sign in sign up
<<
Home , Malaria, Malaria Consortium, World Malaria Day

Consortium 2003-2013: a decade in communicable control and child Contents 1 Chair’s foreword 2 Our birth and growth 6 , 2003-2013 8 Our evolution at country level 14 Disease control: malaria and neglected tropical 22 Linking the to health systems 30 Moving to elimination 38 Going forward

Thank you The last 10 years for Malaria Consortium have been made possible thanks to the unwavering support of our donors, partners and collaborators from across the world. Collaboration and cooperation with others has been the cornerstone of all our achievements in the fight against malaria and other communicable childhood and neglected tropical diseases. It is thanks to these partnerships that we are able to provide some of the world’s most vulnerable people with better health care and offer them a chance for a future free from the burden of diseases which are treatable and preventable.

t A key focus of Malaria Consortium has been effective which helps save millions of lives Tadej Znidarcic Tadej Growing through innovation and partnership Malaria Consortium was founded by a small team of people with a vision – to build the capacity of malaria- countries worldwide to deal with a common and treatable disease that was devastating the lives of poor and vulnerable communities. Over the course of a decade of innovation and Whilst the organisation has grown significantly, our strong partnerships, this vision has grown from focus on the national and grassroots level has enabled focusing solely on malaria control and prevention, us to remain an effective on-the-ground partner, which to include integrated approaches to improving child has meant that in all that we have done, we have health and neglected tropical diseases. Now working continued to build capacity in the countries where across and , we are delighted to take the we work. Dr Julian Lob-Levyt opportunity of our anniversary to reflect on what We remain as committed as our early pioneers Chair we have achieved. in ensuring that we continue to fight malaria, For the last 10 years, the global fight against malaria a disease that is both preventable and curable. has seen an incredible acceleration. Since 2000, global Looking forward, we will continue to grow as an prevention and control efforts have led to a significant organisation but with a renewed focus on developing decline in mortality rates across all ages, but especially integrated strategies that address malaria and other in children worldwide. For the first time, the goal of communicable diseases beyond 2015. These strategies elimination is starting to look achievable in a number will need continued investment, more effective of countries in Africa, an aspiration that would have treatments and new tools to maintain the progress “For the first time, the goal of been dismissed as unrealistic a decade ago. that has been made. elimination is starting to look Today, Malaria Consortium partners with ministries We would like to extend a huge thank you to achievable in a number of of health in 15 countries to combat disease and our partners and supporters who have worked countries in Africa, an aspiration improve child health. We work in six of the 25 highest alongside us for the last 10 years. It is because of malaria burden countries in the world, in post-conflict these partnerships that we are able to continue the that would have been dismissed countries and in areas of Southeast Asia where drug fight against malaria and other infectious diseases, as unrealistic a decade ago” resistance is a developing threat. providing communities worldwide with the support they need to have a future free from disease. Finally, and on behalf of the board, I would like to personally thank the staff and leadership of Malaria Consortium – both past and present. Without their dedication and professionalism, we would not be the respected and effective organisation that we have become.

1 Malaria Consortium: our birth and growth Dr Sylvia Meek Technical director

t Malaria Consortium’s first organisational strategy meeting in 2004, including its founders Sunil Mehra (front row, third from right), Graham Root (middle row, centre) and Sylvia Meek (middle row, second from right)

2 Malaria Consortium: our birth and growth The first 10 years For over a decade the global fight against malaria and other infectious diseases across sub-Saharan Africa and Asia has seen a remarkable acceleration. Malaria Consortium grew out of the early 1990s control versus health systems strengthening. Malaria when malaria was an extremely neglected disease, control needs strong health systems, and the systems whose control was still suppressed by the backlash have to serve a purpose. We saw the importance to the failed global eradication attempts of the of staying practical and continuously testing and 1960s. We started as a non-government organisation improving service delivery. The weakest points in (NGO) in September 2003 with our official launch many systems are where two elements meet, and in 2004 under the leadership of Sunil Mehra as our we aimed to bridge these points between research n n n n n n n n first executive director, Graham Root as our Africa and implementation, facility and community, public director and myself as technical director. The three and private. of us had been involved in a previous project, also We were also keen to incorporate child health into £31.2 millio £31.2 millio £31.2 millio £31.2 millio called Malaria Consortium, which was a collaboration n n n n £30.4 millio £30.4 millio £30.4 millio £30.4 millio our work on malaria and over the past four years between the London School of Hygiene & Tropical we have expanded our activities in this area, with Medicine and32.000000 the Liverpool School of Tropical our work on integrated community case management Medicine to run a resource centre on malaria n n n n (ICCM) of malaria with diarrhoea and £24.6 millio £24.6 millio £24.6 millio £24.6 millio control for the28.444444 UK’s Department for International in young children. Neglected tropical diseases have Development (DFID). It predominantly focused similarly become an additional focus, given the on advising DFID24.888889 on malaria control investment, synergies with malaria control. designing new programmes and evaluating existing £19.0 millio £19.0 millio £19.0 millio £19.0 millio n n n n ones. 21.333333 Malaria Consortium has achieved some significant n n n n successes over the past decade and you can read about After nine years, DFID decided to move on to a a number of the highlights in this publication. I was general health17.777778 resource centre, and that is when £12.5 millio £12.5 millio £12.5 millio £12.5 millio particularly inspired by the first mass net distribution Malaria Consortium the NGO was born. We not that our team organised in . Another highlight n n n n £10.2 millio £10.2 millio £10.2 millio £10.2 millio only wanted to14.222222 continue the work of the original was visiting the ICCM programmes that we continue n n n n consortium, advising on policy and strategy, but to run in . It was encouraging to see how we also wanted to focus more on malaria control n n n n 10.666667 n n n n community health workers that we have trained in £5.4 millio £5.4 millio £5.4 millio £5.4 millio implementation, learning directly from country the country, many of whom have low literacy, were programmes and building local capacity in endemic £3.2 millio £3.2 millio £3.2 millio £3.2 millio 7.111111 performing their work in such a complex environment countries. We wanted to work with ministries to £1.2 millio £1.2 millio £1.2 millio £1.2 millio confidently and with great effect. I have also been £0.9 millio £0.9 millio £0.9 millio £0.9 millio do more with the resources available, trying out extremely impressed seeing the practical information new approaches3.555556 to shape comprehensive malaria 10 11 12 13 10 11 12 13 10 11 12 13 10 11 12 13 systems that have been set up in Asia which are control programmes. We did not want to start up supporting the urgent challenge of eliminating an organisation0.000000 that duplicated what others were 2009- 2010- 2011- 2012- 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009- 2010- 2011- 2012- 2009- 2010- 2011- 2012- 2009- 2010- 2011- 2012- 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 resistance and helping to set the stage for doing, but to fill a gap we had found. We felt some malaria elimination in the area. Another highlight has impatience at the sometimes over-theoretical debates, p Our income growth over the last decade been our ability to communicate better what we are such as the competition between investing in malaria learning through project materials and publications.

3 At the centre of all our work has been partnership and The organisation has a strong culture of debate, and collaboration. We have played a key role in setting encouraging staff to express ideas has meant that u In Nigeria, we have helped up and supporting the global Roll Back Malaria programmes have been developed to the highest build demand for malaria Partnership (RBM). Our executive director at that standard. The Programme Partnership Arrangement related health services through training, support and behaviour time was the NGO representative on the RBM Board, with DFID over the past three years has helped to change communications. and several of our staff are involved in different expand this by allowing us rapidly to pursue new Here women attend an ante- working groups. We have developed partnerships ideas and projects. natal clinic and receive free with a number of other organisations and academic nets and preventive treatment With around 90 percent of our staff based in the for malaria institutions for consortium-style projects and learned countries we support, we have also been able a great deal about how best to work in partnership. to understand the context and what is feasible, Our partnerships in country have been fundamental and develop strong partnerships with different to success in all our work, and we are delighted to stakeholders at country level. It has been crucial to have strong relationships with the ministries of health show that real technical leadership can come from in all of them. We have provided them with support within the countries themselves. in taking forward to implementation a range of new policy directions over the years, such as the shift in As we celebrate a decade of working in communicable policy on malaria diagnosis in and the various disease control and child health, I like to think that policy changes needed for the introduction of ICCM. what Malaria Consortium has achieved really has helped reduce malaria in the areas where we have There has been one constant throughout the growth worked. There are always challenges when working of Malaria Consortium, and that is the calibre and in global , but we do still have extremely dedication of its staff, including technical, financial, effective tools at our disposal. The most important management and operational, who make the thing is not to become complacent. organisation a place where people enjoy working. I would like to conclude with a message from our first executive director Sunil Mehra, who says: We led a single mass “The weakest points in many “I am hugely honoured by the dedication of all the people who have worked, contributed and given drug administration systems are where two elements so much to Malaria Consortium, so today we can that treated meet, and we aimed to bridge celebrate the incredible achievements of the first these points between research 10 years. I would like to thank them all from to , from Uganda to Nigeria and from and implementation, facility and to . My hope when I founded community, public and private” the charity, with help from Pene Key, our first trustee, who successfully recruited most of our first board, and 230,000 our team, was to create a charity that exemplified the people best synergy from diversity and that thus encouraged innovation and achievement amongst all – thank you for helping to realise our dream. Wishing the new leadership another fantastic 10 years.” for in South Sudan

4 Malaria Consortium: our birth and growth Susan Schulman

5 Timeline 2003-2013

2003 2004 2005 2006 2007

Malaria Consortium is Country offices open Country offices open COMDIS launched with Launch in Asia: launched as a non- in London, Uganda, , in Sudan and Mozambique Malaria Consortium as (regional office), government organisation. Ethiopia and Zambia partner to research and Internal developments Sudan office moves to , Our mission: to bring to develop interventions that Internal developments Widen scope to cover other Southern Sudan poor people relief from would provide better health Embarks on a seven-year communicable diseases. and protection against care for those affected by Internal developments project in five African countries Work starts on neglected communicable diseases, communicable diseases Establishes communicable (Clover), strengthening health control, especially malaria diseases resource centres systems for malaria control including schistosomiasis Internal developments in Ethiopia and Mozambique Malaria burden and on control Work starts on neglected Leads first of a series of Over 1.1 million among internally displaced tropical diseases in Southern Advocacy coalitions national malaria surveys in worldwide from malaria people in Uganda Sudan against malaria are created, Cambodia, repeated every comprising civil society three years to 2013 Focus on those most at organisations and private and 1.1 million risk and most vulnerable Starts six-year project to public sector stakeholders – including in northern improve services for in Ethiopia and Uganda and Sudan/Darfur tuberculosis in Northern Over the last three years Uganda Successful implementation 210,000 nets distributed to of large-scale net retreatment External developments internally displaced people in campaign, Uganda The UK All Party Parliamentary Sudan and northern Uganda Group on Malaria and External developments 1,100,000 Assist in the roll out of Neglected Tropical Diseases A five-year, US$1.2 billion antimalarial drugs (artemisinin is launched to inform expansion of US government deaths ) in parliamentarians of the aid for malaria is launched: Mozambique through training negative impacts of malaria the President’s Malaria worldwide 234 community health workers and neglected tropical Initiative (PMI) in Inhambane province from diseases External developments malaria  (April 25th) is established by the The Bill & Melinda Gates Foundation hosts a malaria forum to review progress in malaria control, share challenges and successes, and re-introduce ambition for eradication

6 Malaria Consortium: 2003-2013 627,000 Beyond Garki monitoring malaria deaths worldwide from malaria

2008 2009 2010 2011 2012 2013

Country office opens Internal developments Internal developments Internal developments Internal developments Country office opens in Nigeria Integrated community case Mass drug administrations Work starts on community NetCALC is developed to in Myanmar; Zambia closes management project funded begin in Southern Sudan for based detection and assist countries in calculating Internal developments Internal developments by Canadian International soil transmitted helminths and management of acute LLIN requirements The Support to National New focus on seasonal Development Agency (CIDA) schistosomiasis, reaching in South Sudan, Malaria Programme (SuNMaP) First large-scale household, malaria chemoprevention starts in Mozambique, over 30,000 and 24,000 screening over 2,000 children launches in Nigeria outlet and health facility in northern Nigeria Southern Sudan, Uganda and beneficiaries respectively COMDIS-HSD starts – a survey in Myanmar is Support begins for the Zambia to tackle childhood New project improving mass drug research programme consortium designed in new artemisinin containment of drug resistant diarrhoea, pneumonia and access to injectable administration is carried out in led by University of Leeds, on resistance containment areas malaria in Asia malaria to reduce mortality Unity state, Southern Sudan health service delivery Long-term multi-country from severe malaria Efforts to build national inSCALE starts in Uganda and FEAST project 230,000 LLINs are distributed initiative Beyond Garki is malaria capacity across Mozambique to support the New project rolling out reveals dangers of current in Mozambique and a further formally established to programmes are stepped up motivation and retention of malaria rapid diagnostic practice for severely ill children 1.5 million through other partners monitor changing malaria community health workers tests for private sector in Malaria Consortium extends Acclaimed Malaria 230,000 people receive Nigeria and Uganda operational remit to include Malaria Consortium Consortium/Adam Nadel treatment for schistosomiasis Mass drug administrations other childhood illnesses distributes 4.5 million LLINs Mass country-wide LLIN exhibition Malaria: , in one mass drug for schistosomiasis (reaching distribution through Over 1.1 million nets Clinical audits are introduced sweat, and tears launches administration in South Sudan 238,000 people) and soil government/Global Fund/ (including long lasting as a method of improving at UN in New York transmitted helminths Approximately 200 health PMI partnership in Uganda insecticidal nets – LLINs) quality of care at 29 health (300,000 people) are 7,000 health workers are workers are trained in the with 10 million nets have now been distributed facilities in Uganda and 62 carried out in South Sudan trained in over 3,000 health use of intermittent preventive distributed by Malaria Consortium in Ethiopia facilities in Nigeria treatment of malaria for Across Africa programmes, External developments External developments Role in monitoring, evaluation, pregnant women in Uganda more than 5,100 health Cambodian Malaria Bulletin The Integrated Global Action The Roll Back Malaria surveillance and research for workers from all levels in supports better malaria Plan for the Prevention Partnership launches the artemisinin resistance grows the health system receive surveillance and Control of Pneumonia Global Malaria Action Plan, in Southeast Asia training and nearly three and Diarrhoea launches committing nearly US$3 External developments million LLINs distributed External developments billion towards reducing the A decline in the malaria Malaria Consortium The Africa Leaders Malaria External developments number of malaria deaths burden is noticeable in becomes a member of the Alliance is founded by African The London Declaration to near zero by 2015 many countries new WHO Malaria Policy heads of state to combine on NTDs is launched, Advisory Committee The Asia Pacific Malaria efforts across country and representing a coordinated Elimination Network is regional borders to fight effort to accelerate progress Malaria burden launched to address the malaria toward eliminating or An estimated 207 million unique challenges of malaria controlling 10 NTDs by 2020 cases of malaria, causing elimination in the region 627,000 malaria deaths

7 Our evolution at country level Across the countries where we work, there have been many successes that have helped to bring us to where we are today

u Malaria Consortium delivers long lasting insecticidal nets to some of the hardest to reach areas in Uganda Central region through the Stop Malaria Project

8 Malaria Consortium: our evolution at country level Uganda

The Uganda programme was Malaria Consortium’s The successful roll out of large scale Key successes first strategic move in pursuit of its mission of activities for the AMFm pilot (Global Fund) reflected • Training 1,640 CHWs on directly observed TB reaching those most in need of malaria interventions. the growing experience of the programme in treatment, and 75 health and lab workers in We have since run 15 projects, building our behaviour change communication approaches. TB diagnosis and treatment in northern Uganda reputation with the Ministry of Health and the We also accumulated experience and expertise donor community. • Working with the Ministry of Health to introduce in net distribution through routine distribution integrated community case management (ICCM) Through interplay between three of its projects in (at ante-natal clinics) as well as targeted and • Rolling out ICCM to 17 districts, training 13,000 Midwestern Uganda – the Pioneer project for mass universal campaigns. We are currently the leading community health workers reaching an estimated net distributions and low level health system organisation working with the Ministry of Health population of 890,000 children strengthening (Comic Relief), integrating case to distribute 21 million long lasting insecticidal nets management of malaria with pneumonia and (LLINs) across the country (Global Fund/PMI). • Training over 1,000 health workers on malaria diarrhoea (Canadian International Development rapid diagnostic tests Our support to the Ministry of Health on malaria Agency – CIDA), and the Stop Malaria Project • Delivering the first ever district-wide LLIN diagnostics has also been significant through (USAID) – the programme demonstrated that a distribution to attain universal coverage development of guidelines for parasitological based multifaceted intervention approach considerably diagnosis, training in rapid diagnostic tests and • Leading in the distribution of 21 million LLINs strengthened impact in malaria control. external quality assurance. to attain universal coverage for the population

Ethiopia

Malaria Consortium started work in Ethiopia, in most recently the Beyond Garki project (UKaid/ Key successes response to a need for malaria expertise in the DFID). We have engaged in a range of behaviour • Leading in coordination of the Ethiopia National SNNPR region of Southern Ethiopia. We became change communication activities including anti- Malaria Indicator Survey 2011 the only organisation engaged in the malaria control malaria school clubs and community dialogues on programme in the region and implemented the malaria (Global Fund). We have developed strong • Co-developing malaria communication strategy Clover project (Irish Aid) there from 2004. advocacy groups with the establishment of with the Southern Region Health Bureau The focus was on health system strengthening in the Coalition Against Malaria in Ethiopia and • National training of health workers to develop order to contribute to the improvement of the Coalition of Media Against Malaria in Ethiopia knowledge and skills in malaria diagnosis, National Malaria Control Programme at district (GlaxoSmithKline, MACEPA/PATH, Sumitomo). treatment and epidemic detection level. Our work on increasing the capacity for We have focused on strengthening the health • Carrying out operational research to develop and monitoring and evaluation has resulted in improved management information system in Southern Region test new malaria surveillance strategies planning and reporting. through the provision of computers, training and • Establishing school-based anti-malaria clubs motorcycles to improve supervision. Operational research has been a constant focus in Southern Region throughout Malaria Consortium’s time in Ethiopia, Looking forward, we will roll out the use of injectable • Establishing malaria laboratory external quality with studies on rapid diagnostic tests for malaria, artesunate for severe malaria and commence a assurance systems in 50 health centres in malaria resistance to , and project focusing on pneumonia diagnostics. hot-spots in Southern Region

9 Nigeria

Malaria Consortium’s presence in Nigeria has Malaria Action Plan for States (President’s Malaria Key successes grown from the success of the Department for Initiative/USAID), seasonal malaria chemoprevention • Distributing six million nets in Kano and Anambra International Development (UKaid/DFID) funded (Bill & Melinda Gates Foundation) and Rapid and developing tools and coordinating mechanisms Support to National Malaria Programme (SuNMaP). Access Expansion – RAcE (World Health for national distribution of over 53 million LLINs This £89 million, seven year project is designed to Organization (WHO/CIDA). The project has also strengthen malaria control efforts at the national positioned us as a key partner with the global • Administering seasonal malaria chemoprevention level and in a number of states. Through SuNMaP, Roll Back Malaria Partnership, and in supporting drugs in Katsina, reaching over 176,000 children we are taking the lead in supporting the continuous national and state malaria control programmes • Supporting the first malaria indicator survey in distribution of LLINs and developing the market to take the lead in reducing the burden of malaria 2010 and malaria programme review in 2012 for anti-malaria commodities. We are ensuring the in the country. • Developing action plans for implementation harmonisation of partners’ activities in malaria The Nigeria programme aims to extend its role of malaria control programmes in 10 states control, and demand creation for preventive and to the control of neglected tropical diseases • Comprehensive training package for nationwide case management services. (NTDs), especially lymphatic . We will also roll-out to improve quality of case management in The achievements recorded by SuNMaP have work to improve access to case management at service delivery points contributed to Malaria Consortium’s success in the community level and to integrate with other • Initiating a project to control severe malaria starting up other projects in Nigeria, including common childhood diseases. in health facilities across three states

Zambia

Malaria Consortium opened an office in Lusaka, Key successes Zambia to implement a health systems strengthening • Establishing district-level public-private Malaria project: Clover (Irish Aid). Our close collaboration Task Forces across 19 districts (Irish Aid – Clover) with the National Malaria Control Centre (NMCC) through Clover directly resulted in being chosen in • Completing research (funded by WHO) on 2007 to implement a study on use of malaria rapid use of RDTs within a home management of diagnostic tests (RDTs) as part of home management malaria programme; partnering with NMCC to of malaria in Livingstone district. This relationship implement first roll-out as national strategy in also led to our involvement in the Zambia Access to Livingstone district ACTs Initiative, conducting research on subsidised • Provision of treatments for malaria, pneumonia distribution of artemisinin combination therapies and diarrhoea by community health workers to (ACTs) and RDTs from accredited drug dispensers. more than 170,000 children under five in Luapula province (ICCM-CIDA project) In 2009, Luapula province was selected as one p Dialogues led by trained community health workers location for our multi-country ICCM programme are encouraging better (CIDA). At the conclusion, in 2013, Malaria health-seeking behaviour Consortium’s Zambia programme closed down.

10 Malaria Consortium: our evolution at country level

South Sudan

Malaria Consortium began operations in Sudan in Sudan, supporting assessment, mapping and Key successes 2005, training doctors in malaria case management administration of NTDs. • Providing support to the National Strategic and delivering LLINs to displaced people. By 2007, Based in Juba, the programme continued to support Plan for NTD Control the programme increased its activities in southern the National Malaria Control Programme and the • Working closely with Ministry of Health to new South Sudan government with their malaria support them in developing guidelines for malaria policy documents and treatment guidelines. We have t A child is control and treatment of malnutrition been involved with mass net distributions in Unity assessed for severe • Mapping trachoma and other NTDs across and Northern Bahr el Ghazal. The programme in acute malnutrition South Sudan using a MUAC these states also expanded to include ICCM and used (measuring mid- these established networks to diagnose and treat • Evaluating a community net distribution approach upper arm malnutrition, a chronic health issue for many young to move towards continuous distribution through circumference) a pilot in Central Equatoria State tape children in parts of the country. • Winning an award for “operational excellence We provided technical support to the Government in a difficult environment” for this pilot award of South Sudan as it developed its Malaria Control for our LLIN continuous distribution work in Strategic Plan and fed into the 2011 Health Sector Lainya County Development Plan. We have since been involved in developing ICCM guidelines and harmonisation • Working with Ministry of Health and other of ICCM training materials between all partners. NGO partners to introduce ICCM • First NGO practising management of severe We aim to expand our ICCM activities to reach acute malnutrition at community level with more children under five, providing more than the development of outpatient therapeutic 20 million treatments for NTDs and improving feeding sites pneumonia diagnostics.

Ghana

Based in the Promoting Malaria Prevention and In collaboration with partners, ProMPT helped Key successes Treatment (ProMPT) project office, the Ghana Ghana move closer to achieving the national goal • Distributing more than 12.5 LLINs through programme allowed Malaria Consortium to of universal coverage of LLINs (one net for every ProMPT project support delivery of an effective high quality malaria two sleeping places) through an innovative control programme across the whole country. door-to-door hang-up campaign. • Developing and piloting a strategy for managing malaria in , as well as a supportive As a result of the successful implementation of supervision tool seasonal malaria chemoprevention in northern • Developing and piloting a strategy for continuous Nigeria, we are hoping to extend these to some areas distribution of nets in Eastern Region, now in northern Ghana. managed by NetWorks (USAID)

11 Mozambique

Malaria Consortium’s programme in Mozambique The project also implemented a number of innovative Key successes was set up as a result of a project to develop approaches to increase malaria awareness and • Delivering over three million LLINs to pregnant sustainable LLIN distribution systems for malaria behaviour change, with a focus on school children women and achieving a 96 percent retention prevention in the country (UKaid/DFID). This was and teachers. This helped build Malaria Consortium’s and use rate achieved through private sector development and reputation as an expert in behaviour change health systems such as ante-natal clinics. communication. The programme quickly expanded • Training health workers in case to include the Clover project (Irish Aid) on health management, including for severe malaria systems strengthening, using malaria as an entry • Conducting large-scale surveys (MIS 2007) and point. operational research around LLIN distribution systems, sustainability and durability Advocacy also became key for the Mozambique programme, with Mobilising for Malaria • Preparing policy documents for the Ministry of (GlaxoSmithKline) and Voices for a Malaria-Free Health such as the National Malaria Control Future (Bill & Melinda Gates Foundation) both Strategic Plans (2005-2009 and 2010-2014), successfully building local capacity for advocacy case management guidelines and LLIN policy directed to the national level. • Pioneering implementation of the new Ministry of Health community health worker programme The Mozambique office gradually moved towards more community-focused projects, with the • Designing and producing innovative training implementation of ICCM for pneumonia, diarrhoea packages and communication materials, and malaria in young children (CIDA). Our main including education through entertainment activities currently focus on the development of (edutainment) local capacity and the scaling-up of innovative and effective community health interventions. Malaria Consortium Mozambique will continue to focus on improved monitoring and evaluation in all health work at various levels, including the introduction of digital systems, and on building capacity of government and local actors in all our projects. We will also continue developing and testing innovative and effective approaches to improve p Laboratory technicians in communities’ capacity to take ownership of health Mozambique were trained to diagnose malaria as part of Malaria issues and ensure effective uptake of services are Consortium’s Clover project to available. As an example, we are starting a project help strengthen health systems that will use community dialogues to improve knowledge, attitudes and uptake of mass drug administrations for neglected tropical diseases.

12 Malaria Consortium: our evolution at country level Asia

Currently, we are continuing to focus our work Thailand, Myanmar and / on the containment of artemisinin resistant malaria / in Thailand with Global Fund support. In Malaria Consortium Asia’s early years, much of our activities were intermittent and included long- Cambodia term technical and institutional support to the Asian In Cambodia, under the Containment Project, we Collaborative Training Network for Malaria, which began with a focus on those populations most at we helped to set up. We also worked with WHO on risk of contracting malaria. The lessons learned various surveys. Our regional office opened in 2007. from our support for the review of migrant workers In 2008 we joined the Malaria Partnership. and mobile populations in the GMS were essential Our focus was on strategic information to support in helping to inform policy for developing malaria countries and partners in the Greater Mekong programmes for these vulnerable populations in Subregion (GMS) to refine and improve theircontrol both Thailand and Cambodia. strategies and to mobilise resources. This continues p Migrant agricultural workers We have also supported the national malaria are particularly vulnerable to to be funded through a co-operative agreement with programme in Cambodia in the development of malaria and are a focus of many Centers for Disease Control and Prevention (CDC). a behaviour change communication strategy for of our Asia activities The regional programme has focused on the GMS, malaria elimination and have fostered cross-border particularly Thailand, Cambodia and Myanmar, but coordination between Cambodia, Thailand and and other vector-borne diseases. We are also now including Laos PDR, Vietnam and Yunnan province Myanmar (UKaid/DFID). working to identify the most appropriate diagnostic in . One of the key areas of the programme One of the key highlights of Malaria Consortium’s tools for the management of pneumonia (Bill & has been to strengthen monitoring, evaluation and contribution in Cambodia has been the design, Melinda Gates Foundation) in Cambodia and we are surveillance activities for malaria affecting these areas. piloting, evaluation and scale up of a malaria undertaking further work on dengue (UKaid/DFID). The first of these was theContainment Project information system that incorporates real-time (Bill & Melinda Gates Foundation) to address malaria data for direct action through short message In the future growing resistance to anti-malaria drugs along the service (SMS) based technology. Lessons learned Malaria Consortium’s Asia programme will continue Thai-Cambodia border. The project focused on from using mobile communications technology to contribute to containment and elimination efforts detecting and effectively treating all malaria cases in Cambodia have supported the strengthening of and look for innovative approaches as the region in the target areas in order to reduce drug pressure surveillance systems and have been used for other moves towards malaria elimination. In Myanmar, from resistant parasites and contain countries, including Myanmar. we are exploring potential innovations to provide protection from mosquitoes for rubber tappers of malaria, especially among mobile and migrant Our Beyond Garki (UKaid/DFID) project is now working outdoors at night time and piloting a populations who are the highest risk group. monitoring changes in malaria epidemiology testing, treatment and referral system in the private in the context of malaria elimination in Cambodia Together with other partners including the Bureau sector through SMS technology in Cambodia. to strengthen the existing surveillance system. of Vector-Borne Disease, Thailand and Cambodian Projects such as IMMERSE (CDC) will continue to national malaria control programme, we received Malaria Consortium Asia’s integrated vector strengthen monitoring, evaluation and surveillance funds from WHO as sub-recipients for this project management project (UKaid/DFID) has been activities in the GMS and will provide technical to lead the monitoring and evaluation of the delivering behaviour change communication to support and guidance to national programmes containment strategy. improve the effective use of malaria interventions to develop methodologies and tools.

13 u A trained community health worker prepares medicine for children under the age Disease control: of five to help protect them during the malaria season in malaria and Katsina state, Nigeria neglected tropical diseases Dr James Kananura Tibenderana Development director

We administered 500,000 chemoprevention treatments to 176,000 children in northern Nigeria to prevent seasonal malaria

14 Malaria Consortium: disease control – malaria and neglected tropical diseases 15 t Malaria Consortium is spearheading the adoption of continuous distribution of LLINs via schools and other community-based services in Ghana NetWorks

CHWs trained through Malaria Consortium’s ICCM projects, carried out over

6 million treatments for pneumonia, diarrhoea and malaria* *2.2 million ICCM CIDA and 3.9 million UNICEF ICCM Central (Uganda)

16 Malaria Consortium: disease control – malaria and neglected tropical diseases To achieve this impact, part of our programme logic diarrhoea and malaria being treated at community Disease control: is that high, sustained and complementary coverage level by the end of 2013. Cognisant of the role that malaria and neglected with proven malaria control interventions along a community health workers play in extending the continuum of care, will bring about the systematic health system beyond facilities, we are pioneering tropical diseases changes needed for short, mid and long term benefits. work on improving their motivation and supervision Technical excellence has been a core This is a dynamic process and to maintain optimal in Uganda and Mozambique, while in Cambodia, effects requires an excellent understanding of malaria Ethiopia, South Sudan and Uganda, we are testing value of Malaria Consortium right from epidemiology, information on the changing pattern new diagnostic tools for pneumonia which they the outset. of the burden of disease and community behaviour. can use. By embedding research into implementation and by treated nets are now of the long lasting With origins from the London School of Hygiene strengthening the institutional and capacity to kind. Gone are the days when communities & and the Liverpool School of generate and use evidence, we are working to see that had to treat their nets with insecticide. Malaria Tropical Medicine, it is no surprise that the the gains we make are sustained. organisation chose its niche as a technical Consortium contributed evidence from experiences international non-governmental organisation in Shaping the landscape: learning, in distribution and use of nets through the public and malaria control. Underpinning our technical private sectors.7-12 NetCALC13 and the operational approaches and learning is programme innovating and adapting understanding of the useful life and durability of implementation. By implementing in a variety of Malaria Consortium demonstrated in Uganda that long lasting insecticidal nets (LLINs) are some settings: different geographical locations, different community case management for malaria was feasible examples. In Nigeria and Ghana, we have contributed malaria transmission settings and different health and contributed to the design, acceptance and use immensely to the adoption of continuous distribution systems, we are able to use our experiences to cross of unit-dosed pre-packs of anti-malarials. Whereas of LLINs through innovative channels such as schools learn and to innovate. Our footprint in Africa has this involved presumptive treatment of malaria in and community-based structures. The policy shift to included Ethiopia, Ghana, Mozambique, Nigeria, areas where the disease was endemic, our work ACTs required a concerted effort from a variety of South Sudan, Uganda and Zambia, while in in the introduction of rapid diagnostic tests for stakeholders lead by the World Health Organization. Southeast Asia, we are based in Cambodia, malaria1-2, and working with in-country Roll Back In Uganda, Ghana and Nigeria our operational Myanmar and Thailand, but have also worked Malaria partners led to the change in national policy research and implementation has facilitated the policy in Lao PDR, Vietnam and China. in Uganda to universal parasite-based diagnosis for change process and in so doing helped to save those malaria.3-6 lives that would have been lost from ineffective use In choosing where we work we consider the public of -based combinations.14 health problem due to malaria, the value that we Building on the community-based service delivery bring to the country, the willingness of national platform our work on integrated community case governments to collaborate with us and the funding management of malaria, pneumonia and diarrhoea that we are able to mobilise for our work. was a logical progression. We have shown in four “Whatever the setting or Whatever the setting or circumstance our motivation countries, namely Mozambique, South Sudan, Uganda circumstance our motivation is to reduce the suffering that malaria inflicts on the and Zambia, that community health workers can vulnerable and the less privileged. dispense artemisinin-based combination therapy is to reduce the suffering that (ACTs), antibiotics and oral rehydration salts malaria inflicts on the vulnerable according to national guidelines and, except in South and the less privileged” Sudan where it is not yet policy, can safely use rapid diagnostic tests. Through this strategy, our training of and support for community-based health workers resulted in more than six million cases of pneumonia,

17 In Southeast Asia, we are involved in the containment Health systems underpin the delivery of services. Our presence in Southeast Asia, where pre-elimination of artemisinin resistance to protect the most effective Most of our work tends to be embedded into existing is a target within the next 10 years, provides a cross anti-malarial we have at present. This has involved health systems and this forms part of our approach to continent experience sharing opportunity with participating in the development and implementation programme and impact sustainability. Our approach sub-Saharan Africa. of novel strategies including village based surveillance in using malaria as an entry point for health system The role of seasonal malaria chemoprevention in systems using SMS technology to capture malaria strengthening was developed through seven years of West Africa as a part of an integrated malaria control case data in real time, the promotion of cross- work at sub-national level in Ethiopia, Mozambique, package in areas with seasonal malaria transmission border collaboration, and national household and /Zanzibar, Uganda and Zambia, in which needs to be understood. Involving the private sector malaria indicator surveys to measure the impact of the programme was directly responsible for changes in malaria control and health systems strengthening, interventions over time. A particular focus on the to seven national polices, beneficial effects on the particularly as improved universal access to role of migrant and mobile populations in the spread stability of essential drug supplies, quality of malaria parasite-based diagnosis, causes the approach to of resistance has necessitated the use of novel survey diagnosis, health worker treatment practices, health fever management to include case management of methodologies such as respondent driven sampling information management, planning and budgeting.17 non-malaria febrile illnesses such as pneumonia. and has included innovative behaviour change The approaches to health worker performance communication strategies such as positive deviance Looking ahead management, the role of electronic systems for to motivate and mobilise communities in the fight In Uganda we have had the fortunate opportunity information and logistics management, understanding against resistant malaria. to create a demonstration project which illustrates what promotes community acceptance and continued From malaria, we have extended systematically and the value the organisation brings to malaria control use of proven malaria interventions and looking at strategically into the control of other communicable now and looking ahead. Over the past few years we innovations in sustainable financing are key areas diseases such as neglected tropical diseases, where have made concerted efforts to overlap our malaria we shall be focusing on over the next decade. our research skills and expertise in community-based programming and extensively monitor the effects delivery of integrated services have enabled this on malaria epidemiology. The aspiration is to reduce Conclusion malaria transmission intensity over time and, in extension. In South Sudan we carried out integrated Malaria Consortium has contributed to the changing the process, learn what works. mapping of , schistosomiasis landscape of malaria control. Our work would not 15 and soil-transmitted helminths as well as mapping The infographic opposite illustrates trends over time, be possible without the commitment and efforts of 16 of trachoma. The mapping findings were used to showing both the increase in insecticide treated net our staff, the support and stewardship of national inform the national control and elimination strategies use and the proportion of slide positive cases among governments, the funding from our development for these diseases, and initial rounds of mass drug children aged under five years. Whereas we cannot say partners, the efforts of organisations and institutions administration were conducted in high-burden areas. this relationship is a causal one, it demonstrates the we collaborate with and the cooperation of our In response to the high prevalence of malnutrition in utility of sustained and complementary programming beneficiaries. Over the next decade, there will be the country, we pioneered nutritional rehabilitation over time and results measurement. Programme more changes. We shall continue to innovate and of severe acute malnutrition as a component of our managers, as they strive for malaria elimination, are share our learning. Our technical excellence will ICCM model in South Sudan, which has since been going to be faced with a variety of decisions regarding remain a core value. adopted by other partners. the most cost-effective package of interventions to deploy at what point in the transition from control to pre-elimination and how to maintain the gains made. Malaria Consortium will be an instrumental partner in this learning process.

18 Malaria Consortium: disease control – malaria and neglected tropical diseases In focus This infographic demonstrates trends over time, showing an increase in insecticide treated net use and a decrease in cases of malaria and anaemia in young children. It covers a three year period Central 2 region, 2009 during which a range of malaria prevention and treatment interventions occurred, including those Figures for Central 2 region – shown in brown – relate to 8 districts (including what managed by Malaria Consortium* is now Kyankwanzi) and were recorded in November-December 2009** Uganda

Kyankwanzi, 2012 Figures for Kyankwanzi district (part of Central 2 region in 2009) – shown in white – relate to 1 site and were recorded in September-October 2012 as part of the Beyond Garki project***

67.8% 50.7% 2012 39.9% 2009 36.5% 23.5% 2012 2009 16.6% 2009 11.3% 13.1% 10.7% 1.3% 2009 2012 2012 2009 2012

p Percentage of p Percentage of children p Percentage of children p Percentage of children p Percentage of children households with at least 1 under 5 who slept under under 5 positive with under 5 with moderate under 5 with severe ITN (insecticide-treated net) an ITN the previous night malaria anaemia anaemia

*Malaria Consortium ICCM-CIDA and Pioneer projects. **Uganda Bureau of Statistics (UBOS) and ICF Macro. 2010. Uganda Malaria Indicator Survey 2009. Calverton, , USA: UBOS and ICF Macro. ***Malaria Consortium. Beyond Garki project, Kyankwanzi. Unpublished data.

19 Case study Lainya County, South Sudan To strengthen malaria prevention and control interventions in South Sudan, Community based Malaria Consortium used funding from UKaid/DFID to test whether universal coverage of long lasting insecticidal net distribution nets (LLINs) can be maintained through a community-based continuous distribution network in Lainya County. This approach has been piloted in partnership with the Republic of South Sudan Ministry of Health and USAID’s NetWorks project, of which Malaria Consortium is an implementing partner. Lainya County has a population of over 240,000, with around 35,000 households, and suffers a high malaria burden all the year round. The aim of the project was to provide a sustainable method of replacing LLINs in households where they may have been damaged, destroyed or are simply insufficient. A good understanding of the contextual environment in South Sudan was essential in support of implementation activities, ensuring the pilot was designed to be flexible and allowing strategies to be adaptable. Involving and engaging different community groups such as health workers, clergymen, women’s groups, village health committees and other community groups meant stakeholder feedback was incorporated into on-going implementation.

p A community member exchanges her net voucher for nets at a distribution point in Lainya County, South Sudan

20 Malaria Consortium: disease control – malaria and neglected tropical diseases “As a church leader I was involved, even in the Social mobilisers sent out SMS messages, designed In a country like South Sudan, where populations are planning of this programme,” said Reverend Rufus by Malaria Consortium’s regional BCC specialist, widely dispersed in rural areas, bringing nets closer Lemi, dean of the cathedral for the diocese of Lainya, to provide information to the community. to the community is crucial to keeping up coverage. Episcopal Church of South Sudan. “Key people in Messages on dates and times for net coupon Community-based channels present an effective means the county were called when the programme began, redemption were also shared by social mobilisers of ensuring that, where mass campaigns have not so it could be introduced to them. Ideas were sought at churches and markets on a weekly basis. reached communities, people can still access nets on how best they thought this programme could on a continuous basis. A priority for the success of the pilot was to succeed. The church has a key role in disseminating encourage willingness among local leaders to Malaria Consortium worked with all levels of the information to people. More than 80 percent of the engage in community level monitoring, ensuring the Ministry of Health, including the National Malaria population in Lainya is a member of the Episcopal sustainability of continuous distribution mechanisms Control Programme (NMCP), the State Ministry of Church of South Sudan congregation.” within the community beyond the life of the pilot. Health and County Health Department to plan the In order to ensure the pilot had enough LLINs for pilot and to prepare for its sustainability. International “You must first engage key people so that they will every household, Malaria Consortium and partners NGOs and other agencies working in the health sector then go on to monitor the programme,” said Lona procured 50,000 nets. The nets were kept in the in South Sudan were also consulted during the design. Keji, a community development officer and mobiliser community, in storage units established in primary Linkages and partnerships forged between all partners from the area. “They must be sensitised about the health care centres, including remote rural areas. provided the foundation for key results. In support importance of the programme so that they can The pilot used a ‘pull system’ to ensure storage of efforts to influence policy on malaria prevention, monitor if the nets are really used. This is important, facilities never ran out of stock, with community Malaria Consortium remains an active participant in so that people don’t collect the nets and misuse them. members receiving and redeeming net coupons from the NMCP Malaria Programme Review and Malaria I used to go to the payams and see children playing community level health workers. Technical Working Group. outside after 9pm. But now at 6pm people are inside. The most commonly cited challenge faced by They are now using nets and this is evidence that the “Sustaining a programme without funding is very community members were the long distances project is working.” difficult,” said one community member. “What will between communities and storage facilities. Malaria help sustain it is continuous sensitisation. Also in Distribution began in May 2012 in all fivepayams Consortium responded by opening five new facilities health centres, if community health workers could ask in Lainya County, including through established and allowing relatives and neighbours of net coupon people who return repeatedly with malaria if they are antenatal clinics. Over 11 months, more than recipients to redeem coupons on their behalf. In one still using the nets, this would help. If we do not make 30,000 net coupons were issued to communities. location, a storekeeper responded by taking one bale use of people who are already under the government Some 94 percent of these were redeemed, reaching of LLINs to a distant village each Saturday so that payroll, it will be difficult to sustain.” an equivalent of around 11 percent of the population. people in that area could redeem their coupons. “Health personnel working in health facilities were Community mobilisation and participation are also trained by the project to distribute nets and, before key requirements for the success of any community- “Key people in the county were distribution, messages were shared about health based continuous distribution system. Frequent education so that people understand the importance called when the programme messages were communicated on the eligibility criteria – to change their behaviour,” explained Christine for receiving nets to help with effective distribution. began, so it could be introduced Amude, county health department storekeeper. Behaviour change messages (BCC) were tailored to them. Ideas were sought “Net coupon holders also received training. There to reach various population groups using different were follow-up visits to see whether and how the nets on how best they thought this channels of communications. are being used. Because people know someone will programme could succeed” come to check, this has helped the project succeed. Previously we only received nets from different NGOs Reverend Rufus Lemi and the Ministry of Health for children under five and pregnant women. But with this project the nets are for all and this has made the community very happy.”

21 u Community health workers in Mozambique ensure the continuum of care between Linking the community and the health facilities the community to health systems Helen Counihan Senior public health specialist, community systems Dr Karin Källander Senior research advisor

6,630 children under five with signs of severe malaria were given a fast acting treatment by CHWs before being urgently referred to a health facility

22 Malaria Consortium: linking the community to health systems 23 Linking the community to health systems One of the common challenges for health services in many malaria- endemic countries is the unequal geographic distribution of resources and health workforces, resulting in difficulties in sustaining quality care at the peripheral and community levels. As a consequence, health system strengthening has been a core principle for Malaria Consortium since it was founded in 2003. During our first seven years, we had the opportunity to implement a programme in four African countries (Ethiopia, Mozambique, Uganda and Zambia) which used malaria as an entry point to strengthen health systems. This programme strengthened the delivery and quality of malaria care through many different interventions such as capacity building of health staff at district and health facility levels in supply chain management and supporting the establishment of external quality assurance systems for malaria diagnosis. We have built on this experience through subsequent programmes including our support to the national malaria control programmes in Nigeria and in countries of the in Asia. Extending the continuum of care from the health p A community health worker system to community level has also been a long in Mozambique uses his standing focus, initially through implementation of phone to follow procedure home management of malaria provided by community for assessing a child . health workers. More recently, this developed into Here he is responding to a question on chest indrawing implementation and support for integrated community as a sign of severe pneumonia case management (ICCM) whereby community health workers provide access to lifesaving care to children with malaria, pneumonia and diarrhoea – principally in Mozambique, South Sudan, Uganda and Zambia.

24 Malaria Consortium: linking the community to health systems What we have learnt Our ground-breaking work on the introduction of paved the way for an exciting new study in four RDTs in health facilities and at community level in countries in Africa and Asia which identifies and Enabling all communities to benefit from accessible Uganda provided evidence which was a vital catalyst evaluates new diagnostic tools for symptoms of quality health care requires a strong and well- for the development of a national policy on their use. pneumonia and hypoxaemia for community health functioning health system that has the capacity to In partnership with the Zambian National Malaria workers and first level health facility workers. reach the most remote areas. The formal health system Control Centre, the evidence collected informed can be complemented by programmes delivering An essential element of our work at community the inclusion of RDTs within home management health care through trained community members, but level is behaviour change communication to create of malaria. it is vital to have full support and involvement of both awareness and increase usage of community-based health facilities and communities for this approach With the introduction of RDTs, the management of health services among the target populations and to succeed. Malaria Consortium’s approach has been non-malaria febrile illnesses becomes more pertinent. to strengthen their capacity to manage their own to first provide refresher training to health workers Recognising the natural progression from home health and make informed decisions. before involving them as trainers and supervisors management of malaria to ICCM to include the other Our rigorous formative research for a multi-country of community health workers, creating a strong link major childhood illnesses, our work pioneering this ICCM project showed that community health between the community and health facility from strategy at large scale is informing and guiding global worker retention and quality of care are largely the start. and national policies, both for the public sector for driven by motivation and performance. Innovations diagnosis and more broadly for the private sector. In managing cases of malaria and other , in the use of mobile communications technology the development of resistance to widely used medicines Building on the ICCM training in identifying non- for health (mHealth) and community engagement means the need to treat only confirmed cases has malaria cases, we invested in tools and training, designed to increase community health workers’ become critical. Microscopy for malaria diagnosis improving diagnosis for another common childhood status and enable regular contact with supervisors requires robust quality assurance, which our work in disease, pneumonia: from beads on a string for low and fellow community members, are being tested countries such as Ethiopia has shown can be feasibly literate community health workers in South Sudan for their impact on community health worker and effectively implemented if thoughtfully integrated to mobile phone apps for use at community level in performance. into existing activities. The arrival of malaria rapid Uganda and Mozambique. Our work in this area diagnostic tests (RDTs) has been revolutionary, as Another innovation is using mobile phones for they bring the capacity to diagnose malaria outside malaria surveillance, an excellent example of which the laboratory. Our implementation research provided can be found in our work in Cambodia. Here village evidence on the feasibility and acceptability of RDTs’ “The formal health system can be malaria workers and health facility staff report, via use in health facilities in Uganda, as well as their complemented by programmes short message service (SMS), to a central information unit each case of confirmed malaria. This state-of- safety, accuracy and acceptability when used by delivering health care through community health workers in Uganda and Zambia. the-art surveillance system is already in place for the trained community members, detection of febrile malaria cases. Such a surveillance but it is vital to have full support system offers a unique and inexpensive opportunity to evaluate the potential impact of active detection and involvement of both health and treatment at the household level. facilities and communities for this approach to succeed”

25 26 Malaria Consortium: linking the community to health systems Looking ahead An overarching theme for success of any community based health delivery system is local ownership and t A community health A key priority area for Malaria Consortium in the volunteer with low literacy local accountability for all associated problems, future is the building of an evidence base to maximise uses beads to count breaths solutions and innovations. A continuing priority for to assess for pneumonia the benefits of community based health services: in a young patient in Aweil the organisation will therefore be technical support province, South Sudan • The integration of community based care across to governments in the countries where we work illness conditions, including the delivery of care for through sharing evidence and learning from our and newborns, malnutrition and neglected programmatic experiences, participating in policy tropical diseases within existing CHW programmes, dialogues, and providing input for the establishment will be explored further. of structures that can strengthen the health systems in the long term. • The integration of health system functions at different levels, including methods for collection related goals can only be achieved if and incorporation of community data in national the health system is extended to reach people most health information systems, for more effective at risk of illness and from disease: young, poor planning and supervision. This could potentially and rural populations in resource poor countries. use mHealth tools for real time reporting. With local ownership, accountability and • The creation of sustainable collaborations between stewardship by the government, a strong integrated the public and private sectors at different levels community health service linking public and private of the health system, to increase the reach of high sectors can form a permanent component of the quality and accountable health services in the health system. Information and communications community. technology solutions and new diagnostics can help community-level providers to improve their services. With advances in the health system and epidemiological transitions, the functions of Over community health care delivery systems should be revisited and adapted accordingly, with a long-term 14,000 goal of shifting the focus from service provision CHWs trained in to surveillance and mobilisation. integrated community case management across four countries*

*Mozambique, South Sudan, Uganda, Zambia

27 Case study Building trust and a healthy community

u Beatrice, a community health worker, received training from Malaria Consortium to be able to assess and treat children under five for pneumonia and diarrhoea, as well as malaria Tine Frank

28 Malaria Consortium: linking the community to health systems Today, the rumour being spread about Beatrice is that “People used to dislike sleeping under nets Kisongi village, Uganda she knows what she is doing and is the person you because it is so hot here. So we developed a drama When a child dies, it’s a tragedy. should go see if your child is sick. The reason behind showing how the mosquitoes bite mostly at night and this life-saving shift in opinion is the recently formed how that leads to malaria, and people started sleeping When that death could have been village health club, organised by Beatrice and her under nets. People started attending the meetings. avoided, the tragedy is even more colleague Birungi Tabu through Malaria Consortium’s They would cheer and enjoy and join up as members.” inSCALE project, funded by the Bill & Melinda Gates devastating. Today, the club has 24 members – mostly women Foundation. – and its success is having a great impact on the Sadly, this scenario is all too common for health “The challenge of distrust no longer exists for us”, women’s patient load, with Beatrice now seeing at workers trained to provide integrated community Beatrice explained. “The village health club has helped least 10 per week, while before it would be case management (ICCM) across Uganda. us sensitise the community, to teach them that not one or two, sometimes none at all. “In my early days as a village health team member every fever is malaria, there are other illnesses too. “In the past, you would find me on my bicycle, (VHT) people didn’t have any trust in my skills,” People now understand that the rapid diagnostic tests carrying three children to the health centre at the explained Katusabe Beatrice, a community health are for malaria only, so if the test is negative, they same time,” Bahoire Oliver, the club’s chairperson, worker (known as VHTs in Uganda) in Kisongi village use the referral note to get the proper treatment. joins in. “Things were not good in my home. I have in the remote district of Buliisa. “For example, if Everyone in our community knows Tibangwa eight children, but didn’t have a latrine, so there was I would test a child for malaria and the outcome was Sarah’s story, so I used it as an example in one of a lot of and diarrhoea. Beatrice knew of negative, their conclusion would be that I didn’t know our meetings. I told them that this is what can happen my problems and encouraged me to join the club, what I was doing.” Malaria is so common in Uganda so that they could understand the consequences.” through which I was inspired to build a latrine. that any fever is thought to be malaria and, rather The village health club, though, didn’t change Now there is no more diarrhoea.” than seeking accurate testing and treatment, people things overnight. “The interest wasn’t that big in tend to self-medicate. Voicing the sentiments of all the women gathered, the beginning,” explained Beatrice. “The format we one club member said: “I thank God that my children “I was visited by a , Tibangwa Sarah, whose were taught during the training didn’t seem to work are now okay.” daughter had a severe fever. The malaria rapid for our community; very few people would come for diagnostic test was negative, so I wrote her a referral the meetings. They found it boring and demoralising. Asked whether these clubs will have a future without to the health centre for more tests. Instead, because So we sat down and thought what we could do the continued support of projects such as inSCALE, she didn’t trust me, she went to the drug shop, differently to get people involved.” The result was Dr Mirimo Godfrey, District Health Educator for bought the wrong drugs and the child died.” introducing drama, song and dance as a way of Buliisa sub-county, believes they will, once people start imparting knowledge and educating about prevention seeing the benefits. Sarah herself, as painful as the realisation must have and treatment of common childhood diseases. been, has since admitted she could have saved her “I am very impressed with the Kisongi village health child’s life by listening to Beatrice’s advice. “Shortly club,” he added, which Beatrice and Tabu have now after it happened, I met Sarah at the borehole,” registered as a formal community based organisation. said Beatrice. “After I had expressed my condolences, “The village health club has “As a community based organisation they will have Sarah admitted that it was out of ignorance she didn’t helped us teach the community access to local government funds, so that will really follow my advice. I would feel so frustrated back then. that not every fever is malaria – help sustain them. Also, the government is reliant We knew we could help but we needed people to trust on CBOs to disseminate messages, so it really works us and that is when the village health club came and there are other illnesses too” both ways.” rescued us.” Katusabe Beatrice

29

u A shows how she uses a net to protect herself and her family against malaria Moving to in southern Myanmar. She learns how to pass on this positive approach to other members of her community through a pioneering behaviour change communication project Ghana by Malaria Consortium elimination 12.5 million Dr Sylvia Meek Technical director South Sudan 809,000

We have distributed over Uganda 96 million 18 million nets in Africa since 2003 Nigeria 63 million*

Mozambique 1.73 million*

*Nigeria: 9.8 million directly (through campaign and continuous distribution including commercial sector) and supporting the distribution of a further 53.2 million Mozambique: 230,000 directly and supporting the distribution of a further 1.5 million

30 Malaria Consortium: moving to elimination

31 t “The results are clear: day-by-day resistance is undeniably growing. Artemisinin is quickly losing its ability to work here. The dangers associated with this emerging resistance can’t be overstated. The numbers behind me are the data of individuals who have had resistant malaria” Dr. Rupam Tripra, Research Physician, Mahidol-Oxford Tropical Medical Research Unit Adam Nadal. From the Malaria: blood, sweat and tears exhibition Adam Nadal. From

32 Malaria Consortium: moving to elimination Elimination and resistance There is much still to learn about low level malaria Moving to elimination transmission in Southeast Asia. For instance, why is In parts of Southeast Asia, the prospects for there so much low level asymptomatic parasitaemia Malaria Consortium’s engagement elimination in the short term are greater than in much in people who are unlikely to have much acquired of Africa, as malaria prevalence is lower. However, with work to eliminate malaria, ? We also need to know more about the the presence of artemisinin resistance in the region importance and the behaviour of potential secondary in Asia in particular, has been driven could lead to failure unless efforts to eliminate and vectors in habitats where malaria is still occurring. by three major themes. control the spread of resistance continue and are It is important to understand which intervention scaled up as a matter of urgency. These are: approaches can work, but it is difficult to undertake Huge strides have been made in driving malaria randomised controlled trials of new and existing • To push for falciparum elimination as down in the parts of Cambodia and Thailand where interventions because of the low number of cases. quickly as possible in areas of artemisinin resistance resistance was first detected through thecontainment One approach, which Malaria Consortium is pursuing • To establish much better surveillance systems and efforts, which took off in 2009 after intensive through our multi-country project, Beyond Garki, is to capacity to provide the detailed timely information planning. A Joint Assessment of the Response to undertake long term small area intensive monitoring. needed for elimination Artemisinin Resistance in 2012 recognised the This is allowing us to develop a comprehensive progress, but called for an increased urgency in the picture of all potential causative elements, which • To advocate for continued high quality, highly response, and WHO launched its Emergency Response can help to interpret and attribute changes we see in intense efforts against malaria even when the burden to Artemisinin Resistance. Most recently, there has transmission. Through the project, which is running declines been an increase in political engagement with the in Cambodia, Ethiopia, Nigeria and Uganda, we creation of the Asia Pacific Leaders’ Malaria Alliance. There are two schools of thought on how you would are monitoring medium and long term changes in achieve global malaria eradication – one is that you In the Greater Mekong Subregion, Malaria the epidemiology of malaria within the context start at the edges, where there is very little malaria, Consortium’s work has focused on trying to support of implementation of interventions and assessing and progress later to the centre, where transmission is strategies for rapid elimination in areas where there necessary conditions to reduce transmission below its more intense. The other is that you start your efforts are high levels of artemisinin resistance. This has been critical level. We can then make recommendations that everywhere because, if you wait until you have done primarily through surveillance, monitoring, evaluation adapt prevention and control measures to observed the edges of the global malaria map before you start and implementation research as well as behaviour changes. In Pailin province (Cambodia) it also aims in the centre, the central core is still ready to re-invade change communications and advocacy. We are moving to assess conditions towards malaria pre-elimination the areas where you have already eliminated. Malaria towards more targeted programmes, which require and elimination goals. This will help to develop Consortium supports the second view and is looking robust and up-to-date local data. recommendations on an appropriate response system at how lessons from practical elimination in Asia can in pre-elimination settings by strengthening the existing be introduced in parts of Africa. health surveillance system and tailoring appropriate responses specific to elimination strategies for both We currently have some very good tools to control “The presence of artemisinin malaria including effective drugs for treatment and P.falciparum and P.vivax malaria. resistance in the region could for nets, but both of these tools are under Vector resistance against insecticides used in malaria threat from drug and insecticide resistance. Currently, lead to failure unless efforts to control is an additional major threat to elimination. we are not sure how long it will take to find an eliminate and control the spread Malaria Consortium has been involved in insecticide acceptable future generation of tools. It is critical that of resistance continue and resistance monitoring studies in a number of districts we move forward as strongly and quickly as possible in Uganda since 2009. Results of some of these studies to bring malaria down, while current tools last. are scaled up as a matter of have led to changes in insecticide policy and use of urgency” indoor residual spraying.

33 Improving surveillance and using Another project we have been working on is the mHealth for malaria elimination Innovative Malaria Monitoring and Evaluation, Research and Surveillance towards Elimination Through efforts to develop better surveillance using (IMMERSE) project. Supported by USAID/PMI/CDC, innovative tools in Cambodia, we have learnt some this five-year project is continuing to strengthen useful lessons: monitoring, evaluation and surveillance activities in 1. If a system does not work manually, technology the Greater Mekong Sub-region by providing technical is unlikely to help support and guidance to national programmes, to develop methodologies and tools and also to test and 2. Use existing sources of data as much as possible, evaluate innovative methods to guide transition from and add only to the data collection work of health malaria control to pre-elimination and elimination in workers if absolutely necessary resistance containment and low transmission settings. 3. Keep it simple; smaller systems may be better than a single big system Looking ahead Malaria Consortium’s priority is to support the 4. Decentralise the surveillance system to a level elimination of malaria. This involves: where decisions are made • Improving implementation based on targeted 5. Monitoring and evaluation and sufficient refresher operational research training are needed • Delivering enhanced surveillance of malaria and 6. Try to make the mHealth systems free for the users promote active response to data by working with the telecoms companies • Supporting and enabling technical developments Over 6.6 million More details can be found in our recent learning through field testing new diagnostic and mHealth ACTs distributed paper Moving towards malaria elimination: technologies at the national and community levels developing innovative tools for malaria surveillance in Cambodia. • Focusing more on insecticide resistance management strategies in Africa Elimination will require seeking out every case, and this has been a major challenge in the private • Exploring options to eliminate other neglected sector. Our SMS Project in Pailin and Battambang, tropical diseases in coordination with malaria supported by UKaid/DFID, aims to improve referrals elimination and integrate private patient data into the National Despite resistance, malaria elimination in Southeast Malaria Information System in Cambodia by piloting through health Asia is still feasible, if time is not lost, investment is a short message service (SMS) technology in the steady, information is accurate, timely and shared, service delivery private sector. It plans to design and test an innovative strategies are tested and sound, everybody is committed points in Nigeria* SMS alert system in Pailin Province and Battambang (this needs constant advocacy), and there is fast-track Operational District, and to identify bottlenecks elimination in areas with artemisinin resistance. and challenges that could affect the effectiveness *Artemisinin combination therapy of a full scale-up of this referral system. Many of the strategies can be introduced and anti-malaria drugs. ACTs distributed via public and private health adapted in parts of Africa, when the time is right, but facilities – SuNMaP: 1,237,712; investments in strengthening systems and surveillance MAPS: 3,184,730. Via retail outlets will be a major benefit to programmes at all levels of – MAPS: 2,258,216 transmission.

34 Malaria Consortium: moving to elimination q A child provides a finger- prick blood sample as part of Malaria Consortium’s malaria surveillance work through schools, in Southern Nations, Ethiopia

35 Case study Targeting at-risk migrant populations

t Malaria Consortium and partners set up a border crossing (Cambodia- Thailand) malaria screening checkpoint, targeting hard- to-reach migrant workers

36 Malaria Consortium: moving to elimination has the potential to greatly complicate “The challenges are really for people who are mobile Cambodia-Thailand border efforts to fight malaria in endemic regions if it is and migrant,” said Cheu Long, a village malaria Cambodian farmer, Cheun Seun, allowed to spread. Experts fear that mobile and worker, who is currently working on the Cambodia- migrant workers are more at risk of spreading the Thailand border. “They don’t have information frequently crosses the border into resistant parasite to other regions because of their about where they can access health services and this Thailand to look for work. itinerant lifestyle. is a big challenge for them. At first it was not easy, because people crossing the border here did not really “These people are really hard for us to reach,” said His journey is uneventful, save for a single stop at understand the purpose of this – why we wanted Sophal Uth, who is a field coordinator for Malaria the border. “I cross this border every day,” he said. to test them. We had to explain more about our Consortium in Pailin, Cambodia. “Sometimes they “I live in Cambodia and look for work in Thailand work and why we are here and what we are trying just get one or two doses of malaria treatment and and in the evening I come back to Cambodia.” to achieve. And why it is important to test people then they go away – they move to another place. crossing the border.” Here, beneath a trilingual banner bearing the name This is our big concern, and right now we want to of Malaria Consortium and its partners, he is contain all the resistant parasites. We have to focus But once people learn what the problem is, added approached by a worker wearing a bright green on these people, and make sure that we screen them Thien Su Wit, they are usually more than happy to jersey and a cap. But rather than handing over his as they cross the border and ensure they complete take part in the process. “I have found that most passport, Cheun Seun is asked if he would be willing treatment. We don’t want them to spread the resistant people are happy to consent to this screening. to be tested for malaria. This is because he is one parasite from our country to a neighbouring country.” On one day I will test 20-25 people and I think most of the many migrant workers whose journey takes Sophal and his colleagues are fully aware that of them understand about resistance.” him through one of the world’s hot spots for were the parasite to spread to sub-Saharan Africa, In addition to preventing the spread of drug resistance, artemisinin resistant malaria – a resistance that where malaria is very common, the results could testing at the border has other benefits. Cheun Seun is threatening to reverse years of progress. be devastating. recalls that he has had malaria six times now. The location of the border checkpoint has been “I am not sure why it has happened again and again. strategically chosen to help contain the spread of this Malaria makes things hard – sometimes I am working parasite resistance to artemisinin, currently the most “I hope we end up with a situation in the field and I get a fever. I have to rest.” But with effective drug used to treat malaria. Every working where everyone understands frequent diagnosis and treatment at the border and day, lab technicians like Thien Su Wit go to the in the villages through village malaria workers, he checkpoint and perform tests on passers-by. about malaria and we can work is less likely to have further episodes of malaria and “Here at the border, with the cross-border Malaria together to eliminate it, as well will be able to keep up his work. Consortium team, we complete the consent forms as this resistant parasite” Projects like this one are not only important for so that people can take part in our screening, then Cheu Long identifying and mapping cases, but also providing I take the fingerprints,” he explained. “We do rapid treatment and – importantly – information about diagnostic tests first and dry blood spots second.” malaria for at-risk mobile populations. The tests are used to determine whether any traces of the malaria parasite can be detected in the patient’s Cheu Long hopes that there is an end in sight. blood. If the parasites are found, the patient is “I hope we end up with a situation where everyone treated immediately. understands about malaria and we can work together to eliminate it, as well as this resistant parasite.”

37 By contributing, through operational research, So what does this mean for our priorities as technical assistance and implementation support to we look ahead? affected communities and their governments, we The fight against malaria is not over. Large parts of Going have built a reputation for technical excellence and Africa need to maintain a focus on the consistent supporting high quality, cost-effective, evidence- implementation of control measures that are proven to based health interventions that also strengthen reduce the incidence of malaria. This is the only way the wider health system. forward we can achieve, as quickly as possible, the goal of zero Our world continues to change, with significant deaths caused by this entirely preventable disease. progress in many areas. As a result, we find Over the 10 years that Malaria As the burden of malaria decreases in the move ourselves working in settings that reflect the Consortium has been in operation, towards elimination, a number of factors come into spectrum of endemicities of malaria with highly play. The combination of different interventions must we have seen significant change. varied circumstances of co-morbidity, health system be tailored to the reality of the environment; focus This change is evident in the investment and socio-. on the most vulnerable and hardest to reach must be We also see the worrying developments of resistance investment made by governments maintained; parasite-based diagnosis of malaria must of the parasite to available treatments and of the become universal and institutionalised; surveillance and donors in their efforts to mosquito to established insecticides. As life systems need to develop to increase timeliness and eliminate preventable death and expectancy increases, so does the emergence of accuracy of response; resistance markers of the non-communicable disease in the communities disability caused by malaria falciparum parasite must be tracked; patterns of that have, until now, had a health system focused mosquito behaviour and resistance to insecticide must and other diseases – more generally on infectious disease control and safe maternity. among some of the poorest and be monitored; and the use of technology-supported solutions must be scaled up. most vulnerable in our world, and also in the type and level “We still have a substantial role to In line with these factors is a need for increasingly sophisticated advocacy to ensure the impact of of our contribution to that effort. play in our mission to the world potential resurgence is not forgotten, while the of some of the infectious diseases priorities of the wider health system must be revisited. that impact most on those who The risk of the development of resistance of the parasites to current treatments will ultimately only can afford it least” be removed when the parasite pool is no longer there. Beyond malaria, we will support the roll out of interventions that will ensure that neglected tropical diseases are no longer neglected. We believe more of these can be completely eliminated in the foreseeable future. Research efforts need to continue to find suitable prevention and treatment alternatives for , which, given the lack of current options, is fast becoming a greater contributor to morbidity Charles Nelson for some communities than malaria. Chief executive

38 Malaria Consortium: going forward From a broader health perspective, diagnostic tools and protocols must be further developed to support clinicians and health workers to recognise and know how to respond when a fever is not malaria. This and the next generation of clinicians need to be able to benefit from updated training to ensure approaches remain current and appropriate. All interventions need to become part of the wider health system and aligned with other efforts to reduce and eliminate disease. If it is to be sustainable, it is essential that community-based activity becomes a recognised and facilitated component of the wider approach to health care delivery, and the role of the community worker, both in the breadth and the depth of engagement in each setting, should be acknowledged and formalised. Cost effectiveness and sustainability must remain as drivers of intervention and programme design and the effective, appropriate engagement of the private sector must be leveraged. With this publication we are celebrating 10 years of Malaria Consortium as an independent organisation. However, we are clear that our work is not yet done. We still have a substantial role to play in our mission to rid the world of some of the infectious diseases that impact most on those who can afford it least. Susan Schulman

p Health facility staff are trained under SuNMaP’s capacity building programme to help them manage malaria more effectively

39 Tine Frank

40 Malaria Consortium 2003-2013: a decade in communicable disease control and child health References 13. www.malariaconsortium.org/where-we-work/netcalc_predicting_ t A community health worker llin_net_needs.htm uses a pictorial flipbook Disease control: malaria and neglected tropical 14. Zurovac, D., Tibenderana, J. K., Nankabirwa, J., Ssekitooleko, to facilitate discussions in diseases, pages 14-21 J., Njogu, J. N., Rwakimari, J. B., Meek, S., Talisuna, A. & Snow, R. Kitaleesa Village Health Club, W. 2008. Malaria case-management under - Uganda 1. Mukanga, D., Tibenderana, J. K., Kiguli, J., Pariyo, G. W., Waiswa, treatment policy in Uganda. Malaria Journal, 7, 181. P., Bajunirwe, F., Mutamba, B., Counihan, H., Ojiambo, G. & Kallander, 15. Finn, T. P., Stewart, B. T., Reid, H. L., Petty, N., Sabasio, A., K. 2010. Community acceptability of use of rapid diagnostic tests for Oguttu, D., Lado, M., Brooker, S. J. & Kolaczinski, J. H. 2012. malaria by community health workers in Uganda. Malaria Journal, 9, 203. Integrated rapid mapping of neglected tropical diseases in three 2. Mukanga, D., Babirye, R., Peterson, S., Pariyo, G. W., Ojiambo, States of South Sudan: survey findings and treatment needs. G., Tibenderana, J. K., Nsubuga, P. & Kallander, K. 2011. Can lay PLOS ONE, 7, e52789. community health workers be trained to use diagnostics to distinguish Sturrock, H. J. W., Picon, D., Sabasio, A., Oguttu, D., Robinson, E., and treat malaria and pneumonia in children? Lessons from rural Lado, M., Rumunu, J., Brooker, S. & Kolaczinski, J. H. 2009. Uganda. Tropical Medicine & International Health, 16, 1234-42. Integrated mapping of neglected tropical diseases: epidemiological 3. Nankabirwa, J., Zurovac, D., Njogu, J. N., Rwakimari, J. B., findings and control implications for northern Bahr-el-Ghazal State, Counihan, H., Snow, R. W. & Tibenderana, J. K. 2009. Malaria Southern Sudan. PLOS Neglected Tropical Diseases, 3, e537. misdiagnosis in Uganda – implications for policy change. Malaria 16. Kur, l. W., Picon, D., Adibo, O., Robinson, E., Sabasio, A., Journal, 8, 66. Edwards, T., Ndyaba, A., Rumunu, J., Lewis, K., Lado, M. & 4. Kyabayinze, D. J., Tibenderana, J. K., Odong, G. W., Rwakimari, Kolaczinski, J. 2009. Trachoma in Western Equatoria State, Southern J. B. & Counihan, H. 2008. Operational accuracy and comparative Sudan: implications for national control. PLOS Neglected Tropical persistent antigenicity of hrp2 rapid diagnostic tests for Plasmodium Diseases, 3, e492. falciparum malaria in a region of Uganda. Malaria Robinson, E., Kur, l. W., Ndyaba, A., Lado, M., Shafi, J., Kabare, Journal, 7, 221. E., Mcclelland, R. S. & Kolaczinski, J. H. 2010. Trachoma rapid 5. Kyabayinze, D. J., Asiimwe, C., Nakanjako, D., Nabakooza, J., assessments in Unity and Northern Bahr-el-Ghazal States, Counihan, H. & Tibenderana, J. K. 2010. Use of rdts to improve Southern Sudan. PLOS ONE, 5. malaria diagnosis and fever case management at primary health care 17. The Clover Project: sustained funding for health systems facilities in Uganda. Malaria Journal, 9, 200. strengthening critical for effective disease control 6. Asiimwe, C., Kyabayinze, D. J., Kyalisiima, Z., Nabakooza, www.malariaconsortium.org/news-centre/clover-health J., Bajabaite, M., Counihan, H. & Tibenderana, J. K. 2012. Early experiences on the feasibility, acceptability, and use of malaria rapid diagnostic tests at peripheral health centres in Uganda – insights into some barriers and facilitators. Implementation Science, 7, 5. 7. Kilian, A., Byamukama, W., Pigeon, O., Atieli, F., Duchon, S. & Phan, C. 2008. Long-term field performance of a polyester-based long-lasting insecticidal in rural Uganda. Malaria Journal, 7, 49. 8. Kilian A., Wijayanandana W., Ssekitoleeko J., 2009. Review of delivery strategies for insecticide treated mosquito nets – are we Malaria Consortium is delighted to be one of the founding members ready for the next phase of malaria control efforts? TropIKA.net Journal of the Roll Back Malaria Partnership, the global framework for 9. Kolaczinski, J. H., Kolaczinski, K., Kyabayinze, D., Strachan, D., coordinated action against malaria. www.rollbackmalaria.org Temperley, M., Wijayanandana, N. & Kilian, A. 2010. Costs and effects of two public sector delivery channels for long-lasting insecticidal nets in Uganda. Malaria Journal, 9, 102. 10. Kilian, A., Boulay, M., Koenker, H. & Lynch, M. 2010. How many mosquito nets are needed to achieve universal coverage? Malaria Consortium Recommendations for the quantification and allocation of long-lasting 2003-2013: a decade in communicable insecticidal nets for mass campaigns. Malaria Journal, 9, 330. disease control and child health

11. Kilian, A., Byamukama, W., Pigeon, O., Gimnig, J., Atieli, F., Published by Malaria Consortium Koekemoer, l. & Protopopoff, N. 2011. Evidence for a useful life of Copyright © Malaria Consortium 2014 more than three years for a polyester-based long-lasting insecticidal mosquito net in Western Uganda. Malaria Journal, 10, 299. UK Registered Charity No: 1099776 US EIN: 98-0627052 12. Batisso, E., Habte, T., Tesfaye, G., Getachew, D., Tekalegne, A., Kilian, A., Mpeka, B. & Lynch, C. 2012. A stitch in time: a cross-sectional Design: TRUE www.truedesign.co.uk survey looking at long lasting insecticide-treated bed net ownership, Print: Park Lane Press www.parklanepress.co.uk utilization and attrition in snnpr, Ethiopia. Malaria Journal, 11, 183.

Malaria Consortium Malaria Consortium Malaria Consortium Malaria Consortium regional offices Africa offices Nigeria Asia offices 4th Floor, Abia House Malaria Consortium Malaria Consortium Off Ahmadu Bello Way Malaria Consortium Headquarters Ethiopia Central Business District Cambodia Development House Yeka Sub-City Kebele 08 Abuja, F.C.T, Nigeria #113, Parkway Square, 6/F 56-64 Leonard Street House No. 630 Mao Tse Toung Blvd. Tel: +234 9873 4226 London, Haile G/Selassie Street Chamcar Morn [email protected] EC2A 4LT Addis Ababa, Ethiopia Phnom Penh, Cambodia Tel: +44 20 7549 0210 Tel: +251 11 8963443 Malaria Consortium Tel: +855 2 372 6624 Fax: +44 20 7549 0211 [email protected] South Sudan [email protected] [email protected] Plot 367, Block 3-K South Malaria Consortium First Class Residential Malaria Consortium Malaria Consortium – Mozambique Juba, South Sudan Thailand Rua Joseph Ki-Zerbo 191 Room No. 805 Regional Office for Tel: +211 954 494121 Africa PO Box 3655 Faculty of Tropical Medicine [email protected] Plot 25 Upper Naguru Coop, Maputo Mahidol University East Road, PO Box 8045 Mozambique Malaria Consortium 420/6 Rajavidhi Road Kampala, Uganda Bangkok 10400, Thailand Tel: +258 21 490254 Uganda Tel: +256 31 2 300 420 Fax: +258 21 490261 Plot 25 Upper Naguru East Tel: +66 2 354 5628 Fax: +256 31 2 300 425 [email protected] Road, PO Box 8045 Fax: +66 2 354 5629 [email protected] Kampala, Uganda [email protected] Tel: +256 31 2 300 420 Malaria Consortium – Fax: +256 31 2 300 425 Malaria Consortium Regional Office for Asia Myanmar [email protected] Room No. 805 Building 21, Room 11 Faculty of Tropical Medicine Shwe Ohn Pin Housing Mahidol University Yangon, Myanmar 420/6 Rajavidhi Road Tel/Fax: +95 1 8605039 Bangkok 10400, Thailand [email protected] Tel: +66 2 354 5628 Fax: +66 2 354 5629 [email protected]

Malaria Consortium USA 8313-101 Six Forks Road Raleigh, NC 27615, USA [email protected]

www.malariaconsortium.org [email protected]