Promoting integrated community case management (iCCM)
Five pilot countries (DR Congo, Malawi, Mozambique, Niger & Nigeria) are benefitting for a second year from a major project aimed at building capacity for the integrated community case management of malaria9 to support the Rapid Access Expansion (RaCE 2015) programme. Funded by CIDA-Canada and implemented by the WHO, RaCE delivers training to community health workers, procures supplies and commodities and supports operational research and the use of monitoring and evaluation tools.
A number of countries from the Southern Africa Roll Back Malaria Network (Zambia, Zimbabwe, Malawi, Zanzibar, Mozambique and Madagascar) have developed community health worker projects with help from RBM partners. Zanzibar and Malawi have joined the “1 million CHW initiative”, which uses mobile phones and broadband access to improve access to medical resources and health care to the rural poor.
Seasonal Malaria Chemoprevention
The RBM Partnership seeks to promote the adoption and scale up of new tools in areas where their use has the potential to save more lives. Seasonal Malaria Chemoprevention (SMC) 10 is a highly effective tool for saving the lives of children aged 3 to 59 months during the short transmission season of malaria in the Sahel region.
In August, WHO published technical and operational information and tools for country-level policy-makers and programme managers to guide the implementation of SMC. Based on plans developed by nine eligible countries in the West Africa Roll Back Malaria Network, 19 million children would potentially benefit from SMC during three malaria seasons (2013 – 2015). The Central Africa Roll Back Malaria Network and numerous RBM partners, including WHO, LSHTM, CHAI, MSF, Malaria Consortium, UCAD, MMV, Speak Up Africa and UNITAID are actively involved in this process.
Tools for preventing the spread of artemisinin resistance
In April, RBM Special Representative Princess Astrid and RBM Partners launched WHO’s Regional Framework for an Emergency response to artemisinin resistance in the Greater Mekong Sub-Region. The Global Fund, AusAID, USAID and the Gates Foundation have begun providing financial support for its implementation, while ASEAN, APLMA and APMEN have committed to continuous political support.
Managing malaria in pregnancy and lobbying for broader integration
The critical importance of continuing intermittent preventive treatment in pregnancy, as well as bednet use among pregnant women was highlighted in "Optimising the Delivery of Malaria in Pregnancy Interventions". This consensus statement builds on the January 2013 paper “Malaria Protection in Pregnancy” and advocates for including malaria in pregnancy in the broader planning and resource mobilization for reproductive, maternal, newborn and child health.
Larval source management
WHO, together with other RBM partners, released a new operational manual on larval source management (LSM) during an RBM Ministerial session on malaria at the Abuja African Union Summit in July. The manual describes how and when to use this tool in combination with other vector control methods, including treated mosquito nets and indoor residual spraying.
Strengthening surveillance for malaria programme management
At the RBM May Board meeting, over 40 Ministers of Health and senior government officials signed a Declaration highlighting the need for strong malaria surveillance systems to prevent and respond to disease outbreaks, as well as to direct resources and interventions to where they are most needed. Throughout the year the RBM Partnership continued coordinating surveillance activities through its local networks and the Monitoring and Evaluation Working Group (MERG). MIS, MICS and DHS surveys are carried out every 2 – 3 years. WHO and other RBM Partners continued providing technical support on surveillance, with PATH/MACEPA testing innovative surveillance approaches in the field by supplying simplified malaria information through mobile phones to national programs.
Maintaining coverage with Long Lasting Insecticide Nets
The US President’s Malaria Initiative (PMI) has been monitoring the durability of long lasting insecticide nets (LLINs) in nine African countries while WHO-GMP is testing the fiber strength of all recommended LLINs. A joint consultation by WHO-GMP and WHOPES revealed that LLIN manufacturers have the technology to produce a more robust product but do not always have the incentive to do so because the current bidding process is based on unit cost and not on the number of years of protection an LLIN can offer. Discussions on how to best address this issue are ongoing.
In November, the Global Fund launched a tender for 90 million LLINs in anticipation of the orders to be placed by countries over the following 18 months. This initiative is expected to bring stability in the market and leverage price reduction.
Increasing availability of ACTs
Key lessons learned from Phase 1 of implementing the Affordable Medicines Facility for malaria were shared broadly this year. Piloted nation-wide in seven African countries with funding from UNITAID, DFID, B&M Gates Foundation and CIDA, the AMFm decreased prices and dramatically increased the availability of ACTs, including through private outlets in remote areas. The AMFm Project confirms that subsidised programmes in the private sector can improve access to quality antimalarials.
Malaria Programme Reviews
A total of 12 Malaria Programme Reviews11 (MPRs) and 12 Strategic Plans12 were completed in 2013 with the help of RBM subregional networks. The vast majority of countries in Africa completed their first MPR and updated their Strategic Plan13 and The Asia-Pacific Malaria Elimination Network (APMEN) also updated six national strategic plans for malaria control and elimination.14
Ensuring access to quality-assured products
Countries strengthened measures for quality assurance of malaria health products and were able to mitigate the risk of the delivery of substandard or counterfeit products to end users with support from WHO and RBM partners. However improving in-country quality monitoring and reporting remains a challenge.
Pre-shipment quality control testing of insecticides for IRS and LLINs revealed a lack of compliance with WHOPES-approved standards which increases the risk of insecticide resistance. RBM Procurement and Supply Chain Management Working Group is working with manufacturers to clarify WHOPES recommendations and ensure the production of quality products. These challenges highlight the need for additional quality control laboratories able to test pesticides and the need to diversify manufacturers to provide countries with choices, avoid shortages and decrease cost.
Based on plans developed by nine eligible countries in the West Africa Roll Back Malaria Network, 19 million children would potentially benefit from Seasonal Malaria Chemoprevention (SMC)
9. Integrated community case management (iCCM) of childhood illnesses is a strategic approach that uses Community Health Workers (CHWs) to decrease treatment gaps for malaria, diarrhoea and pneumonia in children under-five, while addressing issues like malnutrition and maternal health.
10. This year this tool has only been used on small scale in Chad, Mali, Niger, Nigeria and Senegal as funding constraints and limited supply of pre-qualified medicines have hampered large scale deployment.
11. Burundi, Cameroon, Cape Verde, Congo, Gambia, Ghana, Eritrea, Liberia, Sierra Leone, Somalia, South Sudan and Sudan.
12. Botswana, Cameroon, Central African Republic, Djibouti, DR Congo, Ghana, Nigeria, Somalia, Tanzania, Togo, Zanzibar and Zimbabwe.
13. In the future, countries will need to plan and budget for conducting MPRs every 5 years (in line with the start and end dates of their strategic plans) and Mid-term Reviews every 2.5 – 3 years to review their strategic plans at the half-way mark – (this will also be a Global Fund requirement). Many countries have strategic plans that expire in 2015. This will require countries to undertake MPRs in 2014/2015 providing data to revise the next generation strategic plans that will start in 2015/2016.
14. China, DR Korea, Indonesia, Nepal, Philippines and Sri Lanka.