The RBM Partnership supports countries to implement their national malaria control plan by establishing sub-regional networks (SRNs) in which malaria strategic planning, implementation review, bottleneck resolution and joint monitoring of progress can be undertaken to ensure the continued scale-up of malaria control interventions.
10 High Burden Countries
Together, WHO, ALMA, IFRC, the RBM Secretariat and the office of the UN Special Envoy on Malaria have established a situation room to track challenges and bottlenecks and provide additional support to accelerate scale up in the following 10 hardest hit countries: Burkina Faso, Cameroon, Côte d'Ivoire, DR Congo, Ghana, Mozambique, Niger, Nigeria, Tanzania and Uganda
These fora provide a neutral platform for all interested stakeholders to align their inputs with GMAP to facilitate coordination of malaria control activities in the sub-region. They also create a supportive network among groups of countries to share experience in addressing operational challenges and enable the exchange of best practices between national malaria control programmes (NMCPs).
DEVELOPMENT AND TRACKING OF COUNTRY ROAD MAPS
Country road maps help countries to plan and record country progress in reaching milestones. The road maps contain key data on commodity needs and gaps, including the delivery of long-lasting insecticide-treated nets (LLINs), treatment and RDTs. As at end 2012,
44 out of 47 (94%) malaria-endemic countries in Africa maintained a country road map.
The graph in Figure 1 reflects the commodities that countries have programmed and that could be delivered within existing country capacities. At the beginning of 2012, considerable gaps were observed between planned and available or funded quantities existed for artemisinin-based combination therapy (ACTs), RDTs and indoor residual spraying (IRS), whereas for LLINs available quantities corresponded more closely with requirements.
MALARIA PROGRAMME REVIEWS
The malaria programme performance review (MPR) is a periodic joint programme management process for reviewing progress and performance of country programs within the national health and development agenda.
Its aim is to improve performance and re define the strategic direction and focus of the malaria control programme.
MPRs also provide a critical basis for coordination among partners and for application of the ‘Three Ones’ principle: one result oriented strategic and operational plan; one national coordinating mechanism for implementation support; one monitoring and evaluation system.
The in-depth review of the entire malaria programme, including the organization and strategies for the delivery of commodities, relies on the data and information collected from field visits and other sources and leads to a re-orientation of country plans to sustain malaria control or to steer towards elimination. In 2012, 60% (27) of all African malaria endemic countries conducted MPRs, including DR Congo, Ethiopia, Nigeria and Sudan, with support provided by RBM partners and sub-regional networks (SRN). Increasingly, this practice has been adopted by non-African countries including Nepal, Indonesia, Bhutan, India and Thailand.
Guidance for MPRs is provided by WHO’s Global Malaria Programme (GMP). In 2012, a strong consensus emerged on the need for the process to be made less time consuming and less resource-intensive for countries. A revised edition of the MPR guidance will be released in the first half of 2013.
JOINT PARTNER MISSIONS TO IDENTIFY BOTTLENECKS
Joint partner missions to 23 African countries were organized by SRNs in 2012. The missions were undertaken to identify specific country support needs and to help strengthen the capacity of national partnerships to implement country plans and overcome operational bottlenecks related to procurement, supply chain and programme management.
CAMPAIGN MICRO-PLANNING TO SCALE UP
THE PROVISION OF LONG LASTING NETS
The Alliance for Malaria Prevention (AMP), working closely with the Harmonization Working Group and SRNs, supported the planning of mass distribution campaigns of long-lasting insecticide-treated nets (LLINs) in Angola, Cameroon, Chad, Guatemala, Malawi, Nigeria, Swaziland, Togo and Uganda, leading to the delivery of some 33 million LLINs for an expected coverage of over 60 million people.
STANDARDIZING RAPID DIAGNOSTIC TESTS
– IMPROVING ACCESS
The Procurement and Supply Chain Management (PSM) Working Group created a consortium to look at the standardization of rapid
diagnostic tests (RDTs), both to avoid the need to retrain health workers every time a new RDT is introduced and to reduce prices by improving market competition. A group led by the Antwerp Institute of Tropical medicine is reviewing all characteristics of RDTs to identify commonalities and explore, with implementers and manufacturers, whether a blueprint RDT can be developed.
COUNTRY-LEVEL COMMUNICATIONS – OVERCOMING BARRIERS TO COMMODITY USE
Few national malaria control programmes have evidence-based strategic communication plans with a set of indicators that can measure increased use of malaria commodities and improved health-seeking behaviour. In 2012, 14 endemic countries, together with USAID-PMI, IFRC, C-CHANGE, CDC, MNM, JHUCCP and UNICEF, finalized a Strategic Framework for Malaria communication which promotes investment in this area and describes best practices.
English and French versions of the framework were promoted and disseminated in the Eastern and Southern Africa sub-regions in September and November, respectively.
BOOSTING ACCESS TO ACTS IN THE PRIVATE SECTOR
The Affordable Medicines Facility for Malaria (AMFm)
was designed to improve access to artemisinin-based combination therapies (ACTs), the most effective anti-malaria treatment currently available. An independent evaluation conducted in 2011–12 showed that this approach increased availability and drove down the
price of ACTs for the end user.
The Global Fund Board extended its mandate to host
the AMFm until 31 December 2013 to ensure that access to quality-assured ACTs is not disrupted.
MONITORING AND EVALUATION
New WHO Surveillance Guidelines were launched by the Director General in Namibia in April 2012. In addition, the RBM Monitoring and Evaluation Reference Group (MERG) updated the Core Population-Based Indicators and Malaria Indicator Survey documentation. The substantial revisions made to these documents are designed to ensure a homogeneous approach to coverage and impact evaluation across countries, as well as surveys carried out at various time intervals. The revision also integrates the most recent sets of indicators that have been used for updated programme management. These changes will ensure a uniform approach to the evaluation of malaria control interventions and will be crucial in determining the impact of programme activities over a specified period of time.
MERG members also developed and adopted a common strategy which promotes the ONE monitoring plan – to be implemented in all malaria-endemic countries – which was shared with NMCP managers and M&E officers from various endemic countries; between now and 2015, more than 15 countries are expected to undertake formal malaria control impact evaluations.
NEW MALARIA CONTROL STRATEGIES
With the changing epidemiology of malaria, a progressive paradigm shift is taking shape from a ‘one size fits all’ approach to the formulation and targeting of malaria control strategies aimed at specific populations and/or locations for maximum effectiveness. Following research
by a task force, WHO recommended the introduction of Seasonal Malaria Chemoprevention (SMC) across the Sahel sub-region, where most of the malaria mortality and morbidity occurs during the short rainy seasons.
Providing malaria chemoprevention throughout these periods of greatest risk has been shown to be effective, cost-efficient, safe and feasible for the prevention of malaria among children aged under five.
On the occasion of World Malaria Day 2012, the WHO Director General Dr Margaret Chan launched the T3: Test, Treat, Track initiative in Namibia. T3 seeks to ensure that every suspected malaria case is tested, that every confirmed case is treated with a quality-assured antimalarial medicine, and that the disease is tracked through timely and accurate surveillance systems to guide policy and operational decisions. The initiative focuses the attention of policymakers in malaria-endemic country and donors on the importance of adopting the latest evidence-based WHO recommendations on diagnostic testing, treatment and surveillance, updating existing malaria control and elimination strategies and country-specific operational plans.