lifting the burden of malaria: an investment guide for impact-driven philanthropy
TRANSCRIPT
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Th Ct f High Ipact PhiathpSchool of Social Pol icy & Pract ice | Univers ity of Pennsylvania
Carol McLaughl in , Jennifer Levy , Kathleen Noonan, and Katherina Rosqueta
Lifting the Burden of MalariaA Ivtt Gid f Ipact-Div Phiathp
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Photo courtesy o Gene Dailey, American Red Cross, provided by VOICES or a Malaria Free Future.
Every thirty seconds a young child dies of malaria.
Each of those deaths is avoidable.
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lIFT InG THe burDen oF mAlArIAi
Lifting the Burden of MalariaA Ivtt Gid f Ipact-Div Phiathp
Carol McLaughl in , Jennifer Levy , Kathleen Noonan, and Katherina Rosqueta
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Th Ct f High Ipact PhiathpSchool of Social Pol icy & Pract ice | Univers ity of Pennsylvania
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THe CenTer For HIGH ImPACT PHIlAnTHroPyiv
Table of ContentsABOUT THIS DOCUMENT i i
How we selected promising opportunities for philanthropists i
I . THE NEED fOr pHIlANTHrOpIC INvESTMENT IN MAlArIA CONTrOl 1
Malaria is a global priority for health and development 1
The global strategy to combat malaria 4
How philanthropists can help 6
Why invest now 7
What are the best investments in malaria control 8
II . TrEAT AND prEvENT NOw 10
Overview of malaria tools 1 1
Malaria tools are both inexpensive and cost-effective 14
Philanthropists can address the current gaps in the coverage of tools 15
Effective tool-delivery strategies 16
Addig ct ctait t div
Strategy 1: Extend the existing health system capacity throughcommunity health workers 17
Strategy 2: Enlist family members and community volunteers toeducate communities 20
Strategy 3: Piggyback on existing systems for delivery of bednets 24
Strategy 4: Scale-up community and household access to new ACTs 27
Hpig pcia va ppati
Strategy 5: Build training networks to prevent malaria in pregnancy 30
Strategy 6: Assist the most vulnerable in areas of conflict ornatural disaster 31
In-depth case study included in this section
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lIFT InG THe burDen oF mAlArIAv
I I I . BUIlD SySTEMS fOr THE lONg TErM 32
Strategy 7: Strengthen health system capacity througheffective par tnerships 34
Strategy 8: Leverage existing financing resources forsystem-wide change 36
Strategy 9: Create information networks to track outcomes,
monitor resistance, and predict epidemics 38Strategy 10: Prepare future health leaders from
malaria-affected countries 40
Iv. INNOvATE fOr THE fUTUrE 42
Strategy 11: Support innovation for new tools 44
Strategy 12: Innovate by harnessing the potential of the privatesector or applying new technology 48
v. TrANSlATINg gOOD INTENTI ONS INTO HIgH IMpACT pHIlANTHrOpy 51
1. Select your entry point supporting the global malaria strategy 51
2. Consider what region you want to target 54
3. Evaluate potential investments 55
4. Measure what matters after you have written the check 58
5. Incorporate proven strategies for successful public health efforts 62
rESOUrCES AND rEfErENCES 65
Glossary of acronyms and terms 66
Summary of philanthropic opportunities 67
Exemplary models and example agents mentioned in this report 68How we calculated cost per impact 70
Where to learn more 72
References and endnotes 74
About the authors 80
Acknowledgements inside back cover
About the Center for High Impact Philanthropy back cover
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lIFT InG THe burDen oF mAlArIAv
ABOUT THIS DOCUMENT
In this guide, we provide independent, practical advice on how to invest
in malaria control in a way that maximizes the impact of philanthropic
dollars. For this document, we combined our analysis of available research,policy analyses, and program evaluations with the insights of a diverse set of
opinion leaders and practitioners.
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I . THE NEED fOr pHIlANTHrOpIC INvESTMENT IN MAlArIA CONTrOl
Every thirty seconds a young child dies of malaria. The disease kills more
than 5,000 people a day, primarily children in sub-Saharan Africa.
Each of those deaths is avoidable. The disease is both a product andan underlying cause of poverty, creating a vicious cycle of poor health
outcomes and underdevelopment. Fortunately, there are effective, low-cost
tools available for the prevention and treatment of malaria, as well as an in-
ternational consensus on a strategy to combat the disease.
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oday, despite known cost-eective tools to treat and pre-
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diagnose and treat Sinaly. Finally, Aramata had a success-ul enough business to have income ready to pay or the
lie-saving treatment.
Adapted rom success story by Amy Ellis and Susan G.
Walters. VOICES or a Malaria-Free Future.http://www.
malariareeuture.org/news/success/mali_mother.php
Image by Amy Ellis, VOICES or a Malaria-Free Future
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interventions is not matched by the power of health
systems to deliver them to those in greatest need,
in a comprehensive way, and on an adequate scale.
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I believe that if you show people a problem, andthen you show them the solution, they will be
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now its time for the world to take action.
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Co-Chair, Bill & Melinda Gates Foundation20
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that a rapid scale-up plan is substantially more
cost-effective than a continuation of the currentfunding trajectory. This is due to the benefits
of community health effects and the significantly
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scale effort.
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t g n: m . If $4 billion is
invested annually to control malaria in Africa, every dollar invested could enable the continent to regain three
dollars in lost GDP.10
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4. Scale-up communi ty and household access to new ACTs
5. Build training networks to prevent malaria in pregnancy
6. Assist the most vulnerable in areas of conflict or natural disaster
STrATEgIES IN THIS SECTION
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I I . TrEAT AND prEvENT NOw
The best way to save lives immediately is to close existing gaps in the delivery
of effective malaria control interventions to communities. In this section, we
rst describe key malaria tools, how to think about their cost and impact, andhow to increase access by supporting effective delivery programs. We then
highlight six strategies that philanthropists can take to immediately have an
impact in this area. For several models, we also include cost-impact proles.
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lIFT InG THe burDen oF mAlArIA15
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THe CenTer For HIGH ImPACT PHIlAnTHroPy16
Image by Bonnie Gillespie, VOICES or a Malaria-Free Future
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lIFT InG THe burDen oF mAlArIA17
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Extend existing health system capacity throughcommunity health workers
STrATEgy 1
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THe CenTer For HIGH ImPACT PHIlAnTHroPy18
PromIsInG PrACTICe:
Cit ca aagt f chidhd i
achig th at qiti with if-avig tatt
proBlem: Many communities are far from clinics and do
not have access to mal aria treatment. At the same time, there
are severe shortages of al l levels of health workers. Combined
with widespread drug resistance to chloroquine and limited
access to new antimalarial medications, these factors can lead
to fatal outcomes.
solution: Lay health workers and community-managed
drug kits
successFul model: In communities more than 5km from
a healthcare facility, community health workers receive train-ing and supervision so that they can safely provide essential
health services. These health services include basic health
education and prevention, as well as diagnosis, treatment,
and/or referral for the most common life-threatening child-
hood illnesses, including malaria, diarrhea, and pneumonia.
The community health workers are affiliated with established
health clinics that provide training, supervision, and consis-
tent drug supply. When feasible, the health clinics also enable
timely transfer of sick children who need higher levels of ca re.
Research studies support the use of both lay health workers
and home-based care for malaria.44
exemplar agent: s c - In partnership
with the target countrys Ministry of Health, Save the Children
uses community case management (CCM) to deliver basic but
critical interventions to those without access. Although most
of its pilot CCM programs are less than five years old, mid-
term evaluations indicate that the programs are on track to
reach targets. Save the Children personnel have also taken
a leadership role in collecting evidence for the model and
sharing its core elements for use by other nongovernmental
organizations.
results: In 2002, Save the Children initiated a community
case management project in the Sikasso region of Mali, West
Africa. The project gave villagers increased access to essential
medications for malaria and dia rrhea by establishing over 450
village drug kits and training kit managers to treat patients
and refer those with signs of severe illness to affiliated health
centers. Household surveys showed that the use of appropriate
malaria treatment for all children in the target area increased
from 24% at baseline in 2002 to 56% i n 2004. A recent mid-
term evaluation of an expansion of the project to other districts
showed that 50% of children treated for malaria in project
districts received their therapy at the community level.45 More
recently, Save the Children has piloted the use of ACTs i n the
village drug kits using the CCM delivery platform.46
what diFFerence can the model achieve? Save
the Children has set a number of targets for its expanded
CCM project in Mali, which serves a target rural population
of 990,000 people, including 250,000 children under the
age of five.
2004-2009 (minimum) targets for change in intervention
coverage in the target population:
Children sleeping under a bednet the previous night:
increase from 8% to 30%
Children receiving therapy within 24 hours of fever onset:
increase from 26% to 60%
Pregnant mothers receiving at least one dose of IPT:
increase from 7% to 70%
Estimated number of child lives saved if the project reaches
its minimum targets:
2,500 (considering only the impact of the three malaria
interventions)
3,200 (if we consider the doubled use of oral rehydration
therapy for diarrhea treatment)
how much does this change cost? About $1000
per additional child life saved, when including the impact of
both malaria interventions and oral rehydration therapy for
diarrhea. The cost rises to approximately $1350 if we only
consider the impact of malaria inter ventions. The total cost for
this five-year project is $3.3 million, or roughly $3 per child
under the age of five per year in a population with 250,000
children.47
We based these figures on project data and targets from
Mali 2004-2009 and the Lives Saved Calculator of CHERG/
CSTS+.48 The figures only include the estimated impact on
deaths averted in children less than five years of age. They
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lIFT InG THe burDen oF mAlArIA19
do not include the cost of medications and bednets, which
the Ministry of Health and other partners (e.g., UNICEF, Red
Cross) typically provide.
The models cost efficiency a rises from two sources. First, the
model relies on partners for referral, commodities, and cost-
sharing. Second, community health workers are addressing
several different priority health issues at once.
additional BeneFits: In addition to preventing death,
the interventions decrease sickness and disability in children.
Older children, pregnant women, and adults also benefit fromdecreased sickness and death. In addition, the community
case management strategy commonly addresses pneumo-
nia, a leading killer of children.49 Health planners are now
considering ways to adapt the strategy to deliver interven-
tions to treat newborn infections, childhood malnutrition, and
HIV/AIDS. This model also builds local capacity for reaching
the poorest of the poor, who experience a disproportionate
burden of illness and death.
F b C C M , Save the Childrens b: .v.
R (0) 1-44 (R@v.) D. Dv M (41) 5-05
(DM@v.).
CASE SNApSHOT
c Community health workers bringlife-saving treatments to families currently without access
i Decrease childhood death and illness
from malaria, diarrhea, and other common conditions
c (, m) Additional %of target population with coverage: +22% (bednet use),+34% (prompt therapy), +63% (IPT pregnancy)
p Aver-age annual cost per child under the age of five (as reportedby the nonprofit) is roughly $3
e Roughly $1000 peradditional child life saved for Mali program
*See page 70 for how we calculated cost per impact.
Image provided by Save the Children
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THe CenTer For HIGH ImPACT PHIlAnTHroPy20
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Enlist family members and communityvolunteers to educate communities
STrATEgy 2
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lIFT InG THe burDen oF mAlArIA2
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PromIsInG PrACTICe:
edcatig, iizig, ad chagig havi i citi
thgh vt twk
proBlem: When community members do not trust their
health providers, do not understand the importance of effec-
tive malaria tools, or lack the ski ll to use those t ools correctly,
they often will underuse or misuse these tools. Key constraints
to the regular use of malaria tools include shortages of trained
health care workers, low rates of literacy i n target populations,
diverse cultural beliefs, and language barriers.
solution: Educate and empower the community to take
appropriate actions to prevent malaria and seek treatment
within 24 hours of symptom onset. Use a system of commu-
nity volunteers and locally-tailored healt h messaging.
successFul model: The c g m is an
innovative and effective way to convey health messages to
large populations. This particular model has been unique in
its ability to overcome the usual difficulties associated with
training, supervising, and sustaining a large number of com-
munity volunteers, and is able to achieve universal coverage
of households.
Programs using this model create a vast network of commu-
nity volunteers that mobilize and educate their neighbors. For
every 10 to 15 households, a volunteer mother is selected. A care group consists of 10 to 15 volunteers. Each care
group meets twice monthly with a staff health promoter to
learn a new health message or skill focused on child survival.
After the care group meeting, all volunteers are responsible
for making individual visits to their assigned households near
their home and teaching other mothers the health lessons that
they learned in the care group. This volunteer-based saturation
system ensures that behavior-change communications reach
every household.
Care group meeting topics include the appropriate use of in-
secticide-treated bednets for malaria; oral rehydration therapy
to treat diarrhea; breastfeeding; and when to seek care at
health clinics (e.g., when a child has a fever).
exemplar agent: w rf originally developed
the Care Group model in Mozambique. World Relief and oth-
er NGOs (such as Food for the Hungry, Plan International,
Curamericas, Red Cross, and Africare54) have since replicated
the model in a diverse range of settings. The Mozambique
project was the subject of an external impact evaluation that
confirmed the positive health impact that the project had esti-
mated using its own household survey.
results: World Reliefs project in Gaza province, Mo-
zambique mobilized 2,315 women to reach nearly 25,000
households in a rural district. An independent external evalu-
ation of the Mozambique program found a 49% reduction
in infant mortality and a 42% reduction in mortality among
children under the age of five in the program communities. 55
In addition, the volunteer networks also implemented a health
information system and collected vital events such as births,
deaths, and childhood illness, thus filling a critical gap in reli-
able health data.
what diFFerence can the model achieve? Beloware selected results of World Reliefs Care Group program
serving a rural population of 160,000 in Malawi (including
37,000 children) before and aft er a four-year program. In Ma-
lawi, malaria is responsible for about 30% of child deaths.
Estimated number of child lives saved:
~ 473 (considering only the impact of the three malaria
interventions)
~ 1,114 (when also considering additional areas such
as nutrition, breastfeeding, and pneumonia therapy
that Care Groups address)
program
staFF
program
director
care group = 10 To 15 volunTEERS onE volunTEER PER 10 To 15 HouSEHolDS
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lIFT InG THe burDen oF mAlArIA23
how much does this change cost? About $1200
per additional child life saved, when including all of the child
health interventions that the Care Groups addressed (~$2800
if we only consider the impact of the malaria interventions).
The total cost for the four-year project in Malawi was $1.3
million or roughly $8 to $10 per child under the age of five
per year in the target area. We do not include the cost of
medications and bednets, as the Ministry of Health or other
partners typically provide these. For these figures, we used
project data from Malawi 2000-2004, the Lives Saved Cal-
culator of CHERG/CSTS+, and data from the USAID Child
Survival Grants Program.56 The figures only include impact on
deaths averted in children under five years of age.
additional BeneFits: In addition to preventing death,
Care Group interventions also decrease sickness and disabili ty
in children. Older children, pregnant women, and healthy adults
also benefit from decreased sickness and death. Furthermore,
the Care Group platform can introduce microcredit, literacy,
and income-generating skills t o rural women and households.
F b C G M, W R b: .. C F
(44) 451-19 (@.).
CASE SNApSHOT
c Reach all households with critical healtheducation using mothers and household volunteers
i Decrease childhood death and illnessfrom malaria, diarrhea, and other common conditions
c (m) Additional % target popu-lation with coverage: +51% (bednet use), +39% (promptmalaria therapy), and +30% (IPT pregnancy)
p Average annual cost per child under the age of five (asreported by the nonprofit) is about $8 to $10
e Roughly $1200 peradditional child life saved
Ipact f Ca Gp i maawi 2000-2004
0% 10% 20% 30% 40% 50% 60% 70% 80%
percent oF target population
PREgnAnT MoTHERS RECEIvIng
AT lEAST onE DoSE of IPT
CHIlDREn RECEIvIng MAlARIA THERAPy
wITHIn 24 HouRS of fEvER
CHIlDREn SlEEPIng unDER A
bEDnET (ITn) THE nIgHT PRIoR To SuRvEydelivery
indicator
31%
61%
35%
74%
9%
60%
BeFore
aFter
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THe CenTer For HIGH ImPACT PHIlAnTHroPy24
B v
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Image by Bonnie Gillespie, VOICES or a Malaria-Free Future
Including the cost of transportation from
manufacturers to the villages and of follow up
by trained volunteers, the total price of getting
each net to the hut is under $10. Since the net
lasts five years and typically two children sleep
under it, the protection is about $1 per child per
year. Roughly every hundred nets in use will save
the life of one child a year and prevent many
dozens of debilitating occurrences of malaria.
Jerey Sachs,
writing about the Measles Initiative58
Piggyback on existing systems for deliveryof bednets
STrATEgy 3
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lIFT InG THe burDen oF mAlArIA25
proBlem: Getting bednets to remote areas is difficult,
especially in areas where there are no functional health
systems or transportation networks.
solution: Integrate bednet distribution with mass vaccina-
tion campaigns
successFul model: In sub-Saharan Africa, mass
vaccination campaigns against polio, measles, and tetanus
reach over 90% of children in target populations. A cost-
effective way to distribute bednets is to integrate them into
these mass vaccination campaigns, taking advantage of theirexisting logistics. The model first integrates bednet distribu-
tion and malaria prevention education into existing vaccine
campaigns. It ensures that families install the bednets during
hang up campaigns, and makes sure that they continue to
use them through keep up campaigns run by community
volunteers.
exemplar agent implementing the model:
the measles initiative and the new expanded partner-
ship, the alliance For malaria prevention
The Measles Initiative is a partnership between the Red Cross,
the United Nations Foundation, UNICEF, the U.S. Centers for
Disease Control and Prevention, and the World Health Organi-
zation. Since 2001, it has supported the mass vaccination of
over 600 million children in more than 60 countries. After its
success in reaching more than 90% of the targeted age group
during each campaign, the Measles Initiative began integrat-
ing other lifesaving interventions, including insecticide-treated
bednets, into its campaigns. Children now receive a package
of interventions: measles vaccine, Vitamin A, a dose of de-
worming medication (Mebendazole), and, at minimum, one
free insecticide-treated bednet per household with children
under five. The integrated delivery strategy is not only able
to reach the poorest households, but is also able to keep
distribution costs low.60 In Ghana, for example, the marginaloperational cost per net delivered was only $0.32. The Initia-
tive now delivers bednets i n over 15 countries.
what diFFerence can the model achieve?
Based on data from Ghana, household ownership of bednets
increased from 4% to over 90% after the campaign. The per-
centage of children sleeping under the nets increased from
4% to approximately 60%.61
This graph underscores the importance of moving from
bednet ownership to sustained, proper use, as the current
gap represents a critical missed opportunity for prevention.
Community education programs (such as Care Groups, p. 22)
can help close this gap.
PromIsInG PrACTICe:
Itgat dt dititi with vacciati capaig
0% 20% 40% 60% 80% 100%
percent oF target population
HouSEHolD ownERSHIP
of bEDnETS
PERCEnTAgE of CHIlDREn
SlEEPIng unDER bEDnETS
Ipact f bdt Capaig i Ghaa
delivery
ind
icator
4%
90%
4%
60%
BeFore
aFter
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THe CenTer For HIGH ImPACT PHIlAnTHroPy26
how much does this change cost? 100,000
bednets delivered through vaccine campaigns can save the
lives of roughly 1,000 children.62 With sustained and proper
use, these bednets can save two to three times this number.
Average costs are about $10 to $12 per long-lasting bednet
delivered. This includes a $5 to $7 unit cost per net, $3 for
delivery platform, logistics, and staff, and $2 for community
education.63
Here are sample cost-per-impact profiles for such programs in
two different African settings: Malawi ($580 to $870 per child
life saved) and Ghana ($1560 to $2350 per child life saved).
Assuming similar costs and coverage change achieved, the
main driver of the difference in the profil es is the addressable
burden from malaria at the outset of the project. Prevention
programs are most efficient when they target the individuals
most at risk (e.g., young children) and the communities with
the most malaria cases and deaths at baseline (e.g., Malawi).
Assumptions behind the estimates:
Use of long-lasting insecticide-treated bednet (LLITN);
one child sleeps under each net; nets last 3 years; 60%
of children actually sleep under the net (conservative
estimates)
Costs: $1 million dollar gift effectively covers the costs of
distributing 100,000 bednets
Impact is estimated only for decreased malaria death in
children < 5 years old
Range shown in impact estimates above reflects varying
protective ability of bednet from 50% to 75%
additional BeneFits: Bednets prevent sickness and
disability due to malaria in both children and adults. Cost-
impact estimates will improve markedly (and the number of
lives saved will increase) if two children sleep under each net,
and if nets are used properly for five to seven years. The num-
ber of lives saved could double or triple if there is consistent
and proper use of the bednets each night.
F , T M Iv b: .v./.
A Lb, D-D, P A, U.N. F b (0) -5 b
b@.. T A M Pv b
v@..
CASE SNApSHOT
c Deliver insecticide-treated bednets to allhouseholds using integrated campaigns
i Decrease childhood death and illnessfrom malaria
c (g) Additional % population whoown bednets (+86%) and regularly use bednets (+56%)
p Average $10to $12 (cost of each long-lasting bednet delivered)
e $500 to $2500 peradditional child lif e saved (depending on the amount ofmalaria and the country demographics)
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lIFT InG THe burDen oF mAlArIA27
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Scale-up community and household access tonew ACTs (Artemisinin Combination Therapy)
STrATEgy 4
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THe CenTer For HIGH ImPACT PHIlAnTHroPy28
Example o AC packaging with pictorial instructions. Image provided by PSI Malaria Department
PromIsInG PrACTICe:
ovc div ttck ad ica acc t af
ad ffctiv aaia tatt
proBlem description: Families most in need do not
have timely access to quality malaria medication that works
(i.e., artemisinin combination therapy (ACT)). Technological
issues, manufacturing supply, and financing are no longer the
primary constraints. From 2004 to 2006, annual production of
new combination ACTs increased from 4 million to 100 million
doses. Funding for malaria drugs from international sources
such as the Global Fund increased tenfold in the last decade.66
Instead, the primary challenge is now delivery. African coun-
tries need new investments to strengthen their capacity so that
they can get the available ACTs into communities.
key constraints: Lack of trained persons in malaria-
affected countries who can secure available funding and
unblock implementation bottlenecks; counterfeit and poor
quality drugs in the privat e sector; low literacy and knowledge
at the household level.
promising model: Use malaria control associates to roll
out ACTs to communities on a national scale. This model con-
sists of two parts. First, develop national-scale programs that
consider the entire value chain of ACT medication delivery,
from drug procurement and culturally appropriate packaging
to care-seeking and use by mothers in rural villages. Second,
train a cadre of young professionals malaria control associ-
ates in each target country. The malaria control associates
will work to ensure effective medication delivery by resolv-
ing implementation barriers as they come up at each step
in the process. Associates will be primarily from the malaria-endemic nations themselves, and will assume country-level
positions after training. The training includes time working wi th
experienced malaria staff and an 11-month, multi-country
apprenticeship in which the associates work on clearing the
bottlenecks that interfere with efforts to scale-up access to
new malaria medications.
h
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THe CenTer For HIGH ImPACT PHIlAnTHroPy30
P vb
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Women holding insecticide-treated bednets received during antenatal care in
Madagascar. Image by Alisha Horowitz via Jhpiego
Build training networks to prevent malaria inpregnancy
STrATEgy 5
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lIFT InG THe burDen oF mAlArIA3
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Te rapid diagnostic test shown here allows both proessional and lay health
workers to diagnose malaria quickly, allowing the patient to be treated
eectively. Image provided by Western Pacic Regional Ofce, WHO.
Photo provided by David Robertson, Drive Against Malaria
Assist the most vulnerable in areas of conflict ornatural disaster
STrATEgy 6
http://www.msf.org/http://www.msf.org/http://www.msf.org/http://www.epicentre.msf.org/http://www.thementorinitiative.org/http://www.thementorinitiative.org/http://www.thementorinitiative.org/http://www.epicentre.msf.org/http://www.msf.org/http://www.msf.org/ -
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THe CenTer For HIGH ImPACT PHIlAnTHroPy32
treat and
prevent now
malaria
control
innovate For
the Future
Build systems For
the
long term
buIlD sysTems For THe lonG Term
7. Strengthen health system capacity through effective par tnerships
8. Leverage existing financing resources for system-wide change
9. Create information networks to track outcomes, monitor resistance,
and predict epidemics
10. Prepare future health leaders from malaria-affected countries
STrATEgIES IN THIS SECTION
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lIFT InG THe burDen oF mAlArIA33
I I I . BUIlD SySTEMS fOr THE lONg TErM
In the previous section, we discussed models that address the current
constraints to the immediate delivery of malaria tools. In this section, we look
at ways to bolster the critical supporting health system to enable sustainable,long-term impact.
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lIFT InG THe burDen oF mAlArIA35
PromIsInG PrACTICe:
stgth atia adhip ad aagt capacit t apid
ca-p aaia itvti
In Zambia, the national government, together with the
malaria control and evaluation partnership
in aFrica (MACEPA, a program atpath), teamed up with
a range of stakeholders to address the system constraints
and hurdles to rolling out a comprehensive national malaria
control program. Their goal is to decrease malaria incidence
in Zambia by 75%.
Since 2006, Zambia has made substantial progress.
Highlights include:76
Distributing 5 million bednets
Implementing two state-of-the-art national malaria indicator
surveys to assess malaria burden and coverage (2006
and 2008)
Rolling out rapid diagnostic testing in all districts
Expanding and improving Zambias household spraying
program, reaching more than 500,000 homes in urban
and surrounding areas, and exceeding the goal of 85%
coverage
Providing any pregnant woman seeking prenatal care at apublic clinic with an insecticide-treated net for herself and
for any child under age five years li ving with her
This work is achieving impact. Zambias 2008 National
Malaria Indicator Survey has provided conclusive evidence
that the countrys efforts are directly improving the health of
the people. In just a few years, Zambia has raised the bar in
malaria control and made rapid progress:77
Since 2006, malaria parasite prevalence in children has
been reduced by 50%
Two-thirds of Zambian households are now covered with
at least one insecticide-treated net or a recent indoor
spraying
More than 80% of pregnant women received at least one
dose of preventive medicine, and more than 65% received
two or more doses
Through committed leadership, a strong united partnership,
and innovative approaches, Zambia is now a global leader in
managing malaria control based on sound data and program
accountability. Zambia is investing in approaches that will
predictably eliminate malaria deaths and economic burden.
Having developed the capacity to rapidly impact malaria,
Zambia is well-positioned to move to the next phase of malaria
control: eliminating the disease as a health and economic
impediment. Critical next steps involve sustaining and building
on these gains.
Now that this Gates Foundation-funded pilot of MACEPA has
shown demonstrated results in Zambia, it has set up a Learning
Community where other African governments can learn from
one another and share their successes and challenges.
Next steps include replicating this successful model in other
interested African nations such as Tanzania, Ethiopia,
Mozambique, and Malawi. Philanthropists could play a critical
role in funding these new partnerships or supporting the
Learning Community.
F b MACEPA , Bj C PAH (b@.) v
PAH b: ://../ .
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THe CenTer For HIGH ImPACT PHIlAnTHroPy36
I , b k
vb
.
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Global Fund to Fight AIDS, uberculo-
sis, and Malaria q v
. Gv-
v
- j Gb
F. C v
k v v -
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Image by Bonnie Gillespie, VOICES or a Malaria-Free Future
Leverage existing financing resources forsystem-wide change
STrATEgy 8
http://www.theglobalfund.org/EN/http://www.theglobalfund.org/EN/http://www.theglobalfund.org/EN/http://www.theglobalfund.org/EN/http://www.theglobalfund.org/EN/ -
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lIFT InG THe burDen oF mAlArIA37
PromIsInG PrACTICe:
Tappig it th Ga Fd patf f fiacig
The gloBal Fund to Fight aids, tuBerculosis,
and malaria(Global Fund) currently provides more than
65% of international malaria funding, and is the main source
of funding for malaria medications and control programs.
It has developed a performance-based, demand-led model in
which malaria-endemic countries develop a national malaria
strategy and submit applications to the Fund based on their
priorities and needs. However, the poorest and most needy
countries often lack the technical capacity to put together
competitive applications.
Private dollars can make a critical difference. For example,in the case of Equatorial Guinea, a private donation of $1
million dollars towards technical assistance led to the design and
development of a national strategy. This strategy formed the
basis for a successful application to the Global Fund for $26
million dollars to finance the national malaria program in
the country.78
Four ways to use the scale and eFFiciency oF
the gloBal Funds Financing mechanism
1. Give to the Global Fund directly (see right for
considerations)
2. Support on the ground organizations that can increasethe capacity for successfully obtaining and imple-
menting malaria control programs with Global Fund
dollars. These NGOs work t hrough the Country Coor-
dinating Mechanisms (CCMs) which bring all relevant
stakeholders together in each country. The contacts
and membership for CCMs in all Global Fund grant
countries are available in the country section of the
Global Fund website: www.theglobalfund.org/pro-
grams/search.aspx?lang=en&component=Malaria
3. Support Friends of the Global Fund, which advocates
and supports the mission of the Global Fund (see www.
theglobalfight.org for U.S. Friends organizat ion)
4. Support activities to build capacities and pri-
vate sector partnerships inside the malaria-
affected country through organizations such
as the gloBal Business coalition on
hiv/aids, tuBerculosis and malaria
(www.gbcimpact.org/)
considerations For philanthropists
Supporting Global Fund activities directly or indirectly has the
following advantages for individual philanthropists:
Efficiency Leverages the Global Funds performance-
based, demand-led model, as well as its rigorous account-
ability/evaluation frameworks
Transparency Information about every Global Fund grant
disbursement is publicly available on their website
Ensures that supported programs are embedded in national
responses to the diseases Has the advantage of providing support from within a large
pool of funds:
Administrative costs are met by interest income on
overall funding, allowing 100% of gifts to go directly
to grants
Provides sustainability for grants
Provides potential exit strategy, if needed, for private
donors
The primary tradeoff for individual donors directly support-
ing the Global Fund has been the loss of the ability to main-tain contact with programs and recipient communities on the
ground. Also, given the very large government donations to
the Fund, individuals may not want their dollars to go into a
big pot where they might lose control of where money is
invested and may be uncertain if their dollars have the most
incremental impact in relation to the size of the donation.
In response to the unique needs of individual donors, the
Global Fund has recently developed a new program for gifts
of $1 million and over. When there is reciprocal agreement
by recipient nations, this program can earmark such dona-
tions to particular country grants, creating a direct association
with particular activities, and giving private donors the abilityto follow the results. In addition, private donors can actively
participate in the governance of the Global Fund through
private sector or foundation constituencies, each of which
controls a seat on the Global Fund board.
F b , Gb F bwww.theglobalund.org/en/ Dv Ev, M,
Pv S R Mbz [email protected], b (Gv) +41 91 1.
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THe CenTer For HIGH ImPACT PHIlAnTHroPy38
I -
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Multi-drug resistantP. falciparum, which includes decreased
sensitivity and possible resistance to artemisinin, has been
recently found in Cambodia bordering Thailand.79
Create an information network to trackoutcomes, monitor drug resistance, andpredict epidemics
STrATEgy 9
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lIFT InG THe burDen oF mAlArIA39
PromIsInG PrACTICe:
Cat/xpad a wd atiaaia itac ifati twk
proBlem: One major reason behind the failure of previous
international campaigns to eradicate malaria in the 20th
century was the emergence of drug-resistant malaria and
insecticide-resistant mosquitoes. These same problems now
threaten the large investment that the global community is
making to roll-out effective new drug combinations to replace
these failed drugs.
solution: By creating an antimalarial resistance information
network, the global effort to control malaria will have a public
resource to guide antimalarial drug treatment and prevention
policies and to confirm and characterize the emergence of
new resistance to antimalarial drugs. In this way, it will be able
to contain the spread of resistance.
program model: The antimalarial resistance informa-
tion network should consist of open-access global databases
containing clinical, in vitro, molecular, and pharmacological
data, and networks of reference laboratories that will support
these databases and related surveillance activities.81
exemplar agent: There is currently an effort underway
to develop such a network. The worldwide antima-
larial resistance network (wwarn) is an inter-
national group of scientists conducting research in the field
of antimalarial drug resistance. WWARN will develop open,
web-based tools to provide malaria control managers, surveil-
lance programs, and policymakers with up-to-date evidence of
temporal and geographic trends in antimalarial drug resistance
at the global scale and in real time. Their goal is to get the
right drugs, to the right people, at the right time.
F , WWARN b: ..//.
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Image by Bonnie Gillespie, VOICES or a Malaria-Free Future
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THe CenTer For HIGH ImPACT PHIlAnTHroPy40
M- v k
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U.S. N I H, k
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Image by Bonnie Gillespie, VOICES or a Malaria-Free Future
Prepare future health leaders from malaria-affected countries
STrATEgy 1 0
http://www.accordiafoundation.org/programs/infectious-diseases-institute/index.htmlhttp://www.accordiafoundation.org/programs/infectious-diseases-institute/index.htmlhttp://www.fic.nih.gov/http://www.fic.nih.gov/http://obtoure.africa-web.org/http://obtoure.africa-web.org/http://www.fic.nih.gov/http://www.accordiafoundation.org/programs/infectious-diseases-institute/index.html -
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lIFT InG THe burDen oF mAlArIA4
S, k S
Pb H -
v
v. P MPH- b
v v - - k/
b. F , John P. Grant School
o Public Health at BRAC University, Dk,
B, v vv -
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BRAC, v v
z, k B-
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b .
T, -
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Network 1 A . I
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exap f sccf Taiig Iitiativ
Inectious Diseases Institute, Uganda T
b/ . P v A
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(.., , v, b ),
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http://www.accordiaoundation.org/aa/JointUgandaMalariarainingProgram.html
Fogarty International Center: Global Inectious Disease raining Program T
b U.S. v
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k v .
http://www.c.nih.gov/programs/training_grants/index.htm
C: D. Bb S, P D
: (01) 40-94
John P. Grant School o Public Health at BRAC University I I
C D D R, B. T b
- MPH -
.
http://www.bracuniversity.ac.bd/I&S/sph/index.htm
E-: [email protected] ( )
Malaria Research and raining Centre (MRC)University o Bamako, Mali C
D E P D Uv M (
Uv Bk), MRC vv v
v
b M, , A.
http://obtoure.arica-web.org/
http://www.bracuniversity.ac.bd/I&S/sph/index.htmhttp://www.bracuniversity.ac.bd/I&S/sph/index.htmhttp://actmalaria.net/home/http://actmalaria.net/home/http://actmalaria.net/home/http://actmalaria.net/home/http://www.accordiafoundation.org/programs/infectious-diseases-institute/training/index.htmlhttp://www.fic.nih.gov/programs/training_grants/gid.htmhttp://www.bracuniversity.ac.bd/I&S/sph/index.htmhttp://obtoure.africa-web.org/http://actmalaria.net/home/http://actmalaria.net/home/http://www.bracuniversity.ac.bd/I&S/sph/index.htmhttp://www.bracuniversity.ac.bd/I&S/sph/index.htmhttp://www.bracuniversity.ac.bd/I&S/sph/index.htmhttp://obtoure.africa-web.org/http://www.fic.nih.gov/programs/training_grants/gid.htmhttp://www.accordiafoundation.org/programs/infectious-diseases-institute/training/index.html -
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THe CenTer For HIGH ImPACT PHIlAnTHroPy42
InnoVATe For THe FuTure
11. Support innovation for new tools
12. Innovate by harnessing the potential of the private sector or applying
new technology
STrATEgIES IN THIS SECTION
treat and
prevent now
malaria
control
innovate For
the Future
Build systems For
the
long term
-
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lIFT InG THe burDen oF mAlArIA43
Most experts agree that in high transmission areas,
f b .83
Iv . INNOvATE fOr THE fU TUrE
In this section, we highlight key areas where capital is needed for the discovery
of new tools and improved delivery methods.
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THe CenTer For HIGH ImPACT PHIlAnTHroPy44
P
b v-
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vb . T v-
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Support innovation for new toolsSTrATEgy 11
-
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lIFT InG THe burDen oF mAlArIA45
Focus organization current projects
v
m v i(..)
A global program working to accelerate
the development of safe, effective, and
affordable malaria vaccines
The Malaria Vaccine Initiatives portfolioincludes three vaccine candidates currently
in clinica l development. Worldwide, there
are currently over 20 vaccine candidates in
different stages of bench or clinica l testing.
d
t F f i
n d
(.f.)
A partnership between academic, public,
and private entities that is dedicated to
the development of rapid, accurate, and
affordable diagnostic tests
The Foundation for Innovative
New Diagnostics currently researches
and improves available diagnostic tests
to ensure their accuracy in the field.
n m
m f m v
(..)
A nonprofit organization that was
created to discover, develop, and deliver
effective and affordable antimalarials
through public-private partnerships
The organizations portfolio contains
over 30 projects, and has the largest and
most diverse portfolio of antimalarial drug
projects in history.
i f ow h
(../)
The first nonprofit pharmaceutical company
in the U.S., OneWorld Health is dedicatedto developing affordable medications for
neglected diseases
The supply of natural ACT is limited, as it
comes from the wormwood plant, which
requires time to grow and harvest. OneWorld
Healths Artemisinin Project is working to
produce a semi-synthetic ACT so that a con-
stant and affordable source of ACT will be
available to communities who need it most.
mq c
i v c c
(.. )
A major research consortium that is
developing new and better ways to
control the transmission of insect-borne
disease; five leading research institutions
are members of the part nership.
IVCC works to develop improved
insecticides. It is also creating information
systems to track resistance and vector sit es,
allowing malaria control groups to make
better decisions about the best times to
re-treat homes/bednets with insecticides.
Fdig pptiti i ivativ ach
-
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THe CenTer For HIGH ImPACT PHIlAnTHroPy46
Pg twad th tiat t i aaia pvti
a ffctiv vacci
Dv v v v
b . I v vb b , -
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alciparum v , b vb
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R v vv . F , k v -
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k . I , v v k
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THe CenTer For HIGH ImPACT PHIlAnTHroPy48
I ,
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b.
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exap f wa a phiathpit ca ppt th pivat ct
i aaia ct
Use the reach and assets o the business sector to strengthen malaria control
Te Corporate Alliance on Malaria in Arica (CAMA) v Gb
B C HIV/AIDS, b, M. CAMA j v
b v
-, b , v v
v z. I -k b k
.www.gbcimpact.org/cama
Invest in local companies producing malaria control commodities
Acumen Fund: A b v
v v q. M v
b AC. www.acumenund.org
Support ranchise medicine shops
Child and Family Wellness (CFW) Shops. I K R, HS
F -- b CFW. S q . T
b v b
v v. T v
v b .
www.cwshops.org
Innovate by harnessing the potential of theprivate sector or applying new technology
STrATEgy 1 2
http://www.gbcimpact.org/about-gbc/camahttp://www.gbcimpact.org/about-gbc/camahttp://www.gbcimpact.org/about-gbc/cama -
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lIFT InG THe burDen oF mAlArIA49
B q q
AC
, v -
b . F ,
Mk S A, 0% AC k.9
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