World Malaria Day 2016: Scaling-up Cost-Effective, Proven Systems Solutions to End Malaria for Good

World Malaria Day 2016: Scaling-up Cost-Effective, Proven Systems Solutions to End Malaria for Good

 {Photo credit: MSH staff}Amina is one of 3 million children in the Sahel region of sub-Saharan Africa who received seasonal malaria chemoprevention malaria in 2015.Photo credit: MSH staff

Four-year-old Amina is why I work on malaria. I met her in Basse District, The Gambia, last year when I was visiting the team distributing lifesaving malaria treatment to children under five. Words can’t describe the feeling of seeing this young Gambian girl, who had been severely ill with malaria, now beaming with joy, literally running to me for her fourth treatment.

Her mother walked up and described to me how sick Amina had been before MSH and partners began ensuring access to the quality-assured malaria treatments for children under five in the district. Since she first got malaria as an infant, every year during the rainy season (from September through December), Amina would become severely ill with malaria. She couldn’t play with the other kids outside, or go to school. One year, she fell into a coma and was hospitalized. But, in 2015, Amina experienced the opportunity for a healthy life: since September, she had received monthly treatment for malaria, known as seasonal malaria chemoprevention (or SMC). At four years old, Amina knew that this was what stopped her from feeling so ill, and enabled her to feel well.

She ran towards me for her medication, smiling ear to ear.

Challenge of malaria in Sahel sub-region of Africa

Sub-Saharan Africa bears the heaviest burden of malaria disease and death. In 2015, there were 214 million new cases of malaria globally; a staggering 88 percent of these occurred in sub-Saharan Africa. Of 438,000 malaria deaths, 90 percent occurred in sub-Saharan Africa. In the Sahel sub-region, malaria remains a leading cause of death and disability among children, with infection particularly high during the rainy season.  

After years of research, scientists developed seasonal malaria chemoprevention: a cost-effective, innovative treatment that prevents children under five from getting malaria and dying. When provided in combination with other preventive methods, if a Sahel child receives a dose of the antimalarial treatment once every month during the rainy season, that child would be protected from getting malaria—and 75 percent of all uncomplicated and  severe malaria episodes would be prevented.

[When provided in combination with other preventive methods, seasonal malaria chemoprevention can prevent 75 percent of uncomplicated and severe malaria cases.]When provided in combination with other preventive methods, seasonal malaria chemoprevention can prevent 75 percent of uncomplicated and severe malaria cases.The World Health Organization formulated a policy for it in 2012. So, why, in 2013, were only 4 percent of Sahel children accessing this lifesaving treatment?

Despite its potential, many Ministries of Health in malaria endemic countries had yet to fully scale-up seasonal malaria chemoprevention distribution. The approach was new, so systems for distributing the intervention were not in place. Some countries were concerned and uncertain about the costs and required financing. There weren’t sufficient resources dedicated for it. And there wasn’t enough evidence of use at scale. In addition, the production of quality assured, user-friendly treatment (sulphadoxine-pyrimethamine + amodiaquine) was inadequate.

Health systems innovation was needed to close this gap between knowledge and action on childhood malaria. 

Rolling-out Seasonal Malaria Chemoprevention in the Sahel Region

That’s precisely why UNITAID, an innovative financing mechanism, launched Achieving Catalytic Expansion of Seasonal Malaria Chemoprevention (Access SMC) in 2014, led by Malaria Consortium and Catholic Relief Services with partners including Management Sciences for Health, to support seven Sahel region countries (Burkina Faso, Chad, Guinea, Mali, Niger, Nigeria, and The Gambia) roll-out this proven, cost-effective intervention at scale and with maximize impact.

MSH’s role in this health system innovation is twofold: measure and monitor the costs of administering the treatments at scale; and optimize the supply chain system that delivers these treatments. [Access SMC supports seven countries in the Sahel sub-region to roll-out seasonal malaria chemoprevention.]Access SMC supports seven countries in the Sahel sub-region to roll-out seasonal malaria chemoprevention.

Through Access SMC, MSH and partners have accelerated sustainable, funded demand for the treatments; stimulated global interest and capacity for quality-assured medicines; identified factors to decrease costs of delivering treatments; and demonstrated effective and safe implementation at scale. Between 2015 and 2016, ACCESS-SMC has influenced more than a three-fold increase in quality-assured treatments availability on the market, which is used to reach a large number of children across the Sahel.

Last year, MSH and partners distributed 14.7 million treatments to more than 3 million children, like Amina. The project plans to deliver 30 million treatments to about 7.5 million children in 2016, potentially averting 36,000 childhood deaths over the two years across seven countries of the Sahel.

The average cost to treat each child is $3 USD each year. MSH surveyed the seven countries to understand the cost drivers of delivering the treatment. Using our modeling tool, countries can see which factors will increase or decrease costs. And, MSH can help countries plan and advocate for future funding. We’re working to decrease the average cost even more by 2017.

As we visit the clinics and wards in the seven countries, time and again, the health workers tell us that their facilities are nearly empty of childhood malaria cases, and they’ve seen significantly fewer deaths. MSH and partners are continuing to monitor the roll-out, including the coverage of seasonal malaria chemoprevention (up to 100 percent in some of the countries), the safety of the medicines (so far all positive), checking for any signs of resistance to the medicines (so far no signs of antimicrobial resistance), and ensuring that the intervention continues to work as expected.

Today on World Malaria Day, as the global community commemorates efforts to end malaria for good, I think about Amina and her smile as she ran towards me for her medication. Through health systems innovation and strategic partnerships, we are closing the gap between knowledge and action on childhood malaria. Thanks to UNITAID, Malaria Consortium, and partners such as MSH, there are millions of children like Amina living in the Sahel who now have the opportunity for a healthy life. The global community can, and will, end malaria for good.

Funded by UNITAID, Achieving Catalytic Expansion of Seasonal Malaria Chemoprevention (Access SMC) in the Sahel is a three-year project led by Malaria Consortium in partnership with Catholic Relief Services,  and includes among its implementers the London School of Hygiene & Tropical MedicineCentre de Support de Santé InternationalManagement Sciences for HealthMedicines for Malaria Venture, and Speak Up Africa.

 

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