Bill and Melinda Gates’ call in 2007 for a global commitment to eradicate malaria increased enthusiasm and political will in countries throughout Latin America, southern Africa, and the Asia-Pacific region to help achieve this important goal. Many countries, including those with a high malaria burden, have in turn declared national goals of eliminating the disease permanently. While political will and national commitment are essential to create an enabling environment for such ambitious health goals, countries face challenges applying currently available tools in a sufficient manner to accomplish malaria elimination.
For the last three years, CHAI has worked to develop relationships to provide operational and technical assistance to national programs pursuing malaria elimination across three continents. When helping a country consider how to pursue elimination, the first thing we assess is whether there is a clear and detailed plan for how the program will strengthen implementation processes, increase efficiency and accountability in routine operations, initiate activities to detect all areas of malaria transmission, and adequately respond to malaria hotspots to halt its spread. Strategic planning is often viewed as routine and repetitive, and not something that national programs are eager to do, but it is critical to achieving the goal of elimination.
Research conducted in 2012 by CHAI’s Senior Director for Global Malaria, Justin Cohen, and colleagues, highlighted the importance of having strong programs with well-planned strategies to reduce malaria and achieve elimination. Their research found that among countries participating in the Global Malaria Eradication Program from 1955 to 1969, those that did not eliminate malaria and experienced a disease resurgence could most often attribute this failure to weakened programs who suffered complacency, funding shortages, or other external issues (such as war, disasters or poor community cooperation) that harmed each programs ability to plan and effectively execute interventions.
At the very beginning of a national malaria elimination campaign, our challenge is to make the case that national malaria programs must spend a significant portion of their time considering their strategy for elimination and what areas of their program need strengthening. To overcome this hurdle, CHAI worked with national malaria programs and local partners to establish a vision for a holistic strategic planning process. This process included better use of available data and evidence, more in-depth discussion among all stakeholders, detailed operation planning for every strategy and activity, and a costed budget for implementation of that national plan.
Applying our experience in the “Elimination 4” countries of southern Africa (Botswana, Namibia, South Africa, and Swaziland), where CHAI has worked since 2008, we exported our model of support to the Greater Mekong Subregion (Cambodia, Laos, Myanmar, and Vietnam) in 2015. CHAI’s support for elimination in the Mekong region is made more urgent by growing resistance to medications used to treat malaria in the region. This drug resistance not only threatens recent progress in Asia, but also malaria control and elimination in Africa if resistant parasites were to spread.
Leveraging CHAI’s relationships with national governments in the Mekong countries through our historical support around HIV and supply chain strengthening, and with new funding from the Bill & Melinda Gates Foundation, CHAI engaged with national malaria programs to initiate the planning process, alongside partners like the World Health Organization. National planning efforts in the Mekong region were undertaken to chart a course on how to apply high-level strategies as laid out in the WHO-supported Strategy for Malaria Elimination in the Greater Mekong Subregion (2015-2030) within the context of local community and health system structures and challenges.
In this effort, CHAI directly supported national strategic planning processes in Cambodia, Laos, and Vietnam from 2015-2016. While the approach was long and challenging, the value of the exercise was immediately obvious. Watching national program staff and partners intensely discuss strategic elimination issues such as how to quickly collect malaria case information from a community healthcare worker, how to investigate a locality that has suspected ongoing malaria transmission, or what tools to use to halt transmission in these localities, sowed incredible optimism among everyone participating. I observed that the louder the conversations and the more people actively participated during the operational planning workshops, the more evident it was that the national government and partners were committed to solving the challenges ahead of them. Following completion of these strategy documents, these countries now have a roadmap to guide them over the next five years and can hold all parties accountable to responsibilities determined during this process.
We have already begun to see the difference that this approach has made. National programs are continually referencing their national strategies and using their documents to train peripheral health staff at the sub-national level on their roles in the national elimination campaigns. Additionally, these countries were able to use their costed plans as blueprints for the 2018-2020 funding request application to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which includes up to $243 million dollars for the Mekong region’s malaria elimination campaign over the next three years.
CHAI is confident that the initial investment and time that countries put in during the strategic planning process will continue to pay off as they continue to execute their strategies and reduce their overall malaria burden. More importantly, we are optimistic that the planning processes undertaken for elimination can be continued until countries achieve elimination certification and potentially extended to other disease programs and health initiatives within these countries.
