Giving Compass' Take:

• M. James Eliades shares how PSI and governments worked to engage private sector healthcare providers to address malaria as it evolves. 

• How can other funders support efforts to engage existing healthcare providers to improve coverage and care 

• Read about one foundation's approach to malaria. 

Malaria has evolved. In countries where malaria is prevalent, overuse of the most common malaria-combating drugs–artemisinin-based combination therapies–has resulted in a drug-resistant strain of plasmodium falciparum, the parasite that causes malaria. This strain threatens to reverse the progress that has been made to reduce malaria and hinders our ability to eliminate the parasite. From 2015 to 2019, PSI supported governments in the Greater Mekong Sub-region (GMS) to eliminate the parasite by engaging key players in the fight against malaria: private sector healthcare providers.

The threat posed by artemisinin resistance has prompted four countries in the GMS to take direct action. Cambodia, Laos, Myanmar, and Vietnam have set the goal of eliminating P. falciparum by 2025. However, elimination is impossible without tracking infections. PSI has been operating in the GMS since 1995 and has firsthand experience surrounding the need for sophisticated malaria surveillance. From 2015 to 2019, PSI led the Bill & Melinda Gates Foundation-funded “GMS Elimination of Malaria through Surveillance” (GEMS) project across all four countries mentioned above. As part of their strategy, PSI chose to engage a diverse cross-section of formal and non-formal private sector providers to deliver quality malaria case management and reporting to national surveillance systems. This effort supported the four national malaria programs (NMP) and all three core pillars of the WHO’s malaria elimination framework: 1) universal access to prevention, diagnosis and treatment, and 2) accelerating elimination efforts and 3) transforming malaria surveillance into a core intervention.

Project results showed that:

  • Private sector providers detected, treated, and reported between 5% to 40% of national caseloads annually, with many cases coming from poor, peripheral, high-risk communities
  • Reporting rates improved and the quality of case management increased throughout the project
  • A provider survey demonstrated that private sector providers were motivated by helping their communities and contributing to a larger goal—not just financial gain

In addition to gathering information, PSI gave direct support to the private sector to build capacity for malaria surveillance. The GEMS project worked with providers to demonstrate, then scale up, their capacity to:

  • Remove oral artemisinin monotherapy (a large contributor to drug resistance) from their prescribing regimens
  • Use malaria rapid diagnostic tests properly and treat with an artemisinin combination therapy based on the test result
  • Report positive cases into national systems using a combination of paper and electronic-based reporting

Read the full article about addressing the evolution of malaria by M. James Eliades at PSI.