How to Improve Access to Malaria Treatment in the Private Sector

Posted avril 11, 2017

PSI recently hosted a webinar on how to transform the market for malaria rapid diagnostic tests (mRDTs) in the private sector. Panelists from PSI and four partner organizations, including the World Health Organization (WHO), Foundation for Innovative New Diagnostics (FIND), Johns Hopkins Bloomberg School of Public Health, and Malaria Consortium, dove deep into the lessons learned from a three-year UNITAID-funded project that worked to increase access to and demand for mRDTs in the private sector of five sub-Saharan African countries.

Missed the webinar? You’re in luck. Below we provide three key takeaways. And be sure to check out the full webinar in addition to our recently released lessons learned brief from the project.

Private Sector Engagement is Critical to Malaria Control

One of the three pillars set forth in WHO’s Global Technical Strategy for Malaria 2016 – 2030 is to ensure universal access to malaria prevention, diagnosis and treatment. While access to malaria diagnostics has improved greatly in the public sector due to the availability and affordability of mRDTs, the same cannot be said for the private sector. Given that 40% of the population in malaria endemic countries seek care and treatment for fever – the primary symptom of malaria – in the private sector, this means there is a critical gap in access to malaria diagnosis. As a result, malaria medications continue to be overused and other potentially life-threatening illnesses are left untreated.

“Addressing the needs of the private sector is a somewhat neglected area in malaria control, but engagement with the private sector is going to be critical if we are to deliver on these ambitious targets,” noted panelist Jane Cunningham of WHO.

PSI’s Nikki Charman additionally noted, “Fever case management in the private sector is the last neglected area in malaria control and should be a critical area of investment in health delivery going forward.”

Engagement of all stakeholders is needed to transform the market for mRDTs in the private sector

The UNITAID private sector mRDT project worked with project partners to use a , identifying which barriers prevented access to and demand for mRDTs in the private sector. The project partners then used these results to determine the most appropriate interventions. A large part of this approach includes taking a close look at all the various players involved in the supply of mRDTs, as well as the factors influencing patients and provider demand.

“In order to get this balance of supply and demand just right in any country all players must be actively engaged,” notes Cunningham. “This includes not only manufacturers but importers, distributors, wholesalers and providers.”

In addition to sufficient supply and demand, a supportive enabling environment is needed to create a sustainable mRDT market. In project countries, regulations forbid malaria testing in many private-sector channels, including pharmacies and drug shops. Engagement with the appropriate government stakeholders has enabled testing with mRDTs among all trained providers in Madagascar, and Tanzania is working towards changing the governing rules on who can provide mRDT services.

Private providers can offer high-quality fever case management services with sufficient training and supporting tools

Given the lack of quality assurance systems for mRDTs and fever case management services in the private sector, project partners developed a comprehensive set of tools and resources for private providers to draw upon. This included job-aids, classroom and online trainings, a tablet based application for supportive supervision, trouble shooting guides, and point-of-use tools for surveillance of mRDTs. The development and use of such tools helped private providers offer high-quality fever case management services as well as the ability of supervisors to monitor the providers’ quality of care.

Charman notes that in a 2015 study in Kenya, in which volunteers known to be negative for malaria were employed to assess providers fever case management skills, it was found that project supported pharmacies and drug shops performed similarly to private health providers in respect to diagnosis and treatment.

Want to get more in-depth knowledge of the learnings from this project? Check out the full webinar or download our brief titled: “Transforming the Private Sector to Support Universal Malaria Diagnostic Coverage.”

If you’d like to tweet about this recent webinar, please use the following link: https://ctt.ec/IUX87

Banner photo: © Population Services Kenya

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Digitalizing contraceptive counseling to reach rural women and girls in Ethiopia

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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.

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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

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“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.”

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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.

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“The men we spoke to [while I was traveling to South Africa for a PrEP project with Maverick Collective by PSI] were not only decidedly open to the idea of taking a daily pill…many were willing to spread the word and encourage friends to get on PrEP too. We were able to uncover and support this new way forward because we had flexible funding to focus on truly understanding the community and the root barriers to PrEP adoption. This is the philanthropic funding model we need to effectively fight the HIV epidemic, and it’s beneficial for all sorts of social challenges.”

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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.

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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.

How to Improve Access to Malaria Treatment in the Private Sector

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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

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