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The President’s Malaria initiative: A collaborative approach to scaling up malaria control interventions

Source: TropIKA

Title of the session: The President’s Malaria initiative: A collaborative approach to scaling up malaria control interventions

Date: 2nd November 2009

Agenda item: Symposium 5: PMI

Session theme: The President’s Malaria Initiative (PMI): A collaborative approach to support National Malaria Control Programs in Africa

Meeting room: Shimba Hills

Chair(s): Bernard Nahlen, Deputy Coordinator of the Presidential Initiative

Presenters:

• Michael McDonald, USAID Global Health Bureau, Malaria Advisors – Presentation

• Steven S. Yoon, ScD, MPH, Center for Disease Control and PMI – Presentation

• Sylvester Segbaya, National Malaria Control Program, Ghana Health Services, Ghana – Presentation

• Dr. Samuel J. A. Mabunda, National Malaria Control Program, Mozambique – Presentation

• Mr. Francois Niyitegeka, Public Health Specialist, TRACplus/Malaria Unit, Ministry of Health Rwanda

TropIKA rapporteur: Faith Apolot Okalebo

Major topics:

• PMI as a partner in malaria prevention and treatment in Africa
• Monitoring and Evaluation as a Key Management principle in PMI programs
• Example of a PMI sponsored program – scaling up of indoor residual spraying in Ghana
• Example of a PMI sponsored program – Promoting universal coverage of long lasting insecticide treated nets in Mozambique
• Example of PMI sponsored programs – malaria prevention, diagnosis and treatment in Rwanda

Keywords:

• Presidential Malaria Initiative
• Africa
• impact

Scope: Policy impact

REPORT ON ORIGINAL SESSION

Overview

The Presidential Malaria Initiative (PMI) was launched by the former of USA President George W. Bush in 2005 and has the support of the current President Barack Obama. The goal of the initiative is to provide leadership in malaria prevention and treatment. The target is to increase coverage of malaria preventive and treatment services in Africa to 85%. From the time of its inception funding for its activities has grown from US$ 30 million in 2006 to over US$ 1 billion in 2009. Fifty percent of the funds are spent on acquisition of commodities and only a small proportion is allocated to operational research. The main focus of PMI is project implementation and provision of technical support. PMI places a strong emphasis on program monitoring and evaluation as well as integration of its programs with National Malarial Control programs. It works in collaboration with WHO, USAID, CDC and Global fund. Its activities are mainly based in Africa though there are future plans to expand its activities in South America and South East Asia. In this session 3 case studies of PMI funded programs were presented. These programs include: residual indoor spraying in Ghana; promoting universal insecticide treated nets coverage in Mozambique; and promotion of the use of rapid diagnostic tests in Rwanda. Each of these cases raised important issues for future research.

CONTEXT AND ISSUE

Malaria is a major cause of morbidity and mortality in Africa. Currently PMI operates in 7 African countries. Problems faced by these countries with regard to malaria prevention and management include unreliable diagnostic methods, erratic drug supply, growing insecticide resistance, low coverage of insecticide treated nets and weak health systems.

Key facts and figures

The Presidential Malaria Initiative (PMI) was launched by the former of USA President George W. Bush in 2005. The goal of the initiative is to provide leadership in malaria prevention and treatment primarily in Africa. The initiative aims to help African Governments to build capacity in malaria treatment and prevention. Its strategic and management principles are health system strengthening; integration and collaboration with other international agencies; a focus on program implementation; and sound monitoring and evaluation. These management approaches are key to overcoming problems in malaria eradication.

Initiatives on the ground; experience/s derived

In this session 3 initiatives on the ground were presented. In the case of Ghana, there were few initiatives to prevent malaria transmission by indoor residual spraying (IRS). In 2005, AngloGold Ashanti (AGA) launched a massive IRS spraying in a mining town called Obuasi. This effort was hugely successful in reducing malaria morbidity and this inspired the government to seek funding from the Global fund to fund its IRS program. Currently PMI is implementing IRS in 5 districts in northern Ghana while 40 districts will be covered by AGA and the Global fund. The IRS program is part of National Malaria Control plan and the Integrated Vector Management policy of Ghana.

In Mozambique PMI is promoting the distribution of ITNs using a unique strategy that involves a carrying out a community census before mass distribution of the nets. This strategy promotes more equitable distribution of nets, promotes better coverage and has the potential to promote community education on the use of nets.

In Rwanda, PMI is involved in a wide range of activities such as promotion of the use of rapid diagnostic kits.

Research Findings

Lessons learned

The first lesson is that private agencies can partner and initiate activities to reduce malaria morbidity. The case of Ghana is very interesting as is unique example of how a private enterprise initiated a malaria control program that inspired the government to seek funding to implement the program country wide. The Ghana IRS program is heavily dependent on the human resource and infrastructural capacity of AGA. The success of AGA has inspired mining companies in Tanzania and Guinea.

Acceptance of programs depends on community education and acceptance of interventions such as spraying.

The success of PMI programs can be attributed to its collaborative, focused approach as well as integration with national programs.

In Ghana, more than 720 IRS implementers have been trained. Coverage of IRS has increased to 5 districts and is set to increase to more than 4 districts.

Distribution of 4.5 million nets in Mozambique and well as more order distribution. Household ownership of nets has increased to 2.5 nets per household per year.

Issues raised, obstacles, difficulties

Difficulties faced in the implementation of programs include poor roads that make it hard to supply drugs; weak monitoring and evaluation capacity in National Malaria programs; and low technical capacity to carry out entomological surveillance; lack of trust of physicians in RDT.

In Rwanda, malaria prevalence has reduced to 11 % in 2008 from 28 % in 2000.

Community health workers are poorly paid.

Future plans

PMI plans to increase its activities in 7 more African countries under its 5 year strategic plan. It also intends to cover the Amazon region. It also intends to carry out a large Monitoring and Evaluation study to evaluate its impact by 2012.

FINDINGS AND CONCLUSIONS

From formal presentations

Policy Impact

The need for greater collaboration and integration between funding agencies, governments and private enterprises.

Translational Research Impact

The Mozambique case highlighted the need for operational research on how to promote use of distributed ITN. How community census can be used to promote use of ITNs and equity in its distribution.

Knowledge gap created

The Ghanaian case study highlighted the need to investigate why IRS has caused an increase in outdoor mosquito bites and how this can be minimized.

Cost implications of carrying out census is need.

From open discussions/debates

The audience felt that PMI should engage in more operations research.

In the case of Rwanda the audience wanted to know how the community health workers are compensated to motivate them. They are compensated by enabling them to join cooperatives from which they can obtain financial services.

Issues were raised as to whether AGA will continue funding its community malaria initiative given that it is a private for profit enterprise.

from rapporteur

PMI seems to be more adaptive than other aid agencies. Its success seems to depend on its integrative approach. Each of the cases presented raised critical issues for operational research.

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