This piece originally ran on impactmalaria.org
Dear partners and friends,
As we approach the conclusion of the PMI Impact Malaria project, which has spanned over six impactful years including an extension, it is with a mix of pride and nostalgia that we announce its closure tomorrow, May 31st, 2024. The baton of progress will be passed on to the PMI REACH project, ensuring the continuity of this vital work.
The accomplishments of PMI Impact Malaria, forged in partnership with 19 countries and two regional programs, are too vast to fully describe here. Its lasting contributions to the global fight against malaria and the advancement of child health will leave an indelible mark. Our entire project team, the nations we served, and all partners involved can take immense pride in the strides made, as showcased in the project’s final report.
Throughout the project, PMI Impact Malaria has focused on reinforcing the quality of laboratory diagnosis and clinical management of malaria along the continuum of care from the community to the health facilities. Using our comprehensive and standardized quality improvement approach, called Outreach Training and Supportive Supervision Plus (OTSS+), we made major strides in accelerating country-driven malaria services in health facilities.
The OTSS+ digital data entry platform allowed for real-time feedback and troubleshooting, along with prompt development of quality improvement action plans. Using OTSS+ data, we performed detailed cross-country analyses to gain a clearer picture of the gaps in health worker performance and health facility readiness for high-quality malaria service delivery. Through developing a digitized global package of OTSS+ checklists, this enabled countries to conduct facility-level supportive supervision and targeted on-the-job training and coaching to improve health worker competency in three main areas: 1) managing uncomplicated and severe malaria, 2) preventing and treating malaria in pregnancy (MIP), and 3) performing malaria rapid diagnostic tests and malaria microscopy.
At the primary health care level, PMI Impact Malaria supported 12 countries to implement OTSS+ and complementary approaches, such as mentoring and peer-to-peer engagement, to strengthen the management of patients with uncomplicated malaria. Overall, we supported countries to conduct between three and 15 rounds of OTSS, training 4,663 health workers with the most up-to-date global and national guidelines during 11,959 visits to 4,700 health facilities. We published learnings from this approach and the impact on health worker competencies and health facility readiness in a Special Supplement in the American Journal of Tropical Medicine and Hygiene.
- We developed a monitoring system – the PMI Impact Malaria Data Hub – to enable our project and NMPs to rapidly review data, use evidence to make decisions that advance malaria service delivery, and identify trends across countries that highlight strengths and areas for improvement. As we close, we supported NMPs to transition data housed in project-owned servers to locally owned systems, thereby promoting sustainable data-driven decision-making.
- We facilitated laboratory OTSS rounds in ten countries, totaling more than 4,200 microscopy observation assessments. For countries who began implementing the OTSS+ approach during the project, initial observation scores averaged 73% and climbed to 93% in the last rounds. This support included improving malaria microscopy skills and ability of laboratory technicians to accurately read malaria rapid diagnostics tests in 12 countries by conducting basic and advanced malaria diagnostics refresher trainings. These trainings help expand the network of experts that can quickly and accurately diagnose malaria from a lab sample so that health providers can provide the right treatment at the right time to their patients.
- We supported NMPs to close gaps in the prevention and treatment of MIP by conducting OTSS+ visits in health facilities and introducing the OTSS+ standardized MIP module in Cameroon, Côte d’Ivoire, Mali, Niger, Rwanda, Sierra Leone, and Zambia. Overall, coverage of intermittent preventive treatment (IPTp) doses one to three in project areas was above the regional average. We also helped NMPs improve and expand access to MIP interventions by producing a Malaria in Pregnancy Technical Working Group (TWG) Quick Start guide to assist countries with establishing or re-establishing working groups and contributed to the revised WHO treatment guidelines for uncomplicated malaria in the first trimester of pregnancy.
- We developed rapid COVID-19 guidance and trained 1,702 health workers and laboratory technicians in Cameroon, DRC, and Ghana to safeguard service during the pandemic. We modified OTSS+ checklists, developed six e-learning modules, and conducted remote mentoring to strengthen the competencies of health workers and further expand training in COVID-19 infection prevention and control, and biosafety.
Through the life of the project, PMI Impact Malaria supported the scale-up of integrated community case management (iCCM) in five countries (Cameroon, Mali, Niger, Rwanda, and Sierra Leone) and seasonal malaria chemoprevention (SMC) in four countries (Burkina Faso, Cameroon, Mali, and Niger), often in areas far from the nearest health facility and affected by conflict and civil unrest.
At the community level, we supported iCCM to expand access to quality care for malaria, pneumonia, and diarrhea in unserved and underserved populations and supported NMPs in bringing these programs into the national primary health care system. Throughout the project, 18,198 CHWs were recruited and trained in these service interventions. Through this support, 1,761,988 children with fever in targeted communities received care.
- We developed competency-based iCCM supervision checklists for community health workers (CHWs) to help them broaden their reach and a quality improvement framework supplemented by national experiences with the implementation of OTSS+. This guidance is also reinforced by PMI Impact Malaria’s and the Child Health Task Force’s toolkit for the institutionalization of iCCM, a product that brings adaptability and synergy to the forefront and is supported by PMI Impact Malaria’s multi-country study of institutionalization processes. By providing national authorities with an evidence-based process for institutionalization, iCCM can harmonize with unique country contexts and dynamics, thereby entrenching it within health systems to optimize its efficacy and scope of implementation.
- We delivered a package of tools and resources on sustained CHW capacity strengthening, focusing on both individual competencies and systemic mechanisms. Our CHW internship curriculum for participants and facilitators is designed to align national capacities with global best practices in MIP and malaria case management, adopting a targeted approach to assess strengthen skills and knowledge across malaria services. At the systems level, we led a study into CHW compensation schemes in Benin, Burkina Faso, Ghana, Malawi, Mali, Niger, and Zambia, providing a top-down overview of the policies and infrastructure that comprise compensation schemes, in addition to recommendations for their expansion. We also became the first PMI-project to provide payment for CHWs, implementing this system in Sierra Leone.
PMI Impact Malaria provided technical and programmatic assistance to five countries (Burkina Faso, Cameroon, Ghana, Mali, and Niger) to implement SMC campaigns providing more than 84 million doses of prevention medicine over the life of the project. We also worked with countries and with the global SMC Alliance to strengthen the collection and use of SMC data to better equip NMPs to plan, monitor, and refine their activities.
- We incorporated adaptations to protect children, families, and health workers and built on lessons learned from the 2019 and 2020 campaigns to protect health workers and families against COVID-19 transmission by conducting independent household surveys, through which we were able to adjust month-to-month to improve campaigns in real time. This resulted in an additional one million children being protected during the pandemic.
- We published a peer-reviewed publication on learnings about high adherence practices to providing medicine to children during the 2020 SMC campaign in the Dosso Region of Niger. The results from this publication show where actions can be taken to improve adherence and achieve greater impact in future campaigns.
- Prior to kicking off 2023 SMC campaigns in Cameroon, Mali, and Niger, we collaborated with NMPs on pre-campaign planning by facilitating the training and deployment of community mobilizers-distributors. Our learnings over 6 years of supporting SMC contributed to global technical learning and best practice, evidenced by our input to WHO’s updated SMC field guide and our SMC Monitoring & Evaluation webinar series, where we shared our experiences supporting post-campaign interventions, such as modelling monitoring and evaluation.
Finally, we are proud of the successful implementation of therapeutic efficacy studies in 40 sites across nine countries and many operational research studies yielding impactful results: Effectiveness of mass drug administration in Senegal which highlighted the impact of local partnerships and interventions; Feasibility and effectiveness of Group Antenatal Care (ANC) and ANC surveillance in Benin; Feasibility and accuracy of a point-of-care test for G6PD deficiency in Cambodia and assessment of the 1-3-7 surveillance system in Laos to achieve the national elimination strategy; and support of regional interventions in Latin America and the Caribbean that better align national capacities in the pursuit of enhanced cross-border collaboration for more impactful P. vivax malaria control.
To the PMI Impact Malaria team, I hope you share in the deep sense of pride I feel for the dedication and success we have achieved. To our partners, your collaboration has been invaluable, and we are profoundly grateful for the chance to work towards such a noble goal together. To the Presidents Malaria Initiative, thank you for trusting us with this responsibility. To those we have served, it has been our honor to accompany you on this journey.
Wishing you all the best,
Ricki Orford
Senior Project Director, PMI Impact Malaria
PMI Impact Malaria was funded and technically assisted by the U.S. President’s Malaria Initiative (PMI) from 2018-2024 and was led by Population Services International (PSI) in partnership with Jhpiego, MCD Global Health, and the Malaria Elimination Institute (MEI) at the University of California San Francisco.
