Delivering Zero Malaria: A World Malaria Day Message from PMI Impact Malaria’s Director, Ricki Orford

Posted Abril 27, 2023
Impact Area PMI Impact Malaria

This piece originally ran on the Impact Malaria blog.

World Malaria Day is a time to recommit to progress towards reaching the last mile goal of ending malaria. In 2022, USAID committed $746million through the U.S. President’s Malaria Initiative (PMI) to that goal which benefitted more than 700 million people. As PMI’s flagship global service delivery project, PMI Impact Malaria owes our continued impact to the generosity of the American people and Congressional support, whose sustained investments in USAID’s PMI align with this year’s World Malaria Day theme: Time to deliver zero malaria: invest, innovate, implement. 

To reach the unreached with lifesaving malaria services, PMI Impact Malaria supports 18 partner countries and their national malaria programs to meet their strategic goals and advance their efforts to control and eliminate malaria. We support investments in essential health workers, developing innovative approaches, and implementing quality improvement tools to end malaria.

*(Source: PMI’s 17th Annual Report to Congress, pg.6)*

Invest

PMI Impact Malaria is committed to investing in local leadership to strengthen Ministries of Health in the countries where we work to better deliver on their commitment towards zero malaria. These investments support health workers like Founèba Traoré in Mali, who is her community’s lifeline providing essential health services that close the gap in quality care. By investing in local leadership and health workers like Founèba, national governments can deliver services, tools, and medicine to where they are needed most and build resilient, accessible health systems.

Innovate

Despite global funding setbacks and health system disruptions from the pandemic, national malaria programs continue to innovate strategies that adapt to health crises. To support them, PMI Impact Malaria works with country teams to help develop and deliver these innovations to achieve sustainable health outcomes. In the Greater Mekong Subregion, we support an innovative surveillance approach that combats antimalarial resistance and meets regional elimination goals. In Burkina Faso, Cameroon, Mali, and Niger, we continue to support adaptations to seasonal malaria chemoprevention campaigns to reach millions of children each year. These are among many efforts that create safer environments and help health systems stay ahead of global challenges.

Implement

Finally, national governments continue to lead by implementing tools that improve the quality of malaria service delivery. PMI Impact Malaria supports the implementation of quality improvement efforts through Outreach, Training and Supportive Supervision Plus (OTSS+). This supportive, on-the-job training for health workers catalyzes the already effective efforts of regional governments and community health facilities by integrating technology, tools, and data. Implementing OTSS+ allows facilities to track progress, make data-informed decisions, and improve skills over time so they can provide the highest quality of care to their patients. 

Aligning this year’s theme – invest, innovate, implement – PMI Impact Malaria remains committed to supporting country leadership, national malaria programs, and health systems through their strategies to achieve their goals of reaching the unreached and ending malaria. As we mark World Malaria Day 2023, we applaud the efforts of endemic countries and the essential frontline health workers like Founèba who will make “zero malaria” a reality.

Respectfully,

Ricki Orford

Project Director, PMI Impact Malaria

Cover photo caption: Community Health Worker Founèba Traoré talks to a group of women about different health concerns including malaria prevention in Wouloufiena Village, Kalaban Coro District, Mali. Photo Credit: Mwangi Kirubi, PMI Impact Malaria

PMI Impact Malaria is funded and technically assisted by the U.S. President’s Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with Jhpiego, MCD Global Health, and the Malaria Elimination Initiative (MEI) at the University of California, San Francisco.

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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.

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.

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Building community health worker capacity to deliver malaria care

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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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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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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.

Delivering Zero Malaria: A World Malaria Day Message from PMI Impact Malaria’s Director, Ricki Orford

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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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