impact (HBHI) approach Malaria Policy Advisory Committee Geneva, - - PowerPoint PPT Presentation

Update on the High burden to high impact (HBHI) approach

Malaria Policy Advisory Committee Geneva, Switzerland 14 May 2020

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HBHI Approach

Effective Health System Multisectoral response Output Output Output Output Political will Strategic information Better guidance Coordinated response 4 mutually reinforcing response elements I II III IV Outcome Implementation of prioritized operational plans derived from evidence-informed national malaria strategic plans Impact Reduction in mortality & morbidity

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Guiding principles for the HBHI approach

Highest burden countries1 are the focus

• f the first wave of the approach

1 11 countries with highest burden of malaria concentrate 70% of cases and deaths 2 All of the 10 highest burden African countries reported increases in malaria cases over the previous year, ranging from an estimated 131,000 more cases in Cameroon to 1.3 million additional cases in Nigeria. Only India marked progress in reducing its disease burden, registering a 24% decrease compared to 2016.

Burkina Faso Cameroon DRC Ghana Mali Mozambique Niger Nigeria Uganda Tanzania India2 Better coordinated support from in- country and external partners paired with increased transparency to ensure efficient responses Commitment from partners to share and jointly analyse data Support for enhanced domestic and international resource mobilization Country-owned, country-led approach, aligned with the GTS, SDGs, national health goals, strategies and priorities Guiding principles

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2019 2020 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Global Fund applications HBHI meeting GF application deadline Activities

Preparation in progress National high-level HBHI meeting

▪ Creation/Acceleration of a national malaria data repository ▪ Global Fund Missions ▪ Malaria Programme Review (MPR) ▪ Mid-term Reviews ▪ Stratification, analysis ▪ National Strategic Plans (NSPs) ▪ Technical support on key areas identified based on the four response elements Country specific follow up activities

Uganda Nigeria Cameroun Burkina Faso Ghana Mozambique DRC Niger Mali Tanzania India Ethiopia iCCM- HBHI meeting

Country-led HBHI meeting and follow-up activities

Nigeria

• reflect new paradigm shift in malaria control; not business as usual
• right mix of interventions based on local evidence and stratification
• link to health sector plan; contribute to health system strengthening

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Pillar 1. Political will

Political Malaria receiving high political attention and movement at country level Partners have rallied behind the approach Political and advocacy mechanisms: Presidential initiatives, Malaria council, etc

▪ In some countries, focal persons for health at presidential level (Niger)

What remains:

▪ Effective communication on malaria burden to ensure high level

engagement

▪ Translation of political will to domestic resources ▪ Subnational level and community engagement

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Advocacy to keep political commitment and translate into increased domestic resources Mass Action Against Malaria (MAAM)

Sustaining the partners’ buying in based on comparative advantage

Uganda: Political will –Core findings and key action points

Ghana Burkina Faso Ethiopia, ICCM-HBHI

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Pillar 2. Strategic use of information for action

▪ Malaria Repository Database (MDRB):

– Bringing all data together to one hub at the NMCP

▪ Stratification:

– Macro-stratification with modelled mix of interventions conducted in all

countries except Mali

– Support MPRs and NSP: guided by stratification

▪ What remains:

– Capacity building at national and subnational level for micro-

stratification and routine use of data

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Pillar 3. Better guidance

Global: Self assessments are helping pick

▪ areas currently lacking global guidance

– SMC (epidemiological settings, age limits and types of

drug, etc)

– Case management – private sector engagement

strategies

▪ global guidance that require more clarity

– Vector control: Simultaneous deployment of LLINs & IRS

vs single VC intervention,, Insecticide resistance and its impact National level adaptation, dissemination and uptake:

▪ Subnational: inadequate capacity and access to national

guidelines

▪ Treatment fees and their impact on access ▪ Larviciding: Its role and impact

Other challenges:

▪ Optimize interventions to reduce mortality (subnational

level)

▪ Scale-up of iCCM

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Pillar 4. Coordination

Structures/ mechanisms:

– Existing dysfunctional mechanisms revitalized (Cameron, Ghana), – Thematic, RBM, Malaria Foundation for Res mob (Ghana) – Malaria Council, Parliamentarian Committee

Capacity building:

– Suboptimal capacity at subnational level in terms of HR and knowledge,

resources, access to guidelines, supervision, etc. M&E activities:

– Programmes being empowered through strong use of data

Collaboration and partnership

– Strong and empowered NMCPs have better in-country partner support and

coordination (Ghana, Uganda, Cameroun)

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HBHI India

• Sustained reduction of malaria cases and deaths since 2015
• Key drivers of success: community-based interventions using ASHAs, support

from Federal and State governments through National Health Mission (NHM) and Global Fund; better targeting of interventions based on stratification

• HBHI approach adapted in 4 high burden States (Chhattisgargh, Madya Pradesh,

Jharkhand, West Bengal); strategic and operational plans drafted

RAJASTHAN ORISSA GUJARAT MAHARASHTRA MADHYA PRADESH BIHAR KARNATAKA UTTAR PRADESH JAMMU & KASHMIR ASSAM TAMIL NADU TELANGANA CHHATTISGARH ANDHRA PRADESH PUNJAB JHARKHAND WEST BENGAL ARUNACHAL PR. HARYANA KERALA UTTARAKHAND HIMACHAL PRADESH MANIPUR MIZORAM MEGHALAYA NAGALAND SIKKIM GOA A&N ISLANDS D&N HAVELI PONDICHERRY LAKSHADWEEP

API - 2015

<1 >1-2 >2-5 >5-10 >10 & Above

RAJASTHAN ORISSA GUJARAT MAHARASHTRA MADHYA PRADESH BIHAR KARNATAKA UTTAR PRADESH JAMMU & KASHMIR ASSAM TAMIL NADU TELANGANA ANDHRA PRADESH PUNJAB JHARKHAND WEST BENGAL ARUNACHAL PR. HARYANA KERALA UTTARAKHAND HIMACHAL PRADESH MANIPUR MIZORAM SIKKIM A&N ISLANDS D&N HAVELI PONDICHERRY LAKSHADWEEP

API - 2018

<1 >1-2 >2-5 >5-10 >10 & Above

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Challenges and Solutions

Anticipated challenges HBHI countries could face extreme difficulty in maintaining malaria services should they experience widespread COVID-19 transmission

• majority of them have community transmission
• lockdownsdisruption of facility-based services«no treatment» or

«home/self treatment»

• high burden rural communities: malaria and malnutrition could be deadlier

than COVID-19 Proposed solutions (Country-level responses)

• Country level quick assessment and prioritization of vulnerability (subnational)
• Quantification and pre-positioning of commodities and food to most

vulnerable populations

• Coordination of partners’ support for harmonized and multi-faceted response
• Engage national/local institutions to support countries to maintain malaria

services during COVID-19 pandemic and to strengthen national capacity

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Key activities (April - December 2020)

• Advocacy and technical support for continuity of malaria services in the

context of COVID-19 response

• Technical support to conduct MPR, update NSPs, develop GF funding

requests, GF grant negotiations

• High level meetings in Mali, Nigeria and Tanzania postponed for post-COVID-

19 pandemic

• Develop tracking tool for monitoring and for proactive response
• Training workshop for NPO and Program Managers if the situation permits
• Documentation and dissemination of best practices

In view of COVID-19 pandemic, GMP and AFRO:

• continue to provide remote technical support
• engage national institutions to support countries