Protecting Those Most at Risk of Malaria: Child Health and the COVID-19 Response

Posted August 31, 2020
Impact Area COVID-19, Malaria

The piece below originally appeared on PMI Impact Malaria‘s blog.

Every two minutes, a child dies of malaria. In 2018, of the estimated 405,000 malaria deaths worldwide, more than 67% were children under the age of five. Fortunately, there are proven methods to prevent malaria among this group, and the last decade has seen considerable progress in reducing the incidence of malaria. However, health service disruptions and drug shortages due to COVID-19 threaten to undermine recent gains.

One method for reducing childhood malaria is seasonal malaria chemoprevention (SMC), a campaign-style public health intervention that involves administering doses of antimalarial medicine to children at monthly intervals during the malaria transmission season. PMI Impact Malaria (IM) supports SMC campaigns in Cameroon, Mali, and Niger and provides technical assistance to Ghana’s campaign.

Training, supervising, and paying thousands of health workers to administer antimalarials to millions of children is no small feat, especially in the context of COVID-19. Through a series of creative country-driven adaptations, PMI Impact Malaria is continuing the delivery of SMC campaigns while also minimizing COVID-19 exposure among beneficiaries and health workers.

Door-to-Door Distribution Only

Last year, Mali and Niger distributed antimalarials to children through a combination of fixed site and door-to-door distribution for each cycle of their SMC campaigns. This year, both countries implemented 100% door-to-door distribution to avoid large crowds from gathering around a fixed site.

*Crowd gathers at a fixed site SMC distribution in Konodimini, Segou Region, Mali during the second cycle of Mali’s SMC campaign in August 2019. Photo credit: Kathryn Malhotra, PMI Impact Malaria*

Remote Microplanning

Niger conducted remote SMC microplanning. Central level health officials provided provisional health authorities with templates pre-filled with 2019 data and updates to certain parameters. The districts then held meetings with the health center directors in groups of no more than five to complete and correct the template. A team of national-level supervisors provided remote technical assistance throughout the whole process.

Safe Supervision

SMC supervisors travel in a car that is washed and disinfected before and during the supervision period. Each car is equipped with a handwashing or gel kit and no more than three people are allowed in each car, including the driver. Supervisors wear obligatory face masks inside and outside the car.

COVID-Secure Trainings

In Cameroon, health workers received SMC training in limited group sizes while wearing face masks and maintaining proper social distance. Classrooms were disinfected and equipped with a handwashing station and the windows were opened for increased ventilation. Trainers briefed participants on barrier measures and incorporated a COVID-19 module into their curriculum.

Clear and Concise Communications

During the SMC campaigns this year, caregivers administer the first treatment dose of antimalarial medicine to the child, rather than community health workers (CHWs) doing so. Mali created a communications aid demonstrating how the CHW should wear a face mask and stand back at a safe distance while supervising the caregiver administering the first dose using the household’s own utensils. After visiting a compound, the CHW washes their hands before visiting the next compound.

In an ideal world, communications under COVID-19 would mean increasing mass media and decreasing face-to-face communications as much as possible. However, some of these zones have very low mass media/radio coverage and so village criers remain an important communications tool and are able to maintain a safe distance with their megaphones.

*Mali’s SMC guidance demonstrating COVID-19 measures.*

Results from the first cycle of the 2020 campaigns show that the vast majority of families are continuing to accept SMC during the COVID-19 pandemic.

For more information, view the presentation of the July 16, 2020 webinar hosted by the Child Health Task Force on delivering SMC in the context of COVID-19.

For more examples of PMI Impact Malaria’s country-driven COVID-19 adaptations, read this recent blog post: Advancing Global Malaria Service Delivery in the Face of COVID-19

Written by Katherine Kemp, PMI Impact Malaria Communications Coordinator. Contributions from Charlotte Eddis, PMI Impact Malaria Senior Technical Advisor, and Anne Bulchis, PMI Impact Malaria Communications Manager.

Source: World Health Organization—World Malaria Report 2019

Header photo caption: Community health worker Boubacar Traore explains SMC doses to Mariam Diakite, mother of 8-month old twins Awa and Adama, in Niono, Mali during the first cycle of Mali’s 2020 SMC campaign. Photo Credit: PMI Impact Malaria

PMI Impact Malaria is led by  Population Services International (PSI)  in partnership with  Jhpiego,  Medical Care Development International (MCDI), and  UCSF.

Sign up to
Receive Updates

Donate to
Support Our Work

PSI staff instructed health workers at private clinics/ pharmacies in Thai Nguyen to use the real-time reporting system, as part of PSI/VN’s private engagement in public health emergency response project.

To Strengthen Health Security, We Must Engage the Private Sector

Health security and pandemic preparedness efforts are usually led by the public sector, and often fail...

The “How” of Person-Centered Care in Family Planning: New Tools for Private Provider Service Delivery

Putting people at the center of health care, focusing on their perspectives and preferences, has long...

1 Million Self-Inject Visits Later – 3 Takeaways from Supporting Woman-Powered Care

Learn how PSI's DISC project supports woman-powered care through user education, empathy-based provider...

Bamboo Strong: The Low-Cost Solution Transforming Sanitation in Liberia

In Liberia, bamboo is being introduced as a low-cost alternative to steel in toilet construction. Ex...

Why Is Progress on Sanitation So Slow, and What Can We Do About It?

Sanitation is one of the most pressing global development challenges, yet progress in achieving universal...

Community Pharmacies to Power Vaccine Access in Africa

Vaccines are a low-cost, high-impact intervention to save lives, but only if people can access them.

World Contraception Day – Building Provider Capacity for Person-Centered Contraceptive Care

This World Contraception Day, we're highlighting the incredible providers driving person-centered care...

Bulsho Kaab nurse, a member of PSI’s social franchise network, checks an infant patient in her pharmacy in Hargeisa, Somaliland.

How holistic care makes health systems stronger

In Somalia, the Marwo Caafimaad Program has emerged as a promising initiative, transforming community...

PSI Partners with Somaliland Ministry of Health Development for First-Ever Digital Health Strategy

Somaliland’s first-ever Digital Health Strategy is being developed in partnership with Population Services...

It Takes Two: Engaging Men in Family Planning

Including men in family planning programs can improve couples’ communication and increase both partners’...

Your Investment,
Real Impact

92%

Program Expenses

Management, General, Fundraising Expenses

$38.96

is all it takes to give a healthy mother and her child a year of healthy life.

Donate

Careers

Resources

1120 19th Street, NW, Suite 600, Washington, DC 20036 P (202) 785-0072 F (202) 785-0120

GDPR Compliance

Anti-Slavery Statement

Integrity and Protection Hotline

PSI

Digitalizing contraceptive counseling to reach rural women and girls in Ethiopia

By: Fana Abay, Marketing and Communications Director, PSI Ethiopia

In rural Ethiopia, women and girls often face significant barriers in accessing healthcare facilities, which can be located hours away. Moreover, there is a prevailing stigma surrounding the use of contraception, with concerns about potential infertility or the perception of promiscuity. To address these challenges, the Smart Start initiative has emerged, linking financial well-being with family planning through clear and relatable messaging that addresses the immediate needs of young couples—planning for the lives and families they envision. Smart Start takes a community-based approach, utilizing a network of dedicated Navigators who engage with women in their localities. These Navigators provide counseling and refer interested clients to Health Extension Workers or healthcare providers within Marie Stopes International-operated clinics for comprehensive contraceptive counseling and services.

In a significant development, PSI Ethiopia has digitized the proven counseling messaging of Smart Start, expanding its reach to more adolescent girls, young women, and couples. This approach aligns with the priorities set by the Ethiopian Ministry of Health (MOH) and is made possible through funding from Global Affairs Canada. The interactive and engaging digital messaging has revolutionized counseling services, enabling clients to make informed and confident decisions regarding both their finances and contraceptive choices.

Clients who received counseling with the digital Smart Start tool reported a higher understanding of their options and were more likely to choose contraception (74 percent) compared to those counseled with the manual version of Smart Start (64 percent). Navigators also found the digital tool more effective in connecting with clients, leading to higher ratings for the quality of their counseling.

By December 2023, PSI Ethiopia, working in close collaboration with the MOH, aims to reach over 50 thousand new clients by leveraging the digital counseling tool offered by Smart Start. This innovative approach allows for greater accessibility and effectiveness in providing sexual and reproductive health services, contributing to improved reproductive health outcomes for women and couples across the country.

Building community health worker capacity to deliver malaria care

By: Christopher Lourenço, Deputy Director, Malaria, PSI Global

Community health workers (CHWs) are critical lifelines in their communities. Ensuring they have the training, support, and equipment they need is essential to keep their communities safe from malaria, especially in the hardest to reach contexts.

For example, in Mali, access to formal health services remains challenging, with four in ten people living several miles from the nearest health center, all without reliable transportation or access. In 2009, the Ministry of Health adopted a community health strategy to reach this population. The U.S. President’s Malaria Initiative (PMI) Impact Malaria project, funded by USAID and led by PSI, supports the Ministry with CHW training and supervision to localize health services.

In 2022, 328 thousand malaria cases were recorded by CHWs); 6.5 thousand severe malaria cases were referred to health centers, according to the national health information system.

During that time, the PMI Impact Malaria project (IM) designed and supported two rounds of supportive supervision of 123 CHWs in their workplaces in the IM-supported regions of Kayes and Koulikoro. This included developing and digitizing a standardized supervision checklist; and developing a methodology for selecting which CHWs to visit. Once a long list of CHW sites had been determined as accessible to supervisors for a day trip (including security reasons), the supervisors telephoned the CHWs to check when they would be available to receive a visit [as being a CHW is not a full-time job, and certain times of the year they are busy with agricultural work (planting, harvesting) or supporting health campaigns like mosquito net distribution].

Supervisors directly observed how CHWs performed malaria rapid diagnostic tests (RDTs) and administered artemisinin-based combination therapy (ACT). They recorded CHW performance using the digitized checklist, interviewed community members, reviewed records, and provided on-the-spot coaching. They also interviewed the CHWs and tried to resolve challenges they expressed, including with resupply of commodities or equipment immediately or soon afterwards.

Beyond the observed interactions with patients, supervisors heard from community members that they were pleased that CHWs were able to provide essential malaria services in the community. And the data shows the impact.

In IM-supported areas of Mali, 36% of CHWs in the first round were competent in performing the RDT, which rose to 53% in the second. 24% of CHWs in the first round compared to 38% in the second were competent in the treatment of fever cases and pre-referral counseling. Between both rounds, availability of ACT increased from 80 percent to 90 percent.

Supportive supervision with interviews and observations at sites improved the basic competencies of CHWs between the first and second rounds, and additional rounds will help to understand the longer-term programmatic benefits.

Taking a market-based approach to scale sanitation in Ethiopia

By: Dr. Dorothy Balaba, Country Representative, PSI Ethiopia

In Ethiopia, PSI leads the implementation of USAID Transform WASH (T/WASH) activity with consortium partners, SNV and IRC WASH. Contrary to traditional models that rely on distribution of free or heavily subsidized sanitation products, T/WASH utilizes a market-based sanitation approach. This approach creates sustainable and affordable solutions, by integrating market forces and supporting businesses to grow, while creating demand at the household level.

During the last six years, T/WASH has worked alongside the private sector and government (Ethiopia’s Ministry of Health, Ministry of Water and Energy, and Ministry of Labor and Skills), among other stakeholders, to increase household access to affordable, quality sanitation products and services. For example, more than 158 thousand households have invested in upgraded sanitation solutions with rapid expansion to come as the initiative scales and market growth accelerates.

T/WASH has successfully trained more than 500 small businesses, including community masons and other construction-related enterprises, with technical know-how in sanitation product installation, operational capacities, and marketing and sales skills needed to run successful, growing businesses. The Ethiopian government is now scaling the approach to all districts through various national, regional, and local institutions with requisite expertise. T/WASH has also worked the One WASH National Program, Ministry of Health, Ministry of Water and Energy, and Ministry of Labor and Skills to examine policies that influence increased household uptake of basic WASH services, such as targeted sanitation subsidies, tax reduction to increase affordability, and increased access to loan capital for business seeking to expand and households needing help to improve their facilities.

To share the journey to market-based sanitation, representatives of the Ethiopian Ministry of Health and the USAID Transform WASH team took to the stage at the UN Water Conference in 2023.

“Rather than relying on traditional aid models that often distribute free or heavily subsidized sanitation products, market-based sanitation creates sustainable and affordable solutions, integrating market forces and supporting businesses to grow.”

— Michael Negash, Deputy Chief Party of T/WASH

Promoting self-managed care like Self-testing and Self-Sampling

By: Dr Karin Hatzold, Associate Director HIV/TB/Hepatitis

Building upon the success and insights gained from our work with HIV self-testing (HIVST), PSI is actively applying this approach to better integrate self-care, more broadly, in the health system beginning with Hepatitis C and COVID-19. Self-testing has emerged as a powerful tool to increase access to integrated, differentiated, and decentralized health services, accelerating prevention, care, and treatment for various diseases, while also increasing health system resilience against COVID-19.

Here’s how we got there.

Seven years ago, the landscape of HIV self-testing lacked global guidelines, and only the U.S., the UK and France had policies in place that allowed for HIV self-testing. High disease burdened countries in low-and-middle-income-countries (LMICs) lacked evidence and guidance for HIVST despite major gaps in HIV diagnosis.

However, through the groundbreaking research from the Unitaid-funded HIV Self-Testing Africa (STAR) initiative led by PSI, we demonstrated that HIVST is not only safe and acceptable but also cost-effective for reaching populations at high risk with limited access to conventional HIV testing. This research played a pivotal role in informing the normative guidelines of the World Health Organization (WHO) and shaping policies at the country level. As a result, more than 108 countries globally now have reported HIVST policies, with an increasing number of countries implementing and scaling up HIVST to complement and partially replace conventional testing services. This became especially significant as nations tried to sustain HIV services amidst the disruptions caused by the COVID-19 pandemic.

By leveraging our expertise, PSI is conducting research to identify specific areas and populations where the adoption of Hepatitis C and COVID-19 self-testing could significantly enhance testing uptake and coverage. This research serves as the foundation for developing targeted strategies and interventions to expand access to self-testing, ensure that individuals have convenient and timely options for testing for these diseases, and are linked to care, treatment and prevention services through differentiated test and treat approaches.

simplifying consumers’ journey to care in Vietnam

By: Hoa Nguyen, Country Director, PSI Vietnam

In late 2022, with funding from the Patrick J. McGovern Foundation, PSI and Babylon partnered to pilot AIOI in Vietnam. By combining Babylon’s AI symptom checker with PSI’s health provider locator tool, this digital health solution analyzes symptoms, recommends the appropriate level of care, and points them to health providers in their local area. The main goal is to support people in low-income communities to make informed decisions about their health and efficiently navigate the healthcare system, while reducing the burden on the healthcare workforce. The free 24/7 service saves people time and subsequent loss of income from taking time off work and from having to pay unnecessary out-of-pocket expenses. Under our global partnership with Meta, PSI launched a digital campaign to put this innovative product in the hands of people in Vietnam. By the end of June 2023 (in the nine months since product launch), 210 thousand people accessed the AIOI platform; 2.4 thousand people created personal accounts on the AIOI website, 4.8 thousand triages to Symptom Checker and linked 2.2 thousand people to health facilities.

Babylon’s AI symptom checker and PSI’s health provider locator tool captures real-time, quality data that supports health systems to plan, monitor and respond to consumer and provider needs. But for this data to be effective and useable, it needs to be available across the health system. Fast Healthcare Interoperability Resources (FHIR) standard provides a common, open standard that enables this data exchange.
PSI’s first consumer-facing implementation of FHIR was launched in September 2022 as part of the Babylon Symptom Checker project in Vietnam, enabling rapid alignment between PSI and Babylon’s FHIR-enabled client records systems. PSI already has several other consumer health FHIR implementations under active development in 2023, including PSI’s collaboration with the Kenya MOH to launch a FHIR-enabled WhatsApp national health line for COVID-19 health information. PSI will also look to adopt and scale health workforce-facing FHIR-enabled tools, such as OpenSRP2, which will be piloted in an SRH-HIV prevention project in eSwatini in partnership with Ona by the end of 2023.

— Martin Dale, Director, Digital Health and Monitoring, PSI

Engaging the private sector for disease surveillance in Myanmar

By: Dr. Zayar Kyaw, Head of Health Security & Innovation, PSI Myanmar

Under a three-year investment from the Indo-Pacific Center for Health Security under Australia’s Department for Foreign Affairs and Trade (DFAT), PSI is enhancing disease outbreak surveillance and public health emergency preparedness and response capacities in Myanmar, Cambodia, Laos, and Vietnam. When PSI conducted a review of existing disease surveillance systems in Myanmar, it identified several gaps: although the Ministry of Health had systems in place for HIV, tuberculosis, malaria and other communicable diseases, they were fragmented, with different reporting formats and reliance on paper-based reporting. In addition, private sector case surveillance data were not routinely captured, yet private clinics and pharmacies are the dominant health service delivery channel in the country. This hindered effective disease prevention and control efforts.

Building on our extensive private sector malaria surveillance work under the BMGF-funded GEMS project in the Greater Mekong Subregion, PSI implemented a case-based disease notification system using social media channels to overcome the limitations of paper-based and custom-built mobile reporting tools. These chatbots, accessible through popular social media platforms like Facebook Messenger and Viber, proved to be user-friendly and required minimal training, maintenance, and troubleshooting. The system was implemented in more than 550 clinics of the Sun Quality Health social franchise network as well as nearly 470 pharmacies. The captured information flows to a DHIS2 database used for real-time monitoring and analysis, enabling rapid detection of potential outbreaks. Local health authorities receive instant automated SMS notifications, enabling them to promptly perform case investigation and outbreak response.

In 2022, private clinics reported 1,440 malaria cases through the social media chatbots, while community mobilizers working with 475 private providers and community-based malaria volunteers reported more than 5,500 cases, leading to the detection of two local malaria outbreaks. Local health authorities were instantly notified, allowing them to take action to contain these surges in malaria transmission. During the same time, pharmacies referred 1,630 presumptive tuberculosis cases for confirmatory testing – a third of which were diagnosed as tuberculosis and enrolled into treatment programs.

Training health workers in Angola

By: Anya Fedorova, Country Representative, PSI Angola

The shortage of skilled health workers is widely acknowledged as a significant barrier to achieving Universal Health Coverage. To address this challenge, PSI supported ministries of health to develop a digital ecosystem that brings together stewardship, learning, and performance management (SLPM). The ecosystem enhances training, data-driven decision-making, and the efficiency of healthcare delivery.

Here’s what it looks like in practice.

In July 2020, PSI Angola, alongside the Angolan digital innovation company Appy People, launched Kassai, an eLearning platform that targets public sector health workers in Angola. Through funding from USAID and the President’s Malaria Initiatve (PMI), Kassai features 16 courses in malaria, family planning, and maternal and child health – with plans to expand learning topic areas through funding from ExxonMobil Foundation and private sector companies. A partnership with UNITEL, the largest telecommunication provider in Angola, provides all public health providers in Angola free internet access to use Kassai.

Kassai’s analytics system to follow learners’ success rate and to adjust the course content to learners’ performance and needs. Kassai analytics are integrated with DHIS2 – the Health Management Information System (HMIS) of Angolan MOH, to be able to link learners’ knowledge and performance with the health outcomes in the health facilities. The analytics track learners’ performance by course and gives visibility by health provider, health facility, municipality, and province. Each course has pre-and post-evaluation tests to track progress of learning, too.

By the end of 2022, there were 6,600 unique users on the Kassai platform and 31,000 course enrollments. PSI Angola’s partnership with UNITEL, the largest telecommunication provider in Angola, allows for free internet access to learn on the Kassai for all public health providers in Angola. Building on its success for malaria training, Kassai now also provides courses in family planning, COVID-19, and maternal and child health. This reduces training silos and provides cross-cutting benefits beyond a single disease.

Implementing the SLPM digital ecosystem brings numerous benefits to health systems. It allows for more strategic and efficient workforce training and performance management, enabling ministries of health to track changes in health workers’ knowledge, quality of care, service utilization, and health outcomes in real time. The ecosystem also supports better stewardship of mixed health systems by facilitating engagement with the private sector, aligning training programs and standards of care, and integrating private sector data into national HMIS. Furthermore, it enables the integration of community health workers into the broader health system, maximizing their impact and contribution to improving health outcomes and strengthening primary healthcare.

Protecting Those Most at Risk of Malaria: Child Health and the COVID-19 Response

Door-to-Door Distribution Only

Remote Microplanning

Safe Supervision

COVID-Secure Trainings

Clear and Concise Communications

Sign up to Receive Updates

Donate toSupport Our Work

Related

Stay Updated

Your Investment, Real Impact

International Tax-Deductible Gifts

Qualified Charitable Distributions

ACCELERATING UPTAKE OF HEALTH INSURANCE

Explore our resources

Building Resilient, Consumer-Powered Health Systems

CAN DIGITAL LOCATOR TOOLS IMPROVE ACCESS TO HIGH-QUALITY HEALTH SERVICES AND PRODUCTS IN LOW-RESOURCE SETTINGS?

Explore our resources

listen to the podcast

Better data for stronger health systems

Explore our resources

View our short interviews

Scaling Digital Solutions for Disease Surveillance

Misinformation and Vaccine Hesitancy

The Frontline of Epidemic Preparedness and Response

HOW COULD PRIVATE SECTOR PHARMACIES AND DRUG SHOPS ADVANCE PROGRESS TOWARDS UNIVERSAL HEALTH COVERAGE?

Explore our resources

listen to the podcast

The Consumer as CEO

Digitalizing contraceptive counseling to reach rural women and girls in Ethiopia

Building community health worker capacity to deliver malaria care

Taking a market-based approach to scale sanitation in Ethiopia

Promoting self-managed care like Self-testing and Self-Sampling

Using peer coaches to counter HIV stigma in South Africa

simplifying consumers’ journey to care in Vietnam

Engaging the private sector for disease surveillance in Myanmar

Training health workers in Angola

WHISTLEBLOWER AND ANTI-RETALIATION

Global Code of Business Conduct And Ethics

The Future of Work

Meaningful Youth Engagement

Zero Tolerance for Modern-Day Slavery and Human Trafficking

UNITED NATIONS GLOBAL COMPACT

Environmental Sustainability

Affirmative Action and Equal Employment Opportunity

Zero Tolerance for Discrimination and Harassment

Diversity and Inclusion

Gender Equality

People & Communities

Scaling Digital Health Innovations

Supporting People to be Active Agents in their Healthcare

Cover

01 #PeoplePowered

02 Breaking Taboos

03 Moving Care Closer to Consumers

04 Innovating on Investments

ICFP Q&A: Let's Talk About Sex

Donor Advised Funds

Employer Match

Sign up to
Receive Updates

Donate to
Support Our Work

Stay
Updated

Your Investment,
Real Impact

ICFP Q&A:
Let's Talk About Sex