Mobilize Against Malaria

Partnership objectives

  1. Increase malaria symptom recognition by providers and patients.
  2. Improve effective malaria treatment and referral.
  3. Increase effectiveness of the informal and public health sectors to deliver appropriate malaria treatments.

Mobilize Against Malaria's partners offer grassroots education programs on malaria prevention and treatment. Here a local health worker in Ghana shares information on the disease with her patient. Mobilize Against Malaria's partners offer grassroots education programs on malaria prevention and treatment. Here a local health worker in Ghana shares information on the disease with her patient. Copyright Mark Tuschman

What are the health needs and challenges?

According to the World Health Organization, malaria is the leading cause of mortality in children under five in Africa and constitutes 10 percent of the continent’s overall disease burden.  This partnership was designed to address critical gaps in malaria treatment and education in Ghana, Senegal and Kenya.

Description of partnership activities and how they address needs and challenges

In each of the three program countries, Pfizer provided support to leading non-governmental organizations to implement and evaluate effective malaria interventions.

In Ghana, Pfizer helped  bring the public and private sectors together to find new solutions to the malaria challenge. The program specifically supported Family Health International and Ghana Social Marketing Foundation which demonstrated that investments in Ghana's licensed chemical sellers, small retail outlets which act as a major source of basic medicines, can dramatically improve malaria treatment, diagnosis and prevention. Through Pfizer's partners, thousands of Licensed Chemical Sellers (LCSs) received training and job support and developied closer ties to the communities they serve. In Kenya, Pfizer helped Population Services International to reduce malaria in pregnant women and children under five, two groups most at-risk for malaria-related mortality and morbidity. While Kenya is one of the most progressive African countries in terms of malaria programming, resources are still needed to reach women and healthcare providers, especially in hard-to-reach rural communities. Recognizing that more than 70% of women attend antenatal clinics at least once during their pregnancy, Pfizer's partners are providing a boost to healthcare providers and patients at these clinics by supplying improved training, health education and new information packets designed especially for new mothers.

In Senegal, Pfizer worked with IntraHealth International to strengthen the country's system of health huts, rudimentary clinics which are often the only healthcare facility accessible to rural communities. During the rainy season, when populations become even more isolated, these clinics frequently function without running water, electricity, adequate supplies or medicines. Recognizing the critically important role these health huts play in the country's healthcare system, Pfizer and its partners are investing in improving their infrastructure, malaria training, supply chain, provider skills, and community demand for services.

Lessons learned

Early partnerships position partners for success because of their collective skills and experience. Partner selection should expand beyond technical expertise to include long-term strengths that may be required later in the program. In advance of proposal preparation, collaborating parties should discuss and formally agree on the rules of engagement.

The Ghana program focused on building capacity of LCS in the management and treatment of malaria, and did not give consideration to other skills areas that would have made it possible for them to meet broader Pharmacy Council requirements. LCS capacity building initiatives should include other areas of their operation to ensure sustainability of the program.

Because LCSs were not regarded as part of the health delivery system, it was difficult to convince clinicians and other public health sector stakeholders that LCSs could be trained to distinguish complicated malaria and conduct referral of severe cases and pregnant women to the health centers. Changing the operational culture of LCSs that are hardly supervised and working with DHMTs that are not mandated to work with LCSs required engagement processes beyond the six months used in each district.

Engaging relevant stakeholders and leveraging support for program goals can accelerate its implementation significantly. In the case of MAM, goals were in alignment with those of National Malaria Control Programs and Ministries of Health. MAM teams led strong advocacy campaigns and brought key representatives from all relevant sectors together to ensure they are well informed about the program.

Additional monitoring may be required when working with CBOs. During the pilot phase of the program’s community activities, some CBOs did not deliver on the goals and objectives agreed. Thus, time spent upfront in setting clear deliverables helped to identify performance issues early and provided an opportunity to address them. 

Summary of impact through December 2013 and forward looking information

By working with partners on the ground, Pfizer was able to treat, teach, build, and serve communities affected by malaria. Uniquely, Pfizer also supported a multidisciplinary team at the London School of Hygiene and Tropical Medicine to assist in developing strong and measurable pilot programs with potential for sustainable expansion through other funding organizations.

The results achieved were a testimonial to the partnership’s success:

  • Ghana: Over 1,200 LCS trained to correctly dose and administer ACTs, and to recognize and refer complicated malaria cases to the nearest health facility in Ashanti Region, Ghana. MAM trained LCSs were significantly more likely to stock an ACT (97%) than those who hadn’t received training (82%). In 2009 23% trained LCSs reported that they would recommend an ACT compared to only 10% of those without training. By 2010 this difference has increased with 84% of MAM trained LCSs reporting that they would recommend an ACT compared to only 60% of those without training. LCSs are now recognized as a critical part of the health care system and the government is evaluating additional roles for nutritional and immunization activities.
     
  • Kenya: Over 1,600 staff working with pregnant women and young children trained to advise women on prevention and treatment of malaria in Nyanza and Western provinces, Kenya. There was significant increase in the prescription and dispensing of AL by public health providers after the intervention rising from 69.4% pre intervention to 87.6% post intervention. In both 2009 (pre-intervention) and 2010 (post-intervention) more than 90% of all caregivers with a febrile child had the knowledge that treatment for fever should be sought promptly and from a public health facility. However, prior to the intervention only 67.5% of febrile children whose caregivers had this knowledge accessed treatment within 48hrs while in 2010, after the intervention, this proportion had increased to 81.8%.
     
  • Senegal: Community health workers trained in malaria diagnosis and treatment at 24 health huts in Tambacounda, Senegal. All health huts were also equipped with furniture, basic medical and surgical instruments, health management tools. There was significant increase in the proportion of febrile children that sought care from health huts from 13.1% in 2008 to 63.9% in 2011. Amongst those that seek care, there was an increase in the proportion that did so within 24/48 hours from 73.2% in 2008 to 82.3% in 2011. The proportion of children with fever that appropriately received an ACT within 48 hours was overall significantly greater in 2011 compared to 2008, increasing from 9.1% to 25.1%. Use of RDTs for children seeking treatment from a community source approximately doubled in the 12 months from 38.1% to 71.8%, suggesting that MAM activities were effective. By September 2011, 24 MAM health huts were in operation.

Pfizer worked with the London School of Hygiene and Tropical Medicine to evaluate program impact and synthesize cross-cutting issues emerging from the programs, which are of strategic importance in the development of regional and global policy agendas on the delivery of health services. Communication between local M&E and implementation partners, as well as the overall evaluation partner was critical from the onset of the program and ensured that all partners are on the same page as to scope and timing of activities. The relationship was a complementary one rather than an investigative one.

The Pfizer Mobilize against Malaria Initiative included USD 15,000,000 of funding, evaluation assistance and the assignment of Pfizer Global Health Fellows to the projects on the ground to help in message and communications tool design, informal provider training, program evaluation, program administration, etc. 

The initial assessment and phased rollout supported better community participation and progress, and helped avoid repeated errors. Integration and recognition of community health volunteers had a significant impact of their motivation.

Videos

Mobilize Against Malaria: Lessons learned from Ghana

Potential health boost of community care in Senegal

Partnership information

Company(ies) Pfizer

Partner(s) Family Health International, Ghana Social Marketing Foundation, Health Partners International, IntraHealth International, KEMRI-Wellcome Trust Research Program, London School of Hygiene and Tropical Medicine

Type of Partner(s) Academia / Hospitals, NGOs, Other Business

Disease(s) Malaria

Program Type(s) Health System Infrastructure - Development of Physical Infrastructure, Health System Infrastructure - Training

Targeted Population(s) Children, Elderly, Marginalised / Indigenous People, Men, Mothers, People with low income, Women, Youth

Region(s) Sub-Saharan Africa

Number of Countries 3

Country(ies) Ghana, Kenya, Senegal

Start Date 2006

More information Pfizer Responsibility

Completed date 2012