Countries across the region are launching country-owned and country-led End Malaria Councils (EMCs) and End Malaria Funds (EMFs). They are composed of senior leaders drawn from across all sectors (government, the private sector and civil society). EMCs and EMFs are not an operational replacement for the National Malaria Control Programme (NMCP), but instead provide a valuable forum where the NMCP can escalate bottlenecks (such as budget gaps) and coordinate a multisectoral response to malaria. In this regard, EMC and EMF members champion initiatives like “Zero Malaria Starts with Me” by
- mobilising advocacy to keep malaria high on the national development agenda
- mobilising action and resources to close gaps in the national malaria strategic plan (NSP)
- promoting mutual accountability across sectors for achieving national targets for malaria control and elimination
EMCs and EMFs can also be established at the sub-national level to engage local leaders and communities to take responsibility for ending malaria and mobilising advocacy, action, resources and accountability locally.
As multisectoral fora charged with supporting the NMCP and NSP, EMCs and EMFs provide a unique opportunity to disseminate national malaria scorecards beyond the health sector. Malaria scorecards are effective, evidence-based tools for the NMCP to call attention to operational challenges and bottlenecks—and drive discussion about their root causes—for the EMC and EMF members. They highlight crosscutting, systemic issues (such as stock-out of commodities) and issues at a local level. This information helps the members prioritise where they should focus their advocacy, action and resource mobilisation. EMC and EMF members can also use the scorecards when engaging their sectors.
Case study: Zambia End Malaria Council
Under the mandate of H.E. President Lungu, Zambia launched the first national EMC in March 2019. The EMC is chaired by the Honourable Minister of Health with members including:
- other Ministers
- representatives of the Zambia Revenue Authority
- representatives of the Bank of Zambia
- religious and traditional leaders
- corporate executives
Zambia has also established sub-national EMCs in each Province and in some districts to promote local ownership and responsibility for ending malaria.
The National Malaria Elimination Centre (NMEC) presents the status of malaria control and elimination initiatives during each EMC meeting. This presentation includes recent accomplishments, bottlenecks and other challenges faced by the programme and the national and sub-national malaria scorecard. Zambia’s malaria scorecard tracks performance against key performance indicators at all levels from the national level down to health facilities. The scorecard is updated quarterly using data from the country’s HMIS (DHIS2). Traffic signal colours are used to indicate whether performance is on track, needs attention or unlikely to meet targets.
Sharing the scorecard with the national and subnational EMCs enables members to independently and rapidly identify – based upon empirical evidence – systemic bottlenecks as well as challenges in particular geographical regions. Thus, the EMC can ensure that it is:
- prioritising its efforts to address priority areas
- assessing whether its activities are resulting in improved performance
- holding the NMEC accountable for delivering on its targets
During an October 2019 EMC meeting, the NMEC presented the national malaria scorecard, which indicated very low coverage of pregnant women receiving three doses of intermittent preventative treatment of pregnant women (IPTp3). EMC members from the private sector and civil society asked the NMEC about the root cause of low IPTp coverage. The NMEC indicated that there was a national stock-out of SP because of a loss of partner funding. In response to this, the Minister of Health formed a task team to ensure sustainable sourcing of SP and partners were engaged to provide funding to procure a supply to restore services. Commitments following the meetings were made and by the next meeting it was confirmed that 2,450 tins of SP worth $230,000 USD were received and distributed to the provinces. The US President’s Malaria Initiative, which was an observer at the EMC meeting, acknowledged the urgency of protecting pregnant women and changed its long-standing policy to support the procurement of SP. As a result of this intervention, IPTp3 coverage returned to the level of service prior to the stock-outs.
Other financial and in-kind resources have been mobilised by the EMC as a result of gap identification, including $500,000 USD to support mass drug administration, in-kind transportation of insecticides for IRS, and national television and radio advertising campaigns to sustain levels of service levels despite COVID-19.
Case study: Eswatini End Malaria Fund
In 2018, H.M. King Mswati III inaugurated the first End Malaria Fund. The Fund’s Board of Directors is chaired by a private sector chief executive and its other members include the PS of Health and PS of Finance, the heads of parastatal organisations, other private sector executives, and traditional leaders. The Fund’s primary mission is to mobilise supplemental resources to close budget gaps in the NSP to help the Kingdom achieve its goal of eliminating malaria and sustaining elimination thereafter.
Eswatini’s National Malaria Programme produces a quarterly malaria scorecard highlighting performance against key indicators for surveillance, case management, and vector control. Key indicators include the percentage of cases that are notified within 24 hours and investigated within 48 hours, IRS coverage, and treatment of cases according to national guidelines.
Following the appointment of the Board of Directors of the Fund, the National Malaria Programme shared and briefed the Board Chair about the national malaria scorecard. The Board of the Fund took several actions related to key metrics on the scorecard. For example, the Board engaged a local telecommunications company to restore the national disease notification system and to provide service to the programme on an in-kind basis for two years. This ensures that health facilities can continue to provide timely notifications of cases within 24 hours. As a result, 92% of cases are notified within 24 hours and 78% of cases are investigated within 48 hours (Q2 2020).
To better understand the gaps and challenges faced by the National Malaria Programme and the impact they have on national performance, the Board of Directors travelled with the Minister of Health to meet with managers of Health Facilities and IRS operators. This has led the Board to extend support and resources for IRS, social and behavioural change communications through advertisements and in-store displays, and sensitisation of traditional leaders to encourage them to engage local communities.
Finally, as a reminder and call to action, the Board Chair had the scorecard framed and hung on the wall of her office.
Key success factors and best practices
- NMCP presents the quarterly malaria scorecard during each EMC/EMF meeting and uses it to focus and prioritise discussion on key bottlenecks and their root causes.
- Where bottlenecks exist, the NMCP and EMC/EMF members openly discuss about how to address these challenges and collaborate to mobilise commitments to overcome the challenges.
- EMC/EMF members are trained on how to use the malaria scorecard as an advocacy tool with their sectors and use it regularly to sensitise those outside of the health sector on the priorities and challenges under the NSP.
- EMC/EMF members distribute the scorecard to their sectors on a quarterly basis to keep them informed of the status of malaria control and elimination and progress against national targets.
- When mobilising commitments, EMC/EMF members identify how commitments will lead to improved performance on indicators on the malaria scorecard and then use the scorecards as a monitoring and evaluation tool to confirm that their support is having the expected outcomes.