This guide is part of the End Malaria Councils and Funds toolkit.

Overview

There is no one-size-fits-all approach for an EMC. Each must be tailored to the local context. During the design phase, the National Malaria Control Programme (NMCP) and its partners work to develop the objectives, structure, composition, and operations for the End Malaria Council (EMC). This is a consultative process involving stakeholders from across sectors. These stakeholders provide feedback and best practices for developing an effective public-private partnership that can help the NMCP overcome operational bottlenecks and resource gaps limiting the national malaria strategic plan (NSP).

Objectives of the design phase:

• Develop a concept note outlining the design of the EMC
• Sensitise and get approval from senior political leaders to establish the EMC

Developing a concept note

The primary deliverable of the design phase is a brief concept note summarising the objectives, structure, composition and operations of the EMC. The concept note is fundamentally an advocacy tool that is used to sensitise senior political stakeholders and gain approval for establishing the EMC.

The concept note should be simple, clear and concise. In practice, the concept notes are typically 8-10 pages (or less) so that they are accessible to senior leaders and their staff.

The concept note is composed of 6 brief sections:

• Background: An overview of the status of malaria control and elimination and the barriers to implementing the NSP
• Mission, vision and theory of change: A statement of the purpose of the EMC and how it will help accelerate the fight against malaria
• Membership: A proposed list of members
• Structure: A high-level overview of the organisational structure
• Operations: A summary of how the EMC will mobilise and track commitments from, and how it will be accountable to, the various sectors
• Regulatory and financial implications: Identify potential risks and costs associated with the creation and operation of the EMC

Background

The beginning of the concept note summarises the current status of malaria control and elimination in the country, the objectives of the NSP, and the barriers to implementation. This section should be brief (such as 1-2 pages) and focus only on the most relevant information needed to explain why an EMC is needed.

The following structure can be used to organise the content in the background section:

• Progress against malaria:
  • What progress has the country made in the fight against malaria since 2000? (for example, how has malaria incidence and mortality changed)
  • What were the key drivers of this change? (for example, political will, increased resources)
  • How does controlling and eliminating malaria support national development priorities?
• Current status of malaria control and elimination:
  • What is the target of the NSP? (for example, eliminate malaria by 2030)
  • What is the current malaria burden?
  • What are the costs and impact of malaria across various sectors? (for example, worker absenteeism, educational attainment, household spending)
• Barriers to elimination:
  • What are the operational bottlenecks and resource gaps that limit implementing the NSP? (for example, from programme reviews, programmatic and financial gap analysis)
  • What is the impact of these bottlenecks and gaps?
• Priorities:
  • What is needed to overcome the bottlenecks and gaps? (for example, renewed and sustained political will, multisectoral action, increased resources, enhanced accountability)

It is important to think holistically when considering what are the barriers and gaps limiting the implementation of the NSP.

• Political will: Do high-level stakeholders regularly discuss and take action on malaria and commit adequate resources to implement the NSP?
• Policy: Are regulations and policies across all sectors conducive to malaria control and elimination? (for example, construction, housing, transportation, community development)
• Advocacy: Are there sufficient advocates for malaria relative to other diseases and development areas?
• Capacities: Does the NMCP, Ministry of Health, and broader health sector have the capacity and capabilities necessary to implement the NSP? (for example, data systems, human resources)
• Resource gaps: Are there adequate resources available to fully implement the activities in the NSP? How will resource needs change over time? Are existing resources sustainable?

There may be other gaps hiding below the surface that need to be addressed. For example, communities may not perceive malaria as a threat because it has always been a part of life or because deaths are declining.

Mission, vision and theory of change

The concept note should outline the proposed mission vision and theory of change for the EMC. These help provide guiderails for the EMC’s overall structure and ensure that there is a clear linkage to the priorities identified in background section.

Mission

The mission is a concise, action-oriented statement of the EMC’s purpose. Ideally, it should tie directly to the objectives of the NSP and outline how the various sectors will work together to support those objectives.

Vision

The vision is an aspirational statement of the future objectives of the organisation.

Theory of change

The theory of change outlines how the EMC will achieve its mission and vision. In particular, it should explain how the EMC will overcome the barriers identified in the background section. This will form the background of how the EMC will operate and work in partnership with the NMCP to implement the NSP.

The fundamental theory of change for EMCs is that they will help the NMCP overcome barriers to implementing the NSP by:

1. Advocacy: Sensitising stakeholders across all sectors to the importance of controlling and eliminating malaria
2. Action and resource mobilisation: Working with those stakeholders to identify resources, expertise, capabilities, and assets that they can contribute to help the NMCP implement the NSP
3. Accountability: Holding each sector accountable for achieving the targets in the NSP

In the concept note, the theory of change is framed as the activities of the EMC

All other decisions about the design of the EMC should work towards fulfilling the mission, vision, and theory of change for the EMC.

Membership

An EMC is fundamentally a multisectoral forum that works together to fulfil the mission, vision and theory of change. Thus, selecting the right mixture of members from across the various sectors is critical—and often more important than selecting the right structure because organisations are only as strong as the people within them.

At the outset, two important decisions need to be made:

1. Will the EMC be composed of individuals, institutions, or a mixture of the two? It is possible to appoint individuals in their own capacity. Some countries, however, have decided to appoint at least some institutions (for example, line ministries, parastatals, companies, faith organisations) as members and let those institutions designate a senior representative to serve on their behalf. The latter approach helps support sustainability because institutions typically have long-term mandates and the representatives can be easily changed if needed over time without needing to appoint a new member.
2. How many members will there be? Finding the right number of members is a balancing act. Fewer members simplifies operations and increases the ownership and accountability of each members. However, it is important to have enough members to ensure representation from each sector without reducing accountability or increasing administrative costs too substantially. While there is no ideal size, starting with a target of 10-15 members will help manage the scope and complexity at the outset. More members can always be added over time if needed.

When selecting which individuals or institutions to serve on the EMC, there are five criteria to consider:

• Influence: Are they trusted and respected? Will they be able to convene others to join the fight against malaria and mobilise impactful commitments for action and resources?
• Knowledge and Capabilities: Do they have unique capabilities that can help the NMCP close gaps in the NSP and drive innovation?
• Strategic Overlap: Does malaria directly affect their and their sector’s strategic priorities?
• Representation: Do they represent priority geographies or constituencies? (for example, women, youth)
• Resources: Can they provide access to substantial financial and in-kind resource directly or through their network?

Structure

The next decision is which structure to use to convene the EMC. There is no one-size-fits-all approach, but there are a variety of different structures that can be used with varying levels of complexity.

• Forum: Members convene without any formal structures and simply agree to meet regularly according to shared terms of reference (for example, Zambia’s End Malaria Council).
• Mainstream into an existing structure: An existing structure or entity agrees to adopt ending malaria as a priority and convenes the members to undertake the activities (for example, Cameroon’s RBM Committee).
• Private foundation: The members incorporate a non-profit company through which they drive the mission and vision (for example, Malaria Free Uganda, Mozambique’s Fundo da Malaria, Zambia’s End Malaria Fund).
• Public entity: The structure is established by way of law, regulation or decree (for example, Eswatini’s End Malaria Fund).

Selecting which approach to use is based on the country’s experience and best practices for public-private partnerships. There are a variety of factors that should be considered, however, when selecting the approach:

• Feasibility: How long and complex will it be to establish the structure? For example, setting up a forum is highly feasible as it is as simple as convening the members for a meeting and having them agree to shared terms of reference. Whereas, in some countries, setting up a public entity can be a labour intensive process that requires parliamentary action.
• Functionality: Can the structure fulfil the strategic objectives of the EMC? For example, a forum lacks a legal structure and would need to be combined with, or evolve into, another structure if it would like to directly receive, manage and distribute financial resources to the NMCP.
• Sustainability: How resource intensive will the structure be to operate?
• Independence and trust: Will the structure be able to operate independently and be trusted by each sector? Several countries have elected to establish private foundations, as opposed to public entities, to ensure that the EMC will be independent and not be seen as a state-owned enterprise.
• Flexibility: Can the structure easily adapt as the context changes? While one approach may make sense now, there is no guarantee that it will be the best fit in the future. For example, a forum can be easily changed by simply appointing new members or adjusting the shared terms of reference. The members can also easily convert a forum into a private foundation by filing to operate as a non-profit company. A private foundation can typically change through a special resolution of the members. Public entities can be flexible, but changing the number of members or operations may require amending the enabling regulations or legislation.

Additional guidance on which structure to use can often be provided by the legal advisor to the Ministry of Health or another local attorney.

Operations

The operations section of the concept note should provide a high-level overview of how the EMC will mobilise advocacy, action, resources and accountability to close gaps in the NSP. The following outlines how EMCs typically function:

• The NMCP escalates operational bottlenecks and resource gaps to the EMC via an update on the status of malaria (including via the national malaria scorecard) during quarterly EMC meetings.
• The members review the bottlenecks and gaps and strategize together on how to remove them.
• The members then engage their respective sectors to mobilise commitments for advocacy, action and resources to address the bottlenecks and gaps.
• These commitments are then documented and tracked by the EMC.
• In-kind goods and services are provided by the sectors directly to the NMCP; financial contributions are given directly to the NMCP or channelled through the EMC to the NMCP. If channelled, the EMC issues a grant to the NMCP.
• In subsequent EMC meetings, the NMCP reports on the use and impact of mobilised commitments and the members hold each other mutually accountable for any commitments that were not delivered.
• To ensure accountability of the EMC to the various sectors, it publishes at least an annual report and submits this to cabinet via the Ministry of Health or another member. The EMC also undergoes an annual audit with the auditor’s report being published publicly as well.

An administrative secretariat supports the EMC members in fulfilling these activities. The administrative secretariat is responsible for organising EMC meetings, documenting and tracking commitments mobilised by the members, liaising with the NMCP and managing any funding requests, and preparing quarterly and annual reports. Because the responsibilities are administrative only (not operational), the secretariat is typically small (for example, a coordinator and two programme officers responsible for advocacy and communications and action and resource mobilisation). The staff are typically seconded by members and development partners, or funded by resources mobilised by the EMC. Additional functions (such as legal, audit) are typically provided as in-kind contributions by the members, as needed, to avoid additional overhead costs.

Regulatory and financial risks

Senior political leaders are often concerned about potential legal, regulatory and financial risks that will be raised by the EMC. In particular, they are often concerned whether there are any start-up or recurring costs that will be imposed on the Ministry of Health or other government entities. They may also be concerned about whether the EMC will require an act of parliament or other enabling legislation (for example, for a public entity).

Validation

To ensure that the concept note is comprehensive and likely to be supported across all sectors, it is helpful to gather input during its drafting. Countries have employed three approaches for this:

1. Establish multisectoral task teams: Convene stakeholders from across the Ministry of Health, other line ministries (for example, Ministry of Finance), development partners, the private sector, and civil society to draft the concept note. This ensures that each sector takes ownership of the EMC from the initial design. This approach can significantly streamline the validation process.
2. Consultation: During or immediately after the drafting process, the NMCP meets with stakeholders and partners from across various sectors to gather input. These one-on-one meetings can be useful because there is an opportunity for the stakeholders to share their priorities and concerns privately.
3. Validation workshop: Following the drafting of the concept note, a meeting is held with stakeholders from across various sectors to present the concept and collect feedback. This approach has the benefit of being quick, but often requires significant resources.

Approval

Following validation, the concept note is then used as an advocacy tool to sensitise senior political stakeholders and gain approval to establish the EMC. The process for gaining approval depends on the country’s internal processes and may involve the submission of a cabinet memorandum announcing the Ministry of Health’s plan to establish the EMC.

The following can be used to streamline and accelerate the approval process:

• Prior mandate: Work with development partners (for example, ALMA) to engage the Head of State and Government to get a top-down mandate prior to drafting the concept note. Development partners can share case studies and examples from other countries and help sensitise senior political leaders to the objectives of EMCs.

• Consultation: Consulting with key stakeholders internally and externally to the Ministry of Health (for example, during the validation process) ensures that they are fully sensitised to the EMC proposal and helps identify potential roadblocks.

Related documents

• Cameroon EMC concept note – in French (PDF 1.2MB)
• Kenya EMC concept note (PDF 850KB)
• South Africa EMC briefing document (PDF 2MB)
• Zambia EMC cabinet memorandum (PDF 700KB)