joined the Malaria Prevention and Control Project team in 2016, motivated by the desire to work with communities and learn new experiences.

As a field officer, the responsibilities of Castélio included support for the District Health Services in the implementation of project activities, training of community structures and teachers on malaria prevention, collection and compilation of activity monitoring data, and coordination between health facilities and community structures, such as health committees and local organisations, and between district education and health services.

In addition to mobilising community structures for malaria prevention, he coordinated the training of teachers with the school health technician of the District Education Services.

“With the schools, I worked well without major constraints. We managed to train the teachers and they reported the work done monthly. There was good collaboration from teachers and school directors.”

Castelio is based at the District Health Services office, but actually spends a lot of time traveling on his motorcycle to reach the various communities and health facilities scattered throughout the district, even the most remote ones. With this knowledge of the terrain, he is able to draw a detailed map of the district in just a few minutes.

In order to work effectively with community structures, it is essential to build a trusting relationship. Castélio joined Malaria Consortium to replace a field officer who had worked with these communities for a few years so he had to use all his interpersonal communication skills to gain the trust of the volunteers.

”Throughout the project I have had good moments. One of these was when I was accepted by the communities and received a warm welcome. This was crucial as they were open to listening to the messages and to making use of them. ”

Castélio says that the communication activities for behaviour change carried out by community structures volunteers, teachers and students have contributed to the reduction of malaria cases, partly as a result of their collaboration.

“We have noted that there is a reduction in the number of malaria cases, a reduction in the misuse of mosquito nets, an improvement in environmental sanitation and a better uptake of the use of mosquito nets, Previously, families would take the nets to go fishing or cover their gardens.”

This is certainly the most rewarding part of being a field officer on the ground. This type of work also offers many learning opportunities for young professionals, such as Castélio, to grow.

“Personally, with the project, I learnt a lot, gained a lot of knowledge and experience. I learnt to be a more open person. One of the lessons I take with me is that working with communities is not an easy task, but humility, love, care and patience are key to success and to overcoming certain difficulties.”

The Malaria Prevention and Control Project has been implemented in nine of the 11 provinces of Mozambique by a consortium of civil society organisations  led by World Vision, with Malaria Consortium, Community Development Foundation and Food for The Hungry. Malaria Consortium carried out interventions in 17 districts of the province of Nampula and six districts in Niassa. Castélio Muwasse is one of the 23 field officers who worked with Malaria Consortium to implement communication activities to change behaviours at the community level.

Empowering communities through village health clubs in Uganda

Posted on

Uganda’s highest disease burden is from child health conditions. In 2015, Malaria Consortium introduced the Integrated Community Case Management – Maternal and Child Survival (iCCM-MaCS) project, funded by Comic Relief, to reduce Uganda’s maternal and child health burden and to empower communities to take control of health issues within their communities.

As the project draws to a close this February, we take a look back at the success of the introduction of iCCM training for village health team members (VHTs) who, in turn, established village health clubs (VHCs) in the 14 districts where the project has been implemented.

The initial purpose of VHCs was to spread health messages and provide community-based primary healthcare, but in practice, they developed into groups that focus on resolving many community issues. When the project began, the VHCs looked to childhood illnesses, such as malaria, pneumonia and diarrhoea, as well as boosted uptake of antenatal care services. They have now evolved into an effectiveool that uses health as a gateway to broader empowerment, helping communities to realise their potential to contribute collectively to addressing and solving various day-to-day issues that arise.

Fred Rwaboona, Community Chairperson, from Kitenguleillage has seen the benefits of VHCs in his own community. He says:

“The village health club brings the community together as they have weekly meetings. This helps them do work as a team so that tasks that would have been done by one person in a week, can be done as a team and solved in a day.”

Village health teams have given village communities a platform to take charge of issues in their own communities. There are many examples of how village health team members have mobilised the community to work on different issues. Karugaba Agnes, nurse and VHT Coordinator in Nyankwanzi Subcounty, explains about how she has seen village health clubs help communities:

“Depending on the problems each village has, we teach them to handle the most urgent and biggest problem first as a community.

“I had Kyarugangma village, and when they had the meeting and went through their problems, they decided their main problem was water. Their water source was very far, so they organised themselves and reconstructed a water source and a road, which helped the community. They built a new water source nearby to reduce the distance that children and mothers had to travel to fetch water.

“Another problem was that we had an old lady who had many vulnerable children, orphans. She didn’t have a latrine, so the kids were always sick, sick, sick. So the community helped her to construct a very nice pit latrine.”

Ali Karim Bagyanyi, a VHT in Kitengule Village, explains his village health club’s plans to pool donations from community members, allowing them to develop a community emergency fund.

“We have a small amount of savings – a thousand shillings each per week – which we give to a community member who has a problem, to solve that problem. We are planning to have a fund for emergency money that we all contribute to, so if someone needs to be referred to a health facility, but they cannot afford transport, they can use that fund to pay for transport.

“In years back, we have not had the medicines we have needed, so we have seen it as a problem, so in the future if that happens and we have a case, we will use that VHC fund to pay for medicine.“

The introduction of village health clubs in the region by the project has eased the work of VHTs, giving them a platform to communicate essential community health messages, like net use, without needing to go to individual households. Village-owned clubs have provided a base for communities to continue enjoy the iCCM MaCS project gains and sustain them by themselves, even as the project has drawn to a close.

Watch our new film on the iCCM MaCS project below to learn more:

Mozambique: The behaviour changing power of radio

View in: English | Portuguese
Posted on

Story collected by Dorca Nhaca and edited by Fernando Bambo in November 2017

Ismael Janato is a presenter and technician at Ngauma community radio, Niassa Province, and Jonas Ali Mussa, director of the community radio on the Island of Mozambique. The Ngauma district, located in the midwest of Niassa Province, near the border with Malawi, has an estimated population of 86,000. The Island of Mozambique is part of Nampula Province with a population of about 53,000 inhabitants.

Despite the enormous distance separating Ismael and Jonas – over 700km – both have the same mission: to discuss the prevention of malaria on their community radio programmes.

Radio is recognised as the ‘African media’ for its broad accessibility and its ability to transcend cost barriers, geographical barriers and low levels of literacy, supporting listeners as they negotiate the challenges of everyday life. The Malaria Prevention and Control Project in Mozambique, implemented by Malaria Consortium in the provinces of Nampula and Niassa, has established partnerships with community radio networks to develop and transmit quality messages and programmes in local languages, promoting essential malaria prevention and treatment behaviours.

Ismael Janato from the Ngauma community radio talks about his experience with the activities:

“For the past three years, I have been managing the project activities. We received audio announcements on malaria, its transmission, signs and symptoms, the use of mosquito nets and the importance of seeking treatment. As a presenter, my job was to translate the spots into the local language, to broadcast the messages every 15 minutes, and to animate public debates live in the communities.”

Often malaria symptoms are not recognised, yet rapid and appropriate diagnosis and treatment of malaria are extremely important for reducing morbidity and mortality. Ensuring population access to essential information can substantially increase the effectiveness of existing interventions for malaria prevention.

Ismael explains that he gained knowledge about malaria through his participation in the training provided by Malaria Consortium, and thus developed the ability to discuss these issues properly. Besides broadcasting the spots, Ngauma’s community radio produces interactive programmes with the public through phone-in discussions on malaria issues and interviews with health technicians. Ismael continues, “With the work we do we have noticed changes in people’s behaviour regarding the use of mosquito nets, better hygiene at home, and there are more people who, when ill, go to the health centre and do not go to traditional practitioners anymore.”

Jonas Ali from the community radio of Mozambique Island also reports an improvement in the correct use of mosquito nets and reduction of malaria cases in the communities.

“With the work we have done, we have been able to see that there is a reduction in the use of mosquito nets for fishing and that fishing communities use the nets more responsibly. People are using the mosquito net correctly, malaria cases are also decreasing thanks to better knowledge of the consequences of malaria.”

Indeed, monitoring data and testimonies indicate an increase in knowledge about malaria and some behavioural changes in the project areas. These developments are likely to be the result of a number of complex factors and combined interventions of the Ministry of Health and its partners. The results of the Malaria Prevention and Control Project indicate that the significant expansion of intensive awareness raising, education and mobilisation activities combined with the mass distribution of long-lasting insecticidal nets may have contributed to this positive development.

Goncalves Bacar, Training Officer at Malaria Consortium Niassa, underlines that “the use of a combination of reliable sources of information – community structures, schools and radios – to disseminate harmonised messages at community level was certainly key.”

This story is part of a broader project documentation exercise; to read more and other lessons learnt, click here.

Leadership makes the difference in defeating malaria

View in: English | Portuguese
Posted on

Story collected by Dorca Nhaca and edited by Fernando Bambo in November 2017

Nacala-Porto, on the northern coast of Mozambique, is the deepest natural harbour on the east coast of Africa. It serves as a terminal for the rail link to landlocked Malawi. Many goods transit through this district on their way to Malawi and other parts of southern Africa. The town is also known for its beaches and diving; this may be the district’s best known feature. What is less well known is the strong leadership within the District Health Service where there is an exceptional team dedicated to defeating malaria and saving lives.

The Nacala-Porto District Health Services were among the pioneers in the implementation of the Malaria Prevention and Control Project in 2011.  Malaria Consortium’s role, as one of the implementing partners for the project, was to support 17 districts of Nampula Province until 2017.

The main objective of the project was to contribute to the reduction of malaria through a combination of interventions aimed at improving malaria knowledge among the population and promoting the adoption of good practices in relation to malaria prevention and treatment at community level.

Successful implementation of this project required strong coordination between the district government and Malaria Consortium, health facilities and communities, as well as with schools and community radios. The excellent leadership of the Nacala-Porto District Health Services represented best practice in managing the partnership, including integrating the Project Field Officer into the district team, in line with the collaboration and coordination approach sought by the project implementers.

Janete Chau is the District Health Director at Nacala Porto. She is as charming and friendly as she is professionally demanding and rigorous, and she has embraced the project and managed to develop an effective partnership approach. It is for these qualities that she was awarded the title of ‘best district director of the province’ by the Nampula Provincial Health Directorate in October 2017.

“The Malaria Consortium Field Officer was actually working under our responsibility. He had to share his work plans and get involved in all the activities, and we had regular review meetings to look at the malaria situation here in the district. …My main role was to monitor and control project activities, see what was being done at district level, know where the activities were being done and what impact the project was having. ”

Janete Chau, District Health Director in Nacala Porto, Mozambique

The District Health Services’ team and Malaria Consortium worked together to map out community structure such as community health committees and local organisations, select and train them, and implement communication interventions towards behaviour change at community level. According to Ms Chau, malaria prevention activities carried out by community volunteers have contributed to increasing knowledge about malaria, care seeking and reducing malaria deaths in the area.

“People have gained knowledge about malaria, they now know how to describe it. They realise that malaria comes from the mosquito and that they breed in stagnant water. They now know they should go to the health centre if they present any malaria signs and symptoms and this has helped us to reduce malaria deaths.”

These efforts to promote good malaria prevention and treatment practices at the population level have also been accompanied by improved diagnosis and treatment of malaria patients at the health facilities level, as Ms Chau explains. “As an institution, through this project we became more aware that malaria is a serious problem and that we must keep it under control. It must be discussed. Our clinicians are more aware that they should not simply attribute malaria based on symptoms, but that we need to test for confirmation of malaria.”

These efforts are already starting to pay off but need to be maintained to achieve long-term impact. Nacala Porto’s team remains committed and motivated: “Every health professional is psychologically prepared to continue doing everything the project was doing so that one day malaria will be out of Mozambique.”

This story is part of a broader project documentation exercise; to read more and other lessons learned, click here.

Children who learn about malaria contribute to disease control in their communities

View in: English | Portuguese
Posted on

Story collected by Dorca Nhaca and edited by Fernando Bambo in November 2017

Fátima Mário, 12 years old, Dinala Muhamudo Aid, 18 years old, Cristina Muanhar, 18 years old, and Carlitos Gabriel Tolembeta, 16 years old, are seventh grade pupils at Undi Primary School. The school is in Chimbonila District, Niassa Province, 30km from the province capital  Lichinga. At school, in addition to learning how to read, write and count, students benefit from educational activities on malaria prevention.

Fátima explains, “Everything we know, we learn at school with our teachers. During the lectures, we pay attention to the teacher’s explanation because in the end she asks us questions and we need to respond. We have learnt many good things. We learnt how to use and take good care of the mosquito net, not to wash the mosquito net in the river, not to accumulate water in the yard, and that when we get malaria we have to go to the hospital.”

In Africa, malaria accounts for up to 50 percent of all school-age deaths. Ensuring that children learn about malaria prevention practices will not only reduce malaria but also contribute to disease control in their communities.

Under the Malaria Prevention and Control Project, implemented in nine of the eleven provinces of Mozambique by a consortium of civil society organisations (2011-2017), one of the innovative interventions was to strengthen malaria education for students in the classroom. Undi Primary School is part of the schools reached by malaria prevention education activities implemented by Malaria Consortium under this project, in Niassa province.

At Undi Primary School, three teachers were trained on basic concepts of malaria, its transmission, signs and symptoms, prevention methods, and importance of early care seeking. In the classroom, teachers conduct interactive educational sessions using a flipchart that contains illustrations, questions and key messages about malaria prevention. Students are expected to share the knowledge they have gained with their families, friends and community.

“When we get home, we talk to our parents, they listen and follow the things we explain to them if they do not know already.” …Everyone likes to use the mosquito net now and last night everyone slept underneath because they know the net serves as protection against mosquito bites and malaria.”, says Carlitos

Helena Samuel, Undi Primary School natural sciences teacher acknowledges the project’s contribution to increasing knowledge about malaria, reducing school absenteeism and drop out.

“It was great to be a part of this project, because I learnt a lot, gained more knowledge about malaria and dispelled many myths that were in my mind. As a natural science teacher I transmit the concepts to the communities. …The project also brought advantages to the school and the students; now we have a low dropout rate because the students are healthier.”

Between 2011 and 2017, Malaria Consortium supported the provincial and district education directorates to train 1,682 teachers in 700 schools in the provinces of Niassa and Nampula reaching approximately 31,289 students on a quarterly basis with key messages on malaria, prevention methods and the importance of care seeking.

Project monitoring data show that school malaria education activities have contributed to increased knowledge of both teachers and students and better adherence to good malaria prevention practices in their homes and communities.

This story is part of a broader project documentation exercise; to read more and other lessons learned, click here.

Saving lives and transforming communities in rural Nigeria

View in: English | French
Posted on

Originally published on Medium

Lessons from the field

In the village of Njediko in Nigeria, Kadigiti Mohammad gently calms her young son, who has a high fever. Her son is being seen by the village community health worker, who confirms it is malaria. He is given medicine before mother and child are sent back home.

I met Kadigiti on a recent visit to Njediko where Malaria Consortium is supporting the Rapid Access Expansion (RAcE) programme in Nigeria. She was worried for her child, but assured that he would recover because he was able to get medication quickly.

It was during this visit when I saw what receiving immediate access to care meant for mothers like Kadigiti and how this transformed the communities they live in.

Reaching the most remote populations

The RAcE programme was launched in Nigeria in 2013, pioneering the implementation of integrated community case management (iCCM) in the country. iCCM is now being scaled-up to increase healthcare access through trained community health workers who can treat pneumonia, diarrhoea, malaria and malnutrition among children at community level.

In Niger State, Malaria Consortium is implementing iCCM in underserved communities in six local government areas. The two communities that I visited, Njediko and Etsu Gudu, were among some of the hardest-to-reach.

The walk downhill to the village of Etsu Gudu (left) / A river blocks the road to a remote community in the local government area of Rafi (right)

 

The journey into these communities involved a two hour drive from the capital of Niger State. The roads were mostly rough and occasionally blocked by small rivers. Another hour travelling along narrow dirt roads led into the communities. Come nightfall, the roads were pitch black.

I thought of Kadigiti having to carry her sick child in these conditions. It was clear that urgent action was needed to reach out to populations who cannot easily access a health centre.

Bringing healthcare closer to the home

Typically, in many remote communities in rural Nigeria, access to healthcare is made difficult as there are no nearby health centres.

Mothers would carry their sick child, often on foot, to the closest health centre which can be miles away and can sometimes take days. During the rainy months, the roads and footpaths can become impassable. Sometimes, upon reaching the health centre, medicines may not be readily available.

One mother who lost a child from malaria said, “if we had immediate access to care and medicine then, my child could have had a chance to survive”.

Such was the challenge mothers faced in Njediko and Etsu Gudu until iCCM was introduced. Today, mothers like Kadigiti no longer need to travel far. Instead, they can immediately take their sick child to a community health worker.

This means that unnecessary deaths are prevented, as children can be treated for pneumonia, diarrhoea and malaria right in their village.

Empowering communities

Community health workers are trained, supervised and equipped to provide free and timely treatment of malaria, pneumonia and diarrhoea. And because they are selected by their own community and live in the community they serve, they have become a valuable resource in remote and rural villages that otherwise have no means of accessing healthcare.

The community health workers I met were hardworking, proud of what they do, and deeply committed to the health of their people.

In Ndejiku and Etsu Gudu, village leaders and parents talked about how their community health workers helped improve the health of their children and how they no longer face the burden of the cost of healthcare and making the long journey to a hospital.

Across the community, this appreciation is shown in extraordinary ways.

“When I am treating children all day, the people bring me firewood and help me with the farming,” says Miriam, community health worker in Etsu Gudu.

“The community raised money collectively to build me a house, so I can continue doing my work,” says Muhammed, the community health worker in Njediko.

Miriam Mohammed, community health worker in Etsu Gudu prepares to test a young child for pneunonia using a respiratory rate timer (left) / Community health worker Mohammed Jiya stands in front of the house his community built for him in Njediko (right)

An effective and sustainable solution

In Niger state, results from the RAcE programme show that iCCM is an effective and sustainable approach to decreasing childhood mortality.* At community-level, one way for iCCM to become sustainable is community support for community health workers.

In Njediko and Etsu Gudu, I saw evidence of all these. I saw progress in reduced child deaths, as a result of access to life-saving health services in rural and remote areas.

But I also saw people owning their own health, community leaders advocating for the health of their people, and communities coming together to sustain the health services they now have.

The community of Njediko, where child deaths have significantly reduced since the introduction of iCCM

Portia Reyes is Publications Manager at Malaria Consortium. She recently visited communities in Niger state as part of a project to document the impact of iCCM. Malaria Consortium is working with the Ministry of Health and partners in Niger state to implement iCCM through the RAcE programme.

View our latest film, Saving lives and transforming communities, to learn more about our work on iCCM in Nigeria

The Rapid Access Expansion (RAcE) programme is funded by the Government of Canada through the World Health Organization to support the scale-up of iCCM in five malaria-endemic countries in sub-Saharan Africa.

More from Malaria Consortium

Malaria Consortium in Nigeria: reflections from a new Trustee

Malaria’s Consortium’s approach to community delivery

Malaria Consortium’s RaCE project: Implementing iCCM in Nigeria

Expert Q&A: Innovations and challenges in malaria surveillance

View in: English | French
Posted on

Monitoring, evaluation and surveillance techniques are central to Malaria Consortium’s work to improve overall performance and maximise the delivery of disease control interventions. Malaria Consortium consistently engages in monitoring and evaluation activities, using the results to guide the design of malaria surveillance systems and implementation of malaria control programmes.

In June 2017, the School of Public Health at the University of Ghana, in collaboration with MEASURE Evaluation, hosted the 7th Annual Workshop on Monitoring and Evaluation of Malaria Control Programmes (http://bit.ly/2s0gIWj). The aim of the workshop was to provide professionals with the skills in fundamental concepts, surveillance, and practical approaches to monitoring and evaluation of malaria programmes in sub-Saharan Africa.

The event was co-facilitated by Malaria Consortium’s Head of Monitoring and Evaluation, Dr Arantxa Roca-Feltrer. In this Q&A, Arantxa discusses the importance of surveillance activities, innovations in surveillance processes and the challenges encountered by surveillance practitioners in the control and elimination of malaria.

What is malaria surveillance?

Malaria surveillance is the systematic and regular collection of information on the occurrence, distribution and trends of malaria with sufficient accuracy and completeness to inform decision-making. The latest World Health Organization (WHO) Global Technical Strategy (GTS) identifies malaria surveillance as an intervention that encompasses the tracking of diseases (including malaria), programmatic responses, and taking action based upon the received data.

Is surveillance done differently in Asia and Africa?

Malaria surveillance is not intended to be implemented differently in Asia or Africa. The difference in the surveillance process depends on where the country lies in relation to the elimination spectrum. In countries with a high malaria burden aiming to control the disease, surveillance is focused on collecting aggregated data for use in planning, implementation and evaluation of public health practices. Surveillance in malaria eliminating countries, on the other hand, is focused on gathering individual level data, where programmes implement activities related to the identification, investigation and elimination of continuing transmission, the prevention and cure of infections, and the final proof of claimed elimination.

Why should we monitor and evaluate surveillance systems?

Monitoring and evaluating a country’s existing surveillance system is important for several reasons. Firstly, there is a need to ensure that the surveillance system follows national malaria control or elimination priorities. Secondly, we need to document the effectiveness of the surveillance system as well as its linkages with existing health information systems such as the national health management information system. Finally, monitoring and evaluation allows government teams to introduce new surveillance methods or techniques that might strengthen the system once proven evidence has been gathered through small scale pilot evaluations, such as reactive case detection or cross border surveillance techniques.

How can we monitor and evaluate what makes a good surveillance system?

The World Health Organization considers several quality criteria:

  • Simplicity
  • Adaptability and flexibility
  • Acceptability
  • Performance (sensitivity, specificity, predictive positive value, predictive negative value)
  • Representativeness
  • Ability to respond and identify actions

One example of a good surveillance system can be seen in Southeast Asia, where Malaria Consortium has been supporting strategies for rapid malaria elimination through cross-border surveillance in areas with high levels of artemisinin resistance. In Uganda and Ethiopia, we have been monitoring the changes in the epidemiology of malaria and the effectiveness of interventions through our Beyond Garki project.

What were the key lessons learnt from the MEASURE workshop on malaria surveillance?

The workshop highlighted that malaria surveillance activities should be adequately budgeted and resourced to enable the effective implementation of case notification and investigation activities. Also, the use, interpretation and feedback of data are key for a successful malaria surveillance system, and this requires proper training and a cultural move towards ‘using data for action’.

Are there any novel or innovative approaches to surveillance?

The WHO GTS Framework for Malaria Elimination emphasises the importance of research and innovation for malaria elimination. This document states that ‘investment in basic science and product development must be sustained to create new tools and strategies for malaria elimination and its eventual global eradication’. It goes on to say that the ‘operational feasibility, safety and cost-effectiveness of new tools and strategies should be evaluated by context-adapted operational research as a basis for reliable policy recommendations by national policy-makers and WHO’.

The operational research agenda within the WHO GTS Framework, which covers a range of topics, is currently exploring the use of digital strategies to improve the rapid reporting of malaria cases. It also looks at other participatory surveillance approaches that include and deliver interventions to groups at the greatest risk. With over seven years of experience in mobile health (mHealth) and health systems strengthening, Malaria Consortium believes that effective digital health strategies can help governments manage malaria and disease control programmes better. In the countries we work in, we have explored how digital strategies can play an important role, particularly to improve the motivation and supervision of community health workers, to provide effective diagnostic tools, and to strengthen surveillance and data management.

Given that the new WHO elimination strategy incorporates malaria surveillance, how can we prioritise surveillance and what challenges might we face?

Strengthening surveillance is crucial for implementing country-wide malaria elimination activities. Malaria surveillance systems require new functionalities which facilitate/incorporate surveillance, such as data visualisation, and new data quality features for the effective implementation of surveillance activities, such as timeliness and comprehensiveness. Other priority areas include product development of medicines, diagnostics, vector control methods and vaccines.

However, countries also face specific challenges that are unique to their context. These require careful attention – particularly at the community level – in order to ensure feasibility, user acceptability at various health levels, sustainability and long-term system flexibility. Therefore, it is important to stress that a ‘one-size-fits-all’ approach does not apply to malaria surveillance and information systems, and that contextual factors must be taken into consideration when strengthening malaria surveillance activities.

 

Links to the projects as stated above:

  1. UpSCALE: http://www.malariaconsortium.org/inscale/pages/about-upscale
  2. inSCALE: http://www.malariaconsortium.org/inscale/pages/inscale-project
  3. IMMERSE: http://www.malariaconsortium.org/pages/immerse_project.htm
  4. Trans-border malaria: Mapping high-risk populations and targeting hotspots with novel intervention packages, Cambodia and Thailand: www.malariaconsortium.org/resources/publications/743/
  5. Targeting malaria infection and artemisinin resistance in formal/ informal border points, Cambodia-Laos border: www.malariaconsortium.org/resources/publications/620/
  6. Innovative Malaria M&E Research and Surveillance towards Elimination (MESA), Cambodia, Myanmar, Thailand: www.malariaconsortium.org/resources/publications/262/
  7. Moving towards malaria elimination: developing innovative tools for malaria surveillance, Cambodia: www.malariaconsortium.org/resources/publications/257/
  8. Transitional, Enhanced, Accessible Malaria Surveillance (TEAMS), Myanmar: www.malariaconsortium.org/resources/publications/975/
  9. Pioneer project 2009-2014: A holistic systems strengthening approach towards malaria control in mid-western Uganda: www.malariaconsortium.org/resources/publications/408/
  10. Beyond Garki: http://www.malariaconsortium.org/beyondgarki/

 

Related Links (journals and learning papers):

The time to invest is now: fighting malaria in the Sahel

View in: English | French
Posted on

Children in sub-Saharan Africa are 14 times more likely to die before the age of five than those living elsewhere in the world. Preventable and treatable diseases, such as malaria, claim hundreds of thousands of lives each year.

Since 2014, leading players in malaria prevention have come together to deliver seasonal malaria chemoprevention (SMC) to children under five in the Sahel. SMC – a World Health Organization recommended intervention – is an antimalarial medicine given to children each month for up to four months of the rainy season, when 60 percent of malaria cases occur. It provides a high degree of protection, with about 90 percent efficacy and has the potential to reduce cases of malaria by 75 percent.

After concentrated efforts from the UNITAID funded ACCESS-SMC project, led by Malaria Consortium in partnership with Catholic Relief Services, and other organisations’ SMC programmes, roughly 12 million children received SMC in 2016. Over 6.4 million of those children were reached through ACCESS-SMC across seven countries[1].

Many children will still miss out on receiving SMC in 2017 though, due to lack of funding and production capacity for quality assured medicines used in SMC (SP+AQ). Nine million children in Nigeria alone, will remain unprotected this rainy season.

With areas in the Sahel having the highest incidence of malaria in the world, it is time to look towards reaching all 25 million eligible children. For less than $5, one child is protected with SMC each year. To support our continued efforts as a GiveWell Top Charity protecting all 25 million children in the Sahel from malaria visit http://www.givewell.org/charities/malaria-consortium.

 

[1] Burkina Faso, Chad, Guinea, Mali, Niger, Nigeria, The Gambia