Background:
Over the past few years, CHAI has been working to integrate a gender lens into our malaria strategy. Here, we share our experience with introducing the Malaria Matchbox Tool in three African countries. We supported the use of this tool to integrate a gender lens in our work to answer these critical questions:
- What impact do equity dimensions, including gender, have on progress toward improved health outcomes?
- How do we structurally account for them in our work?
Introducing the Malaria Matchbox Tool:
The Malaria Matchbox Tool is a gender equity assessment toolkit created by the Roll Back Malaria (RBM) Partnership and The Global Fund (GF). It is designed to empower programs to examine discrepancies in access to and uptake of lifesaving malaria services. These services include insecticide-treated bed nets and indoor residual spraying. Moreover, programs can use the tool to assess whether people are actively choosing not to use services or if there are social/historical barriers preventing their access.
The Malaria Matchbox Tool has five overarching principles:
- Multi-stakeholder engagement
- A gender-responsive approach
- A rights-based approach
- Evidence-driven decision-making
- Taking action
The framework is divided into pre-assessment and assessment phase. Each phase has clear modules to guide governmental and non-governmental partners through the process of investigating which groups are most invisible to and unreached by malaria services and why? The framework then guides stakeholders to explore solutions that actively account for these discrepancies. These may include gender inequities, socioeconomic vulnerabilities, and other factors keeping certain malaria interventions out of reach of women and girls.
While geared toward malaria, the line of questioning and methods that the Malaria Matchbox Tool facilitates is one that all disease programs can and should use.
CHAI’s work with the Malaria Matchbox Tool:
CHAI conducted equity assessments in partnership with the ministries of health of Benin, Burkina Faso, and the Democratic Republic of Congo. In all three countries, CHAI first secured political commitment from the National Malaria Control Program (NMCP)’s senior leadership to ensure they will use the assessment findings. The team also timed the Malaria Matchbox assessments with the Global Fund application cycle (GC7). As a result, the countries used the findings for their grant applications. Key insights from the processes in the three countries are shared below with a deeper dive in DRC.
Malaria Matchbox Tool: DRC
In DRC, there is limited local information on issues of equal access to and uptake of malaria prevention and care across the population. To date, DRC has never conducted research directly examining how the risk of exposure to malaria and access to services correlates with gender. The Malaria Matchbox Tool process found no evidence of gender being used in data disaggregation and analysis to inform malaria program strategies and decisions. At the time of the assessment, DRC did not have any specific interventions addressing human rights and gender inequities within its national malaria program.
CHAI actively ensured the malaria matchbox toolkit process and findings informed the country’s Global Fund application. Data collected found barriers faced by different groups across six areas:
- Knowledge, attitudes, practices, and beliefs about malaria and malaria interventions
- Health-seeking behavior
- Physical and environmental obstacles
- Financial obstacles
- Negative experiences with health centers
- Broad influence of gender norms
CHAI used the Interagency Gender Working Group (IGWG)’s Gender continuum to assess the extent gender was integrated into DRC’s malaria programs, policies, and strategies over the past few years.
Equity gaps in DRC
The assessment phase found serious equity gaps in access to and uptake of malaria interventions in the country:
CHAI facilitated the integration of equity-facing interventions into the country’s Global Fund grant. Moreover, we suggested incorporating priority actions into the country’s 2024 Malaria National Strategic Plan. CHAI also developed and proposed gender indicators for integration in the NMCP’s malaria monitoring and evaluation (M&E) framework.
Download the DRC Malaria MatchBox Tool Report (French)
Malaria Matchbox Tool: Benin & Burkina Faso
Benin and Burkina Faso underwent a similar process and received strong support from their respective NMCPs. CHAI participated actively throughout the process in Benin and during the draft reporting stage in Burkina Faso.
In both Benin and Burkina Faso, the Malaria Matchbox Tool process helped to identify areas vulnerable to violence and natural disasters. It also uncovered the unique challenges directly impacting progress toward national malaria goals faced by local populations.
Limiting factors
We found the following limiting factors:
- Limited decision-making power of girls and women regarding where and when to access healthcare
- Unequal levels of malaria knowledge and access to malaria interventions across genders
- Poor suitability of traditional vector control methods for mobile populations
- Inadequate engagement of traditional practitioners in malaria prevention and care
- Unreached populations within insecure areas and prisons which were, at the time, absent from national malaria strategies.
Similar to DRC, these exercises encouraged key stakeholders in Benin and Burkina Faso to identify and prioritize solutions that are responsive to the needs of the most vulnerable. The assessments prompted the following investments:
- Biannual meetings with humanitarian actors on malaria prevention and case management
- Training of targeted traditional practitioners on recognizing signs of severe malaria
- Strategies to improve irregular preventive treatment with sulfadoxine pyrimethamine and pre-natal consultation for incarcerated pregnant women. This involves collaborating with the Ministry of Justice to include prisons in mass campaigns and vector control activities and
- Engagement with military camps in insecure and flood-prone areas.
Download the Benin Malaria MatchBox Tool Report (French)
Download the Burkina Faso MatchBox Tool Report (French)
Challenges associated with the process
Teams supporting DRC, Benin, and Burkina Faso found multiple challenges throughout the Malaria Matchbox Tool assessment. All three countries found securing funding, both for carrying out the assessments and closing identified gaps, highly challenging. In addition, countries struggled to convene stakeholders and identify country champions to lead the process. Finally, teams developed context-appropriate accountability frameworks, and M&E plans to track progress. These are critical to ensure CHAI can follow up to determine whether these efforts made a difference.
Conclusions
Health programs need to incorporate equity assessments to ensure health services reach the most marginalized with lifesaving interventions. The Malaria Matchbox Tool is one of such assessment tools. Other toolkits include the WHO’s Health Equity Assessment Toolkit and the UN’s Leaving No One Behind tool.
The Malaria Matchbox Tool was effective in identifying gaps in access to malaria interventions to people in most need— women, children, and the vulnerable. In addition, it highlighted gaps in data needed to strengthen the quality and availability of services. Our experiences in Benin, Burkina Faso, and the DRC indicated the need to partner with government stakeholders in every step of implementing the toolkit.
Please reach out to either of the Gender Equity Network (GEN) co-chairs, Maimouna Lehman Mohama or Sharon Muhwezi, to learn more about equity assessments and their applicability to your program.
