Supporting countries to achieve their malaria elimination goals: the WHO E-2020 initiative

Background Malaria causes more than 200 million cases of illness and 400,000 deaths each year across 90 countries. The World Health Organization (WHO) set a goal for 35 countries to eliminate malaria by 2030, with an intermediate milestone of 10 countries by 2020. In 2017, the WHO established the Elimination-2020 (E-2020) initiative to help countries achieve their malaria elimination goals and included 21 countries with the potential to eliminate malaria by 2020. Methods Across its three levels of activity (country, region and global), the WHO developed normative and implementation guidance on strategies and activities to eliminate malaria; provided technical support and subnational operational assistance; convened national malaria programme managers at three global meetings to share innovations and best practices; advised countries on strengthening their strategy to prevent re-establishment and preparing for WHO malaria certification; and contributed to maintaining momentum towards elimination through periodic evaluations, monitoring and oversight of progress in the E-2020 countries. Changes in the number of indigenous cases in E-2020 countries between 2016 and 2020 are reported, along with the number of countries that eliminated malaria and received WHO certification. Results The median number of indigenous cases in the E-2020 countries declined from 165.5 (interquartile range [IQR] 14.25–563.75) in 2016 to 78 (IQR 0–356) in 2020; 12 (57%) countries reported reductions in indigenous cases over that period, of which 7 (33%) interrupted malaria transmission and maintained a malaria-free status through 2020 and 4 (19%) were certified malaria-free by the WHO. Two countries experienced outbreaks of malaria in 2020 and 2021 attributed, in part, to the COVID-19 pandemic. Conclusions Although the E-2020 countries contributed to the achievement of the 2020 global elimination milestone, the initiative highlights the difficulties countries face to interrupt malaria transmission, even when numbers of cases are very low. The 2025 global elimination milestone is now approaching, and the lessons learned, experience gained, and updated guidance developed during the E-2020 initiative will help serve the countries seeking to eliminate malaria by 2025.

Seeking research questions from implementers: considerations for leveraging ground actors research needs in the fight against malaria in West Africa

Background To strengthen the fight against malaria, it is imperative to identify weaknesses and possible solutions in order to improve programmes implementation. This study reports experiences gained from collaboration between decision-makers and researchers from a World Bank project (Malaria and Neglected Tropical Diseases in the Sahel, SM/NTD). The objectives of this paper were to identify bottlenecks in malaria programme implementation as well as related research questions they bring up. Methods Questionnaire addressed to National Malaria Control Programme managers and prioritization workshops were used as a medium to identify research questions. The bottlenecks in malaria programme implementation were identified in seven thematic areas namely governance, human resources, drugs, service provision, use of prevention methods, monitoring and evaluation (M and E), and public support or buy-in. The first five priority questions were: (1) compliance with drug doses on the second and third days during the seasonal chemoprevention (SMC) campaigns, (2) the contribution of community-based distributors to the management of severe cases of malaria in children under 5 years, (3) the SMC efficacy, (4) artemisinin-based combination therapy (ACT) tolerance and efficacy according to existing guidelines, and (5) the quality of malaria control at all levels of the health system. Results and conclusion This work showed the effectiveness of collaboration between implementers, programmes managers, and researchers in identifying research questions. The responses to these identified research questions of this study may contribute to improving the implementation of malaria control programmes across African countries.

Seeking research questions from implementers: considerations for leveraging ground actors research needs in the fight against malaria in West Africa

BackgroundTo strengthen the fight against malaria, it is imperative to identify weaknesses and possible solutions in order to improve programmes implementation. This study reports experiences gained from collaboration between decision-makers and researchers from a World Bank project (Malaria and Neglected Tropical Diseases in the Sahel, SM/NTD). The objectives of this paper were to identify bottlenecks in malaria programme implementation as well as related research questions they bring up. MethodsQuestionnaire addressed to National Malaria Control Programme managers and prioritization workshops were used as a medium to identify research questions. The bottlenecks in malaria programme implementation were identified in seven thematic areas namely governance, human resources, drugs, service provision, use of prevention methods, monitoring and evaluation (M&E), and public support or buy-in. The first five priority questions were: (1) compliance with drug doses on the second and third days during the seasonal chemoprevention (SMC) campaigns, (2) the contribution of community-based distributors to the management of severe cases of malaria in children under 5 years, (3) the SMC efficacy, (4) artemisinin-based combination therapy (ACT) tolerance and efficacy according to existing guidelines, and (5) the quality of malaria control at all levels of the health system. Results and ConclusionThis work showed the effectiveness of collaboration between implementers, programmes managers, and researchers in identifying research questions. The responses to these identified research questions of this study may contribute to improving the implementation of malaria control programmes across African countries.

Scaling up Malaria Elimination Management and Leadership: A pilot in three provinces in Zimbabwe, 2016 -2018

Background Focus for improved malaria programme performance is often placed on the technical challenges, while operational issues are neglected. Many of the operational challenges that inhibit malaria programme effectiveness can be addressed by improving communication and coordination, increasing accountability, maintaining motivation, providing adequate training and supervision, and removing bureaucratic silos. Methods A programme of work was piloted in Zimbabwe with one malaria eliminating province, Matabeleland South in 2016-2017, and scaled up to include two other provinces, Matabeleland North and Midlands, in 2017-2018. The intervention included participatory, organization development and quality improvement methods. Results Workshop participants in Matabeleland South reported an improvement in data management. In Matabeleland North, motivation among nurses improved as they gained confidence in case management from training, and overall staff morale improved. There was also an improvement in data quality and data sharing. In Midlands, the poorly performing district was motivated to improve, and both participating districts became more goal-oriented. They also became more focused on monitoring their data regularly. Participants from all provinces reported having gained skills in listening, communicating, facilitating discussions, and making presentations. Participation in the intervention changed the mindset of malaria programme staff, increasing ownership and accountability, and empowering them to identify and solve problems, make decisions, and act within their sphere of influence, elevating challenges when appropriate. Conclusions This pilot demonstrates that a participatory, organization development and quality improvement approach has broad ranging effects, including improving local delivery of interventions, tailoring strategies to target specific populations, finding efficiencies in the system that could not be found using the traditional top-down approach, and improving motivation and communication between different cadres of health workers. Scale-up of this simple model can be achieved and benefits sustained over time if the process is imbedded into the programme with the training of health staff who can serve as management improvement coaches. Methods to improve operational performance that are scalable at the district level are urgently needed: this approach is a possible tactic that can significantly contribute to the achievement of global malaria eradication goals.

Assessment of surveillance activity for malaria control under national anti malaria programme in Yadgir district, Karnataka

Background: This paper reports the findings of evaluation of National Anti-malaria programme (NAMP) conducted independently for Government of India in Yadgir district of Karnataka state in February 2011, by the Department of Community Medicine, Sri Devaraj Urs Medical College, Kolar.Methods: A community based cross-sectional study was conducted in Yadgir district. Multistage sampling was employed to select the study population. The head of the household and other members present in the household were interviewed and the data was recorded in a predesigned semi-structured questionnaire. The obtained data was entered in the MS excel sheet and analyzed for proportions.Results: Data was collected from 1026 eligible persons. Eight (0.77%) fever cases were distributed among study population. Among fever cases only two (25%) had taken chloroquine. Only one (12.5%) blood smear were taken from fever cases by health worker. Indoor residual spray was not done in any of households.Conclusions: Considering the poor blood smear collection, low intake of chloroquine among fever cases, there is a need to ensure the delivery of these services by health workers. Also steps should be taken to increase the awareness among health workers regarding second line treatment of malaria and insecticide impregnated bed nets.

A methodology for malaria programme impact evaluation

This document describes a methodology for continual assessment of the impact of malaria interventions, and the efficiency of the malaria programme. The methodology is designed to be implemented recurrently on a cycle of 2–5 years, with the involvement of stakeholders, including National Malaria Control Programmes, development partners and other organizations active in the programme. Their participation should inform the impact and efficiency assessment, so that it is linked to subsequent decision making defining the nature and scope of malaria control interventions. The methodology is designed in a modular way, providing some flexibility with regard to which elements are implemented at any given time. Some modules require technical capabilities usually not available in a regular monitoring and evaluation (M&E) team, and will require contributions from other national and/or international partners.

A methodology for malaria programme impact evaluation

This document describes a methodology for continual assessment of the impact of malaria interventions, and the efficiency of the malaria programme. The methodology is designed to be implemented recurrently on a cycle of 2–5 years, with the involvement of stakeholders, including National Malaria Control Programmes, development partners and other organizations active in the programme. Their participation should inform the impact and efficiency assessment, so that it is linked to subsequent decision making defining the nature and scope of malaria control interventions. The methodology is designed in a modular way, providing some flexibility with regard to which elements are implemented at any given time. Some modules require technical capabilities usually not available in a regular monitoring and evaluation (M&E) team, and will require contributions from other national and/or international partners.