|Mozambique is among the ten countries with the highest burden of malaria worldwide and Malaria Consortium is committed to reducing the burden of this and other communicable diseases in the country, especially those affecting children under five. We work closely with the Ministry of Health (MoH), the National Malaria Control Programme (NMCP), the National Community Health Workers Programme, provincial and district health authorities and affected communities. We provide technical assistance to our partners to strengthen existing health systems by: improving the integrated community case management (iCCM) of common illnesses, such as malaria, diarrhoea and pneumonia; deploying functional surveillance mechanisms; developing and scaling innovative community-focused platforms to facilitate data informed decision-making; addressing knowledge gaps through operational research; and through social and behaviour change approaches.
Data-informed strategies are key to achieving the World Health Organization (WHO) target of reducing global malaria cases and deaths by 90 percent by 2030. Following the development of Mozambique’s landmark National Malaria Surveillance Roadmap in 2017, we supported a comprehensive assessment of the country’s Malaria Information System (MIS) and are now working with the Bill & Melinda Gates Foundation to set up a high-resolution surveillance system that can drive decision-making across all transmission strata through strengthening of routine data quality, data use and data to action packages.
This innovative, digitised platform harmonises all sources of malaria data into a centralised repository and we have developed the platform integrations and configurations, including defining reporting mechanisms, forms and thematic dashboards that visualise risk stratification. In 2020, we supported the training of master trainers on the use of the platform, who then provided training to district-level malaria focal points and provincial technicians and health workers from health facilities.
We believe that digital technology provides new opportunities to address health system challenges in low- and middle-income countries. Context-adapted digital health solutions can connect patients and health workers, improve the quality of services and bolster health information reporting in remote areas. In 2009, we collaborated with the MoH and UNICEF to transform our successful pilot project, the inSCALE mobile phone application, into a complete digital platform. Since then, we have developed the upSCALE platform, which builds on inSCALE’s aim to overcome limited access to primary healthcare for rural populations and poor linkages between community health workers (CHWs) and the national health information system by improving the quality and coverage of integrated community case management (iCCM) through assisting CHWs with diagnosis, treatment and referral. Data entered through the app is captured in the District Health Information System at district, provincial and national level and the ability to analyse local disease-specific trends in near real-time improves resource allocation. Mozambique’s Ministry of Health began a country-wide rollout of the app in 2019 – the first of its kind on this scale.
In 2020, Malaria Consortium supported Mozambique's Ministry of Health in making adaptations to the existing upSCALE digital health platform, which allowed for the rapid gathering of essential insight into community health workers' knowledge gaps and misconceptions around COVID-19. The results helped shape and target relevant messages that have been vital in helping community health workers (CHWs) to respond more effectively to COVID-19 pandemic.
We work with communities and health authorities to support the development and implementation of locally adjusted social behaviour change (SBC) approaches and community outreach activities to strengthen community ownership of health issues and improve understanding and awareness of diseases and disease prevention. In Mozambique, through the Malaria Prevention and Control Project, we encouraged uptake of effective malaria prevention and treatment practices at the community level, through SBCC distributed via community radio and primary school teachers, as well as trained community structures.
We have also employed a community dialogue approach as part of the upSCALE project, enhancing rural communities’ understanding of digital health services. Trained volunteers led participatory community meetings that provided a platform to discuss locals’ concerns and draw up collective solutions. During the sessions, the volunteers were able to address misconceptions surrounding upSCALE and demonstrate the platform’s benefits. This was key to increasing community members’ acceptance of CHWs’ using the tool during consultations. By framing the devices as communal property, the volunteers further promoted community ownership.
Malaria Consortium specialises in conducting operational research to identify best practices and health system innovations. We share our results and findings at national and international levels to inform policy. Having reached over 12 million children in Burkina Faso, Chad, Nigeria and Togo in 2020 through our seasonal malaria chemoprevention (SMC) programme, we are now assessing the feasibility, acceptability and impact of implementing SMC in Mozambique in partnership with the NMCP and CISM.
We adapted our implementation model to the local context, evaluating the intervention through key informant interviews, focus group discussions, health facility data analysis, a non-randomised controlled trial and a bio-marker study. Our findings will be used to inform SMC policy and practice in Mozambique.