Getting to Zero: An Overview of the Southern Africa Malaria Elimination Support Team

1. Getting to Zero: An Overview of the Southern Africa Malaria Elimination Support Team Rwanda Malaria Forum 26 September 2012 Southern Africa Malaria Elimination Support Team

2. Evolution of CHAI Malaria – We have grown in strategic areas, countries and numbers CHAI Malaria Staff: WorkingAcross ~13 Countries # of people thinking about malaria all the time in CHAI Year

3. Overview of CHAI MCT CHAI MCT in the global malaria community: Providing unique country support to achieve maximum impact with limited resources Challenges CHAI MCT • Increase access to ACTs in the public and the private sector • Provide management assistance to ensure robust strategic/operational planning and mobilize financial resources • Increase access to quality diagnosis at all levels of the health care system • Making the case for sustained malaria financing and exploring/testing novel funding mechanisms • Limited access to ACTs, the recommended first line treatment • Limited management capacity and financial resources in low endemic countries that aim for malaria elimination • Very low proportion of parasitologically confirmed malaria cases • Decrease in malaria funding in countries that have achieved low endemicity AMFm Evidence Generation & Research SAMEST Diagnosis Financing CHAI LST CHAI DAT

4. Countries in sub-Saharan Africa are making historic progress in reducing malaria morbidity and mortality Countries in sub-Saharan Africa that cut malaria cases by over 50% over the last decade Swaziland Namibia WHO, World Malaria Report 2011 Swaziland and Namibia HMIS, 2012

5. In 2007, recognizing the considerable progress made in southern Africa, SADC approved a regional framework for malaria elimination Southern Africa Malaria Elimination Support Team (SAMEST) Global advocacy and dissemination of evidence to advance global understanding of elimination Strategic planning and direct management support to NMCPs/MOHs reorienting towards elimination

6. However, gaps remain in areas that are critical to an Elimination Program.SAMEST aims to help the MOH/NMCP to overcome these challenges and reduce local transmission to ZERO. Critical Operational Elements of an Elimination Program Reduced local transmission

7. As malaria decreases, diagnosis and surveillance become essential to identifying the number , type and location of actual cases and appropriately responding to these “hot spots” Swaziland How many true malaria infections are there that could potentially lead to onward transmission? Uganda Cohen , J and Swaziland NMCP, 2011 Stensgaard A, Vounatsou P, Onapa AW, et al. Malaria Journal 2011

8. SAMEST provides targeted support to countries to plan for and rapidly scale up critical operations for elimination

9. Priority Area of Work 1: Diagnosis Impact in Namibia SAMEST Support Increase in proportion of fevers tested • Support MOHs on the development/ revision of diagnosis and treatment policies to align with current WHO recommendations • Design and scale up fully functional QA diagnosis systems • Improved case management training, mentoring/monitoring visits, SOPs, SMS reminders, cross-checking of RDTs • Support the introduction and increased access to community case management 96% reduction in RDT- cases treated with ACTs

10. Priority Area of Work 2: Surveillance For elimination purposes, a malaria case is a person in whom, regardless of the presence or absence of clinical symptoms, malaria parasites have been confirmed by quality-controlled laboratory diagnosis. A Paradigm Shift for Surveillance Infections Clinical Cases Interventions during elimination programs are based on the concept of a malaria focus, assuming that transmission is focalized and no longer homogeneous across the country. Targeting Foci Universal Coverage

11. Elimination: A Paradigm Shift for Surveillance SAMEST Support • Support risk mapping and integration of GIS into program activities • Introduce and scale up active surveillance systems – identify most effective ACD and case investigation strategies • Identify incentive mechanisms for the private sector to ensure adherence on reporting and case management guidelines

12. If the same intervention coverage is achieved everywhere, results will vary with the baseline

13. To achieve uniform results given different baselines, intervention coverage would have to be proportional to the baseline

14. CHAI Malaria Financing Work

15. Goal of malaria financing work: Sustained, predictable financing for more impactful malaria programs “More health for the money” Increase efficiency & effectiveness of available financing Sustainability Malaria financing need Malaria available funding Sustainability looks to optimize two sides of the same coin – the demand for funding, and the supply of funding “More money for health” Ensure adequate and predictable financing

16. “More money for Health” Revenue Generation - there are two main categories of mechanisms that expand the fiscal space of the health sector. Development loans Development Assistance (grants) Private sector Raise more money from new sources Domestic revenue collection Ministries of Finance Ministries of Health Taxes Debt relief Use the money in more effective mechanisms that increase predictability Results based financing Trust funds Budget support Risk pooling Sustainable health financing

17. The following examples may be available as options to countries looking to sustain domestic financing for malaria 1 2 3 4 5

18. “More Health for the Money” Efficiency and Effectiveness The Challenge • There is minimal guidance for countries on the optimal balance of interventions needed to maintain low malaria prevalence in areas with reduced but non-zero risk. • Efficiency and effectiveness is not just about cost savings, but about optimizing resources to maintain the gains. Our Objective • Provide guidance on cost-effective operational strategies to maintain reductions in malaria burden in different contexts Our Goal • To increase efficacy and effectiveness of available resources

19. Thank you!