Category Archives: Strategy

Jhpiego at 40 – commitment to malaria prevention and control in Burkina Faso

Jhpiego 40th Anniversary celebration in Ouagadougou with First Lady, US Ambassador, Minister for Health and Jhpiego's President and Vice President

Jhpiego 40th Anniversary celebration in Ouagadougou with First Lady, US Ambassador, Minister for Health and Jhpiego’s President and Vice President

Jhpiego was founded in 1973 to provide technical assistance to countries where the risk of maternal mortality and morbidity was quite high.  While focusing on local capacity building from the start, Jhpiego’s model for technical assistance has evolved.  Burkina Faso first benefitted in 1983 by having health staff attend intensive training at Johns Hopkins Hospital.  Subsequently Jhpiego’s work moved to the field, and some of the early trainees became staff on the ground.

Jhpiego established an office in Ouagadougou in 1996, and one of the earliest projects focused on malaria in pregnancy as part of USAID’s flagship program “Maternal and Neonatal Health” (MNH).  It was during that time that Jhpiego collaborated with partners like CDC to do some of the early testing of the intermittent preventive treatment of malaria in pregnancy (IPTp) in West Africa.  The results of this life-saving intervention were published in the American Journal of Tropical Medicine and Hygiene.

Jhpiego continued to provide technical assistance on malaria in pregnancy interventions and capacity building to the Ministry of Health (MOH) in Burkina Faso through the MNH project and into its successor, USAID’s ACCESS project. Jhpiego worked with partners to update malaria guidelines, training materials, supervisory tools and job aids during this period.

Cover Page Directives finalisées du 23 5 2013In 2009 USAID presented the Maternal and Child Health Integrated Project (MCHIP) with the opportunity to carry out an integrated package of malaria care and prevention strengthening with the MOH and particularly the National Malaria Control Program (NMCP). Over a period of three years Jhpiego, the lead organization in MCHIP, working with together with partners from the NMCP and MOH, was able to accomplish among others the following:

  • Updating Malaria policy and guidelines
  • Updating Malaria supervisory tools and training of supervisors
  • Updating In-service training materials on malaria and training of health facility staff
  • Developing a Strategic communications plan and strategy for malaria
  • Forming of curriculum update committee on malaria at national training schools for primary health staff
  • Training of US Peace Corps Volunteers to support malaria activities in their communities
  • Building the capacity and organizational strengthening for the NMCP itself
  • Conducting a situation analysis of rapid diagnostic test acceptance and use
  • Undertaking a health systems analysis of the strengths and bottlenecks of malaria program implementation in Burkina Faso

Jhpiego 40th Malaria BoothLast week, the Burkina Faso office of Jhpiego hosted the organization’s African Malaria Technical Update Workshop with staff from 15 countries participating. Today Jhpiego is taking its 40th Anniversary celebrations to Ouagadougou.  Jhpiego will express appreciation to local partners in the fight against malaria and threats to maternal and child health.

Jhpiego has been committed on the ground in Burkina Faso to building national capacity for controlling malaria specifically for over 15 years. The recent award by USAID of its bilateral program “Improving Malaria Care” to Jhpiego last October cements Jhpiego’s commitment to the country and to reducing malaria for another five years.

Taking malaria capacity building to scale: Lessons on an Integrated Policy Package from Burkina Faso

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Presented at Jhpiego’s Mini-University, 24 June 2013 in Baltimore by Bill Brieger, Rachel Waxman, Elaine Roman and Ousmane Badolo

Between October 2009 and March 2013, with support from the USAID Malaria Program, the Maternal and Child Health Integrated Program (MCHIP), led by Jhpiego  has worked in close collaboration with the National Malaria Control Program (NMCP) and the Family Health Directorate (MCH) to accelerate malaria prevention and control in Burkina Faso with a focus on nationwide scale up.

steps-to-scale-up-in-burkina-sm.jpgScale up is defined as program coverage nationwide.  During the project years, Jhpiego provided technical and programmatic support to address comprehensive malaria prevention and control with a focus on diagnostics, treatment, and malaria in pregnancy (MIP) in Burkina Faso.  This resulted in: 2,648 health facility providers trained using the integrated malaria training package; these providers in turn, oriented 4,867 of their colleagues.

Other key components of technical support included strengthening- a) supportive supervision; b) pre-service education; c) human capacity (team building); and d) communications and behavior change guidance at national level as well as targeting communication messages to both health facility providers and clients.  Training is US Peace Corps Volunteers helped reinforce that this guidance reached front line health facilities and volunteer community health agents.

Some of the lessons learned in going to scale are balancing reaching providers en mass with quality support; ensuring a link between revised policies and guidelines and both pre-service education and in-service training; and recognizing the need for national level leadership and capacity to ensure effective implementation.

As countries accelerate and scale up their malaria programs, the lessons learned from Burkina Faso a systematic development of an integrated package of malaria policies and guidelines are important to consider moving forward.

Can We Simplify Malaria History?

Scientific American is known for making the latest scientific advances – from dark matter to disease management – accessible to a wide audience.  An article in the November 2010 issue on malaria vaccine progress is generally a good example. The following passage though, may simplify the history of eradication a bit too much.

In the 1960s an enormous campaign wiped out the disease in many parts of the world and drove down its number in others. But that success ultimately bred its own end. As malaria became perceived as less of a threat, global health agencies became complacent; their chief tool, DDT, was found to be toxic to birds, and they largely abandoned their efforts. Malaria numbers roared back more fiercely than before.

sciam-mal-vaccine-research.jpgTwo specific issues from the foregoing do not paint the full picture. First, bird deaths did not stop malaria eradication, though the toxicity issue is true in its own context. The real end of DDT was bred by mosquitoes developing resistance to the pesticide, which was discerned even before the campaign reached its height. The Lancet in reviewing Randal Packard’s book, The Making of a Tropical Disease, a Short History of Malaria, explained that …

It (the eradication campaign)was far too monodimensional, relied too much on DDT spraying, and neglected the palpable problem that the delivery infrastructure was not in place in too many parts of the malarious world. The emergence of widespread mosquito resistance to DDT, and parasite resistance to the cheap mainstay of therapy, chloroquine, compounded the difficulties.

Secondly, at least for colleagues in the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), malaria research overall did not halt. Surely the funding levels were not as high as we see today, but persistent research provided us with new tools including insecticide treated bednets, artemisinin-based combination therapy, and nearly a dozen insecticides for indoor residual spraying, for which we are thankful.

True, these additional tools do not confer permanent immunity as a vaccine eventually should, but their implementation has driven down the number of malaria deaths in many countries, and when a vaccine comes along to strengthen the toolkit, we will be farther down the long road to elimination. The malaria lifecycle is complex, and health systems designed to deliver malaria interventions is equally complex (and challenging), which means we cannot  and should not expect a magic bullet in the near future.

As Randal Packard pointed out a key lesson from the first eradication campaign needs repetition, lest we again blame it all on the birds. Aside from developing insecticide resistance, there was clear indication that the health systems in the most highly endemic areas were not able to maintain continuous IRS application.

Health systems are stronger today, due in part to recognition by partners (international and internal) that malaria cannot be controlled, much less eliminated, without health system strengthening. It is these same health systems that will also be required to deliver the new malaria vaccines, so they better be strengthened before vaccines are rolled out.

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Another short note of concern about the Scientific American article – in a box entitled “Plan B: Vaccine Alternatives” we are correctly shown that the effort to eliminate malaria has other tools that must be sustained. Unfortunately the text refers to malaria as a ‘virus’, though elsewhere in the article the stress on ‘parasite’ prevails.

Kenya Launches National Malaria Strategy 2009-2017

If you want to walk fast, walk alone
If you want to walk far, walk together
  (Maasai Proverb)

kenya-strategy-sm.jpgWalking together in partnership was the theme of the launching, held last night, of Kenya’s second national malaria strategy covering the years 2009-2017.  Officials from the Ministry of Public Health and Sanitation acknowledged throughout the ceremony the value of  partnership with the donor, research and civil society communities.

The document had been one year in the making and is accompanied by the Kenya Malaria Monitoring and Evaluation Plan for the same years. Dr Elizabeth Juma, who heads the Division of Malarial Control explained that the two documents are based on an extensive Malaria Program Performance Review, so that it is not a theoretical exercise.

In his keynote address Dr. James Gesami, the Assistant Minister for Public Health and Sanitation, reported that Kenya has made substantial progress in reducing child mortality and hospital admissions for malaria by to date distributing 90 million nets, prescribing 41 million doses of ACTs and protecting 8 million people in targeted areas with IRS.

kenya-malaria-risk-map-2009.jpgA new feature of the strategic plan is to make future targeting of these interventions more epidemiologically appropriate based on a new map of malaria prevalence across the country. Dr Gesami said we have fallen short in the past of adequate documentation. Therefore, M&E is intended an a strong companion to the Strategy so that intervention can be monitored and impact measured.

Partnership at all levels was seen as the way to achieve the goals of the new strategy – involvement is needed of the public health sector, the private health sector, civil society, research institutions, donors, the communities and other public and private sector agencies such as agriculture and education. An example of the latter is the malaria free schools initiative enshrined in the Strategy. In short, “Malaria control is not the preserve of the Health Ministries, but is the responsibility of all of us.”

Speakers acknowledged that there are areas where past performance could be better, such as providing Intermittent Preventive Treatment to pregnant woman. There was hope though that the Strategy will guarantee a uniformity of purpose among all partners to achieve targets and result in a malaria free Kenya by 2017.

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