Category Archives: Human Resources

World Health Worker Week – Improving Capacity to Defeat Malaria

The Frontline Health Worker Alliance reminds us that, “Frontline health workers are the backbone of effective health systems – and are those directly providing services where they are most needed, especially in remote and rural areas.” These are the people who make delivery of essential malaria prevention and case management services possible. They further note that April 3-9, 2016 is World Health Worker Week and “is an opportunity to mobilize communities, partners, and policy makers in support of health workers in your community and around the world.”

Nigeria CDD performs RDT in Upenekang Community Ibeno LGA Akwa Ibom StateUnfortunately the very areas of the world that have the most malaria also have the greatest shortage of health workers as seen in Africa, South and Southeast Asia. In this situation skills and dedication of every single available frontline health worker are crucial for defeating malaria. This can only be achieved if they are up-to-date in the latest malaria programs.

For example, most malaria endemic countries in Africa have updated their malaria in pregnancy guidance to reflect the need to provide intermittent preventive treatment (IPTp) at every antenatal care visit after the 13th week of pregnancy with doses at a month interval. This means a pregnant woman may now receive 3 or more doses. What is still needed in many countries is full dissemination of this guidance to all frontline health staff so that they can implement this service correctly and fully.

DSCN3778As we move toward malaria elimination, more people will live in areas with unstable or epidemic transmission. The chances of developing severe malaria will increase. Updated skills on managing severe malaria that results in convulsions, chronic anemia and death are needed for these frontline staff.

Enhanced skills in surveillance are now needed as we move toward malaria elimination. Good diagnostic, record keeping and reporting skills are needed by frontline staff to help identify malaria transmission hotspots. Skills are also needed on treatment regimens that include transmission blocking medicines.

Vector control will remain an essential part of defeating malaria, but health workers will need to learn about new technologies as these become available. They will need skills for better targeting of complimentary interventions like larviciding. Continual efforts to manage routing distribution of long lasting insecticide-treated nets must ensure that health workers have the skills and resources to follow-up and promote actual use of the nets for their intended purpose.

Vaccines and other new technologies will become available for controlling malaria. Health worker capacity building will be needed to ensure each of these new additions to the malaria arsenal are implemented in the most effective manner.

From the foregoing we can see that there are many reasons why the malaria community should observe World Health Worker Week now and continue to build health worker capacity to defeat malaria throughout the year.

Improving provision of malaria services through provider training in Burkina Faso

Colleagues[1] from Jhpiego’s Burkina Faso Improving Malaria Care USAID-supported project and the Johns Hopkins Bloomberg School of public Health are presenting a poster at the 64th ASTMH Annual Meeting in Philadelphia at noon on Tuesday 27th October 2015. Please stop by Poster 969 and discuss the results as presented in the Abstract below.

Staff to be trainedIn 2013, malaria was the main reason for consultation (53.90%), hospitalization (63.20%) and death (49.60%) in health facilities; children under 5 and pregnant women are most affected. Recent revisions to the World Health Organization’s (WHO) guidance to maintain effective approaches to defeating malaria, include monthly dosing of intermittent preventive treatment for pregnant women (IPTp), starting from the 13th week of gestation.

To align with the latest WHO guidance, the Burkina Faso Ministry of Health, with support from the USAID-funded Improving Malaria Care (IMC) project, revised national malaria guidelines in March 2014. 68 trainers from 9 health regions were trained on the revised national malaria guidelines.

From June to September 2014, 744 providers from 524 health facilities in 21 districts (33%) were trained on the prevention and management of malaria cases. To ensure updated guidance reaches all health workers, the training included a module on how to update colleagues in their respective facilities.

IPT coverage increases 2During supervision visits, most trained providers were using the new guidelines and pregnant women are increasingly receiving the third and higher doses of SP before delivery. In the first six months after the training sessions, pregnant women, who received the third dose of SP (IPTp3) increased from 0% to 12%. Three months later, that proportion rose to 30%. Comparatively, in the remaining 42 districts who received only the copies of the new guideline without training, IPTp3 was 5% nine months after receiving the guidelines.

The training sessions contributed to improving the implementation of revised IPTp guidelines and uptake of IPTp 3 and higher better than distribution of the new guidelines alone. As a result the IMC project will scale-up the training in Year 2 to 600 more providers from 464 health facilities, and other partners have also agreed to support the National Malaria Control Program to reach remaining facilities. Challenges in increasing IPTp uptake include commodity distribution and inadequate engagement of private health facilities to update their practices and reporting of SP distribution.



[1] Ousman Badolo, Stanislas Nebie, Moumouni Bonkoungou, Mathurin Dodo, Thierry Ouedraogo, Rachel Waxman, William R. Brieger

Inspiring Quality in Pre-Service Education on Malaria in Tanzania: Jhpiego at ASTMH

Monday at noon (3 October 2014) at the American Society for Tropical Medicine and Hygiene Annual Meeting in New Orleans, Jhpiego will be presenting two posters. Grace Qorro of Jhpiego’s Tanzania office has one entitled: #Quality Inspired Project – A Key to Achieving Results with Malaria Interventions.” Her abstract is shared below.

Tanzania Picture1With an aim to accelerate malaria case management, Tanzania Ministry of Health and Social Welfare (MoHSW) is strengthening its pre-service education program to ensure graduates have the right knowledge and skills to diagnose and treat malaria. Investment in pre-service education lessens the burden on in-service training since those entering the workforce will have the knowledge and skills they need to provide.

Maisha Picture1Jhpiego, through MAISHA (Mothers And Infants Safe, Healthy and Alive) program, provided technical assistance to the MoHSW to help develop a pre-service malaria case management-updates Learning Resource Package (LRP), which includes: Facilitator’s Manual, Participant’s Manual, Activity Worksheets and Training Modules addenda.

case management updates IMG_5901The LRP was developed based on national malaria policy, guidelines and in-service training materials; it is taught using job aids, power point presentations, video demonstration and numerous case scenarios which reflect what actually happens in real life situations at service delivery points. The LRP aims at reinforcing appropriate practices for care of malaria patients and management of commodities with emphasis on parasite-based diagnosis and compliance to results, proper recording and reporting; and management of malaria in special situations and groups.

Training manual IMG_5901The training package is well organized with laboratory and medical supplies which gives each participant an opportunity for hands-on activity to acquire and strengthen their skills. Checklists to guide Quality Assurance/Quality Improvement (QA/QI) processes have been included in these training materials.

The project successfully provided competence-based orientation on malaria case management updates to 210 medical instructors. Annually, it reaches more than 4,000 students from eight Zonal Health Resource Centers and 480 students from Medical Universities.

There is a need to incorporate the addenda developed into these training modules for easy use. In the near future, clinical skills-mentorship will be conducted in selected schools using the nationally approved QA/QI checklists.

Jhpiego at ASTMH: Performance Quality Improvement for IPTp in Kenya

Monday afternoon (3 October 2014) at the American Society for Tropical Medicine and Hygiene Annual Meeting in New Orleans, Jhpiego and USAID/PMI are sponsoring a panel on “Integrating and Innovating: Strengthening Care for Mothers and Children with Infectious Diseases.” If you are at the meeting please attend to learn more about our Malaria activities in Kenya.

Endemic areasOne of the panel presentations is “Performance Quality Improvement Lending to Corrected Documented Outcomes for Intermittent Preventive Treatment in Kenya,” by Jhpiego staff Muthoni Kariuki, Augustine Ngindu Isaac Malonza, and Sanyu Kigondu, who are working with USAID’s Maternal & Child Health Integrated Project (MCHIP).

According to Malaria policy in Kenya all pregnant women in malaria endemic areas receive free intermittent preventive treatment with SP have access to free malaria diagnosis and treatment when presenting with fever have access to LLINs (National Malaria Strategy (NMS) 2009–2017).

By 2013 80% of people living in malaria risk areas should be using appropriate malaria preventive interventions. Intermittent Preventive Treatment of malaria in pregnancy using Sulfadoxine Pyrimethamine (IPTp-SP) intervention is recommended for use in malaria endemic region.

PQI approachMCHIP broadly implemented Capacity Development and service delivery and improvement interventions that also had impact on the delivery of malaria in pregnancy services through collaboration with the Ministry of Health divisions/units at national level: (malaria, reproductive health, community health).

At county level scale up provision of IPTp at facility level took place in 14 malaria endemic counties. This included 8 counties in the lake endemic region including Bondo sub-county (the MCHIP model sub-county) and 6 in the coastal endemic region.

Quality Improvement through Performance Quality Improvement (PQI) process was instituted to enhance service delivery. The MCHIP era in Bondo Strengthened ANC Services using the following:

  • Development of MIP Standards-Based Management and Recognition (SBM-R) standards
  • Orientation of facility in-charges, supervisors and service providers on the standards
  • Monitoring of IPTp uptake using DHIS2 data
  • Feedback to facility in-charges and supervisors on DHIS2 findings
  • Collection of ANC data from ANC registers (2011-2013)
  • Feedback to facility in-charges and supervisors on ANC data

Quality improvement in the malaria in pregnancy component was undertaken with the objective to improve quality of MIP services including IPTp data management at facility level using PQI approach. An Example of a MIP SBM-R standard is seen below.

Sample StandardIn-service training focused on orientation of facility in-charges on PQI who then continued orientation at Facility Level. Overall we oriented 1200 facility in-charges and 100 supervisors on the standards. Facility in-charges cascaded orientation to 2,441 service providers.

ANC DataWe then analysed ANC data from DHIS (2011-2013) indicated proportion of pregnant women receiving IPTp2 was higher than IPTp1 (IPTp2+ doses reported as IPTp2 dose). We helped improve reporting by  service providers not oriented on use of the ANC register in order to reduce data errors.

In conclusion, PQI is a best practice in provision of MIP services. Standardization of knowledge among service providers is essential in provision of quality MIP services. Development of facility in-charges as mentors in the facility to ensure continued orientation of new service providers.

Use of appropriate monitoring tools is necessary to assist in assessment of quality of services provided including data management. Feedback to service providers is one of the performance rewards and encourages participation in knowledge acquisition



Improved Malaria Services in Malawi: Jhpiego and USAID at ASTMH

ASTMH 2014Monday afternoon (3 October 2014) at the American Society for Tropical Medicine and Hygiene Annual Meeting in New Orleans, Jhpiego and USAID/PMI are sponsoring a panel on “Integrating and Innovating: Strengthening Care for Mothers and Children with Infectious Diseases.” If you are at the meeting please attend to learn more about our Malaria activities in Malawi.

One of the panel presentations is “Improving Malaria Outcomes in Malawi: Focusing on Integration of Services at all Levels” presented by John Munthali, Senior Technical Advisor, Jhpiego/Malawi. John works with Support for Service Delivering Integration-Services (SSDI-S), a USAID bilateral program (2011-2016) with Partnerships in 15 Districts involving the Ministry of Health, Jhpiego, Save the Children International, Care Malawi and Plan International.

Malawi IPTpSSDI-Services focuses on Malawi’s Essential Health Package (EHP) Focal Areas with particular emphasis on Maternal Health, Newborn and Child Health, Family Planning and Reproductive Health, HIV/AIDS and TB, Nutrition and Malaria. Aspects of the Malaria Component include Intermittent Preventive Treatment and Insecticide Treated Bed Nets

SSDI-S is based on Promotion of the continuum of care from household to hospital. Health Facility Approaches address Improved Technical Capacity of Health Workers, Functional Health Facility, and Data-informed Decision Making. Community Approaches involve Improved Technical Capacity of CHWs, Functional Village Clinics, and Community Mobilization. Integration is a major concern such that there are no missed opportunities of EHP services at all levels.

Positive Trends since have been seen since Inception. Malaria in Pregnancy interventions supported the National Malaria Control program to review the Malaria in Pregnancy guidelines and training manuals to adopt the new WHO policy recommendations. 74 Trainers were trained in all 15 districts. MNCH services were established in selected districts. 344 HSAs were trained. 70 community-based Core Groups oriented on MNCH. SSDI supported ongoing MNCH activities through review meetings and distribution of reporting forms.

Malawi IPT2 improvementsAs a result of these integrated high impact interventions there has been a remarkable increase in the uptake of IPTp 2 (16% in June 2012 to 64% in Sept. 2013) by pregnant women in the SSDI-services focus districts. Central to this increase is the integration of services at the facility level where malaria has been highly integrated into maternal, newborn and child health. The project has also seen IPTp 1 uptake maintained at above 91% in all the 15 districts

Malaria Care capacity building has resulted in improved iCCM services delivered by Health Surveillance Assistants (HSAs) at village clinics. iCCM is serving as the foundation for community-based treatment of malaria by HSAs while at facility level IMCI provides an integrated approach to manage childhood illnesses including malaria.

In conclusion, it is feasible to integrate MNCH programs at all levels using SBCC and Systems Strengthening. Having an integrated project looking at the whole spectrum of health services (system strengthening, service delivery and behavior change) can help improve programming & service delivery.

MIM/TDR Grant Alumni Make an Impact

MIMDuring his talk in the final sessions of the MIM2013 6th Pan African Malaria Conference Dr. Olumide Ogundahunsi of WHO/TDR Geneva, highlighted four people who have demonstrated the multiplier effects of MIM research grants. Below are Dr. Ogundahunsi’s remarks.

In 1999, Lizette Koekemoer obtained her PhD from Witts.  Her first independent research grant was in 2003 and between 2004 and 2007 she was supported by MIM to study insecticide resistance in Anopheles arabiensis in southern Africa. She subsequently receieved funding from the national and international agencies to support her work on insecticide resistance mechanisms and novel control interventions.  She now heads the  Vector Control Reference Laboratory (VERL), National Institute For Communicable Diseases (NIED) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa

CAM01488 SamSam Awolola obtained his PhD from the University of Ibadan in 1997 and received a grant to support his research on insecticide resistance of the malaria vector mosquitoes in Nigeria from MIM/TDR in 2003 after his post doc in South Africa. He subsequently received research grants from the welcome trust, European Commission and several other agencies.  He is currently the Deputy Director (research), Coordinator Malaria Research Program at the Nigerian Institute for Medical Research and chairs the indoor residual spraying subcommittee of the National Malaria Elimination Program In Nigeria.

Eric Achidi obtained his PhD in 1994 at Ibadan, Nigeria.  He was supported by MIM & TDR from 1998 to 2009 and over time has successfully competed for and received grants from WT, EU, FNIH.  He is presently the Vice Dean Faculty of Science at the University of Buea Cameroon … an institution that did not feature in the 3 publications per year list of the 1999 WT report.

Jane Chuma is one of the more recent recipients of capacity building support from MIM.  She obtained her PhD in 2006 from the University of Cape Town and received MIM support about the same time to study access to effective malaria treatment and prevention among the poorest groups in Kenya. She is now a researcher at the KEMRI-Wellcome Trust Research Programme where she is working on health financing for universal health coverage with funding from the Wellcome Trust and DfID. She supports the health financing task group in her country, helped initiate the establishment of a masters in health economics and policy at University of Nairobi and supports researchers in various countries in their work on health systems and health financing.

These are among the 90 plus MIM alumni, the vast majority of whom have remained in Africa and resisted the pressures of brain drain.  Our congratulations go to MIM-TDR with hopes that other agencies can step up and match this track record.

Looking toward Generation F3 and Beyond – Sustaining Malaria Research Capacity in Africa

Olumide Ogundahunsi, of WHO/TDR Geneva, Switzerland provided a look back and toward the future of the Multilateral Initiative for Malaria (MIM) during one of the final plenary sessions at the MIM2013 6th Pan-African Malaria Conference in Durban.  Excerpts from his talk and slides are presented below…

Sustaining research capacity aTwenty years ago, we were asleep, malaria elimination was a dream, and the reality was a nightmare.  After the serial failures of the malaria eradication campaign in Africa, malaria control was barely moving along. But today we are wide awake, it is not yet “uhuru” as far as malaria goes but we are making gains having learnt the importance of combined interventions, we are applying them with success in a number of places.

However, there is still some distance to go in this war and many battles ahead.  To quote one of the plenary speakers during this conference, “the fight against malaria can only be won by well-trained people” (Dr Robert Newman).  …..

  • People who have the necessary capacity to optimise the available tools and develop new ones.
  • People who are embedded in the endemic countries
  • People who know and understand the contexts in which the tools and interventions will be deployed.
  • Communities empowered to implement and sustain interventions

The issue I would like to ponder in the next half hour is how we ensure that we have enough of these people to do the job!

pub research papers aThe last time we were in Durban (as the MIM), the Welcome Trust, the MIM secretariat at that time, had just published a comprehensive report on malaria research capacity in Africa.  The report included data on for example the number of African institutions publishing more than 10 malaria related papers in the 3 years preceding the report – a mere 15 in the whole continent! This has changed significantly in the past 14 years to 38 Institutions.

Fifteen years ago only a handful of agencies and programs were interested in research capacity strengthening and there were even those who considered capacity building poor investments…..the situation has of course changed since and the members of my generation – the so called F2 generation who were either graduate students or post docs at that time maturing as

  • Established researchers in reputable and highly successful institutions
  • Working in Africa and meeting the challenges of working in a challenging environment
  • Highly motivated scientists recognised by their peers and the international scientific community
  • Contributing to research and control of malaria in their countries and the continent

 Of the 90 plus researchers in the F2 generation only 4 are no longer working in Africa.  They remain committed and well recognized experts in their fields.

CNRFP aThere are also several institutions that have evolved in the past 14 years because of support for RCS…. Noguchi Memorial Institute or medical research in Ghana and the health research facilities in Kitampo, Bagamoyo, Centre Muraz Bobo Diolasso and the Centre Nationale de Recherche et de Formation Paludisme (CNRFP) in Ouagadougou.   CNRFP received the first grant in 1999 (slide 11) to study the relationship between malaria transmission intensity and clinical malaria, immune response and plasmodic index. The institution has since grown from a modest staff of six in 1999 to 36 currently.

It has acquired well established capacities for operational / implementation research, clinical trials and studies on vector management (slide 113, and funding from several international partners.

These stories illustrate how capacity is being built in Africa not only by WHO/TDR and the MIM but also MCDC, the WT, EDCTP/EC, the NIH, BMGF and SIDA/SAREC among others.

Is this enough? And can we rest content on the success and contributions of the current generation of African malaria researchers?  Is the capacity adequate?

It will be naive to look at Africa as a single entity as is often done.  The capacity (human resource and infrastructure) for research and control against malaria does not match the burden or the scope of the battle.  There are still places where there are:

  • Limited human resources
  • Lack of infrastructure
  • Funding disparity
  • Limited access to technology
  • Limited interactions between the research and control communities

CNRFP Scientific staff aThe last of these….. “limited interactions between research and control communities“ in particular pose a significant barrier to effective deployment of interventions and strategies.

It is not enough to prove that a strategy or an intervention works (often in a controlled setting).  In the real life context, there are multiple factors ranging from the quality and structure of the health system, to culture, the political, and the socio economic  that impact on our ability to effectively implement or scale up for impact.

The next generation of malaria researchers in Africa must be able to better address this gap if we must extend the frontiers of malaria elimination and shrink the malaria map further.

I can say most of the current generation (my generation) stood on the shoulders of an older generation of African scientists and their collaborators in other continents (someone referred to them as baobab trees a few days ago), the exposure, training, mentorship and the opportunities they created following Dakar have helped us along……

However when you consider the proportion of Africans speaking at the plenaries during this conference and the number of young scientists and graduate students attending as a whole, I think we have still have a long way to go!

How can we foster the next generation and further strengthen capacity for malaria research in Africa – within the unique context of each country.

As I conclude I want to reflect on the African perspective of training needs and solutions. 14 years ago in identifying enhancers of developing and maintaining a research career in tropical medicine in Africa, we put forward the following:

  • Research funding
  • Research infrastructure
  • Communications
  • Better salaries and career development
  • High quality training

To this I could add one more …. Mentoring

CAM01526 smThese issues remain highly relevant and must be continuously addressed if we are to sustain and indeed improve malaria research capacity in Africa.

Since the creation of MIM, we have seen an increase in research funding in Africa, emergence of centers of excellence, better communication and collaboration to a large extent driven by the global it boom. Better salaries, career development and high quality training!

However in general, funding for research including operations research (and capacity building) in Africa is to a large extent dependent on external funding.

National efforts at capacity building are to a large extent limited to statutory funding for graduate, postgraduate and diploma programmes. Beyond this there is little funding for post-doctoral research training, operational research within programs or innovative product research and development.

In the more than almost one and a half decade since the global community committed to Roll Back Malaria, we have had malaria initiatives from presidents but the human resources to under pin these efforts remain inadequate. We have to do better in capacity building so that 10 years down the road, there is a new generation of well-trained people embedded in the endemic countries with the capacity to optimise the tools and develop new ones if necessary.  Now is the time ……….

  • To lobby and convince African political leaders and governments to invest in research and capacity building
  • To convince the African billionaires who feature in Forbes list to invest in African scientists
  • And to the senior, successful and established African scientists and managers…. It is time to invest in younger talent as mentors.

In 1997, MIM was in the vanguard of an effort to address the issues of

  • Research funding
  • Research infrastructure
  • Communications
  • Better salaries and career development
  • High quality training

Bringing these issues to the attention of the international community and in some cases providing inputs to address them is still an important part of the MIM agenda.

The MIM is even more important now as an advocate for research and capacity building in Africa. WHO/TDR will work with the MIM secretariat to conduct an independent review of the MIM for continued relevance and contribution to the fight against malaria.

Where are human resource capacity issues addressed at MIM2013

MIM2013 is at its half-way mark. Ironically the issue of the number, the quality and the location of human resource capacity for malaria programming has not been explicitly addressed in the program.

Sure, individual speakers had talked a bit about personnel needed for vector control, community case management, diagnostics, among others, but few specific session – symposium, plenary or parallel paper presentations- were titled in a way that focused conclusively about the people who are needed to achieve these program tasks and goals. There were even two parallel sessions on health systems strengthening, but these addressed such topics as changing prescribing practices, vaccines and treatment seeking.

One looked forward to human resource issues being raised in a session that addressed task shifting in malaria prescribing and in capacity for designing clinical trials for vaccines. This was overwhelmed by the plethora of presentations on vector issues that did not include a specific presentation on adequacy and skills of entomologists in endemic countries.

Fifteen years ago the Roll Back Malaria partnership recognized that malaria targets could not b achieved unless malaria programming went hand-in-hand with health systems strengthening.  Malaria services were seen as an integral part of basic primary health care and the people, staff and volunteers who provided PHC.

Conference speakers recognize the financial and logistical factors that make coverage, let alone achieving a complete cure and complete prevention as described by Dr Magill challenging. Yet this is not enough. Who are the people who will provide these complete interventions, how will they be trained, and where will they be posted?

One MIM conference participant observed that conference panels were dominated by too many older, non-African scientists.  This reflects either an oversight by conference planners of the reality that we lack enough African health and research personnel to take the lead in eliminating malaria. We are particularly concerned for the special people and skills needed to apply appropriate surveillance and lead us to malaria elimination.

It will be too late to address these human resources issues by the next MIM conference.  Hopefully in the meantime countries will plug into the ongoing moves to strengthen human resources for health and ensure that they have enough well trained people to diagnose disease, manage cases, prevent transmission and track malaria, This needs to be addressed through both in-service and basic pre-service training programs.

Human Resources for Malaria

Two major international meetings are coming up in the next two months. One if the Multilateral Initiative for Malaria’s 6th Pan-African Malaria Conference (MIM2013) and the Third Global Forum on Human Resources for Health.  Neither apparently cross-reference the other.  None of the Plenary Sessions or Symposiums at MIM2013 explicitly address the crucial need of appropriate human resources to eliminate malaria, though we are sure it will be woven in to several presentations.

Nigeria CDD performs RDT in Upenekang Community Ibeno LGA Akwa Ibom State 2One of the most prominent focal points for malaria human resources arises from the effort to expand integrated Community Case Management (iCCM). The American Journal of Tropical Medicine and Hygiene features a special supplement launched at its 2012 annual Conference on iCCM.  The most interesting aspect of the iCCM movement is the innovative task shifting that is occurring to bring malaria and other disease solutions to the grassroots through a variety of auxiliary health workers and community volunteers. It has become clear that malaria treatment coverage cannot meet targets  – either the 2010 Roll Back Malaria goal or 80%, let alone the push toward universal coverage – without involving non-formal providers such as volunteer community health workers (CHWs) as well as patent medicine shop staff.

But finding human resources for treatment tasks is only the tip of the iceberg.  A variety of health workers are needed for malaria work in the areas of entomology/vector control, health information systems/surveillance, and laboratory/diagnosis, to name three.

The Global Health Workforce Alliance did issue a report in 2011 that questioned the ability of countries to meet Millennium Development Goal number 6 – reducing the inpact of HIV, TB, Malaria and other endemic diseases. Issues such as the distribution of health workers in a country were raised – especially the challenge of meeting the needs of rural areas where malaria is more common.

Training has a major role to play. When Jhpiego/MCHIP began a 3-year effort with USAID to improve malaria services in Burkina Faso in 2009, they found a need to provide in-service training on malaria for newly graduated nurses and midwives. An examination of the curricula of the various cadres and branches of the National School for Public Health (ENSP) found a paucity of malaria content, especially content that reflected current national malaria guidelines from the Ministry of Health. This led to work with the ENSP to set up a planning committee to update the malaria components of its curricula.

DSCN3798 Ghana smWHO has a variety of training materials on issues and cadres ranging from strengthening malaria laboratory workers, entomology and vector control staff, as well as the basic training of health workers involved in malaria case management.

In addition to issues of health worker number are the issues of retention and performance quality. Researchers in Kenya are undertaking a study that will test whether a pay-for-performance (P4P) will improve malaria case management. Pay incentives might aid retention as well as improve quality of care. We need more such efforts to tackle the coverage gaps in malaria service delivery.  This also means addressing the human resource gaps among malaria researchers in national institutes and universities in endemic countries.

We need to use every forum available to discuss human resources for malaria control, elimination and eradication. The scourge of malaria will linger as long as we lack the quantity and quality of human resources to fight the disease.

Nigeria Midwives Scheme May Help Control Malaria

Nigeria has introduced the Midwives Service Scheme (MSS) through its National Primary Health Care Development Agency (NPHCDA) to meet the needs of women and children served by basic primary health care clinics rural communities. There is hope that the scheme will help to address the country’s high maternal mortality rate, which according to the 2008 Demographic and Health Survey, averages 545/100,000 live births, but ranges widely across the country’s six health zones from 165 to 1549.

maternal-mortality-rates-across-health-zones-2008-sm.jpgNigeria used to have separate midwife and nurse training, but some years ago midwifery became a specialty area for nursing training, not a stand alone profession. Fortunately the Nursing and Midwifery Council of Nigeria maintained its name and is now an active player along with the NPHCDA and the Society of Gyneacology and Obstetrics of Nigeria (SOGON) in reintroducing and strengthening the training of midwives.

The first batch of the new midwives graduated in 2006. The intention is that up to four midwives will serve a basic primary health clinic (PHC) enabling 24-hour delivery services.

The NPHCDA conducted a baseline survey recently in 652 PHCs throughout the country where the midwives are or would be serving.  Of interest to malaria control, the study reported that 73% of these facilities offered Intermittent Preventive Treatment with sulphadoxine-pyrimethamine to pregnant women, and only 48% provided insecticide treated bednets.

Providing a cadre of health workers focused women and children is an important step in malaria control. Ensuring that these staff have the resources to prevent malaria during and after pregnancy must be part of the total package.