Since 2000, the world has seen major reductions in death and disease from malaria. Indeed, the progress in reducing the malaria burden is considered one of the greatest public health success stories. The theme of this year’s World Malaria Day is “End Malaria for Good.” Thanks to investments by USAID, the U.S. President’s Malaria Initiative, and the Global Fund in vector control, diagnosis and prevention treatment, Abt Associates has a played a major role in reducing the burden of malaria for more than a decade. We work on the frontlines to prevent malaria in more than 18 countries in sub-Saharan Africa, which accounts for 90 percent of malaria deaths.
Caused by parasites that are transmitted through the bites of female mosquitos, malaria remains one of the most dangerous and life-threatening diseases. Through our flagship malaria-prevention project, the President’s Malaria Initiative Africa Indoor Residual Spraying Project (PMI AIRS)
, Abt works to kill those mosquitoes. We protect on average nearly 13 million people a year through insecticide sprayed on the wall, ceilings, and other indoor surfaces where the malaria-carrying mosquito rests. Abt has sprayed on average more than 3.3 million structures a year, and trained more than 30,000 people a year, increasing the skills of country National Malaria Control Programs to conduct their own spray campaigns. Through its robust entomological monitoring and surveillance, Abt ensures that the insecticide used is effective in killing the mosquitoes.
Abt works directly with communities, Ministries of Health (MOHs), National Malaria Control Programs (NMCPs), environmental agencies, nongovernmental organizations, local entomology research institutions, universities, parastatal organizations, to protect millions of people through indoor residual spraying, effective and comprehensive malaria control strategies, and increased access to affordable and preventable care and treatment.
We’ve also built the skills of NMCPs, health facilities, NGOs, and community and business leaders to take action on their own. In Mali, Nigeria, Senegal, Zambia, and other high malaria burden countries, Abt is helping governments develop health policies supervision strategies for case management, including diagnostics, as well as training facility- based and community health workers
Expanding Access to Services
Here are a few ways we’ve worked to expand access to malaria services:
In Ethiopia, through the Private Health Sector Program, Abt expanded access to malaria services by supporting training of private sector providers;
In Nigeria, through the USAID-funded Strengthening Health Outcomes through the Private Sector (SHOPS) Project, Abt worked closely with the Pharmacists Council of Nigeria and the Clinton Health Access Initiative to develop and deliver a training of trainers guide and curriculum to train proprietary patent medicine vendors on case management and treatment of malaria and other childhood illnesses. We also trained health workers in 283 facilities in case management and improved quality of service delivery by reconstituting moribund health facility committees and by working to address gaps in health information systems and supply chain management;
In Mali, Abt partnered with the NMCP and other stakeholders to conduct health provider training of trainers on new malaria case management guidelines; andIn Zambia, we collaborated with the National Malaria Control Centre to update the malaria case management guidelines and trained 1,013 health workers from 77 districts in the diagnosis and treatment of uncomplicated and severe malaria.
Abt has helped countries develop and implement a comprehensive package of services for pregnant women, including Intermittent Preventive Treatment for Pregnant Women (IPTp), during their regular antenatal clinic visits. Working closely with the Ministry of Health in Zambia, Abt trained health workers in antenatal care, including the use of IPTp to prevent malaria. And in Mali, Abt supported communications campaigns that ensure that the long-lasting insecticide-treated nets distributed are used nightly.
In Uganda, Abt worked with Gulu University to renovate an insectary for entomological monitoring. The insectary supports the university’s undergraduate and master’s degree programs in biological studies and increases the country’s capacity to carry out entomological monitoring.
Increasing Access to Prevention and Treatment
Through system-wide interventions, such as development of community-based health insurance, Abt has increased access to malaria prevention and treatment. In Ghana, through the SHOPS Project, Abt improved licensed chemical sellers’ access to accreditation with the National Health Insurance Authority (NHIA), thereby increasing availability of NHIA-supported malaria services in rural areas.
While significant evidence exists on the impact of malaria control strategies on prevention and treatment, there is less evidence of their broader impact on the health system, particularly on service utilization, resource use, and costs incurred. Abt assessed the impact of scaled-up malaria control activities on two health facilities in Zambia, finding that as malaria was better controlled in the hospitals’ catchment areas, facility-level resources used for malaria treatment also declined, potentially freeing resources for treatment of other conditions.
Abt’s Health Finance and Governance (HFG) Project
has conducted research to support decision-making by key stakeholders, including National Malaria Control Program officials. Published studies
based on innovative research conducted in Zambia suggest that investment in scale-up of malaria prevention, diagnosis and treatment programs could free up facility-level resources, such as blood supplies and financial resources, which can be used for other patients.
In Senegal, HFG researchers conducted a cost-effectiveness analysis of targeted malaria prevention and treatment intervention packages that vary by district and region. Preliminary results have provided Senegal and other malaria-endemic countries with methods and data to support sustainability planning and domestic resource mobilization to eliminate malaria.
Effective coordination, communication, and collaboration among stakeholders is essential to ending malaria for good. With support from the President’s Malaria Initiative (PMI), HFG facilitates a Malaria Economic Research Community of Practice
to ensure that research produced on the economic impacts of malaria control interventions addresses the key questions that implementers, policymakers, and funders have.
In the push to end malaria, Abt is stepping up preventive efforts through its SHOPS Plus
project by training private providers on protocols for pregnant women. Malaria infection in pregnant women can cause serious effects in both mother and child. In areas of high malaria transmission, it is assumed that every pregnant woman has malaria parasites in her blood or placenta, whether she is symptomatic or not. A few years ago, the World Health Organization called for a new therapy to be administered to pregnant women starting after the first trimester. The new therapy, known as intermittent preventive treatment, reduces low birth weight, anemia, and miscarriages. At the end of 2016, 38 private doctors and nurses completed a SHOPS Plus training in maternal and child health that included this protocol. Integrating malaria prevention with maternal and child health updates reduces one of the key barriers to widespread adoption of this critical intervention.
As we celebrate the gains in malaria prevention and control on World Malaria Day, we also recommit ourselves to “End Malaria for Good.” While I consider all of this work impressive, it’s not enough. According to the World Malaria Report 2016
, in 2015, there were 212 million new cases of malaria and 429,000 deaths. Every two minutes, a child dies from the disease. In the time it took you to read this, a child’s life was lost to malaria. The fight is not over. Abt is biting and fighting back.