In the Democratic Republic of the Congo (DRC), MalariaCare works in East Kasai, Katanga, Orientale, South Kivu, and West Kasai provinces and in Kinshasa to improve diagnosis and treatment of malaria and other illnesses. The project supports DRC’s National Malaria Control Program (NMCP) in expanding and improving the quality of diagnostic testing through training, establishing strong quality assurance measures, and providing regular supportive supervision. The project also strengthens treatment of malaria and febrile illness through training and supervision of health providers.
Context for MalariaCare in the DRC
Malaria is a major health problem in the DRC, accounting for an estimated 40 percent of outpatient visits to health facilities among children under five years of age and 40 percent of overall child mortality.
In 2010, the NMCP adopted World Health Organization guidance calling for universal diagnostic testing for malaria and recommending that antimalarial treatment be administered only when a test is positive. Previously, most health providers in the DRC diagnosed malaria clinically based on the presence of fever.
In recent years, there has been a steady increase in the number of malaria cases confirmed with a diagnostic test. However, many cases are still treated with antimalarials in the absence of a confirmed diagnosis. In addition, there is a need to increase the number of patients receiving rapid treatment with a recommended antimalarial drug. According to the DRC’s 2010 Multiple Indicator Cluster Survey, 39 percent of children under five with fever received antimalarial treatment but only about 24 percent of these children got the treatment within 24 hours of the onset of fever.
Although the NMCP and partners have recently made progress toward improving malaria case management, health systems issues are a major barrier to scaling up interventions. Challenges include a lack of qualified health workers and a weak health infrastructure. Additionally, it is estimated that only 25 percent of the population has access to health facilities.
Building diagnostic capacity. The project is improving the capacity of providers at the national, provincial, and sub-provincial levels to accurately diagnose malaria through the use of microscopy or rapid diagnostic tests (RDTs). At the national level, MalariaCare conducts refresher training for expert laboratory technicians. In addition, the project provides training and supportive supervision to strengthen the diagnostic capabilities of clinicians and laboratory staff at health facilities. MalariaCare offers bench aids to workers performing malaria microscopy or rapid diagnostic testing in health facilities.
Testing the feasibility of rapid diagnostic testing in the private retail sector. To address the high percentage of patients seeking care for fevers at local drug shops, MalariaCare is testing the feasibility of conducting a pilot of RDT use among retail outlet workers. If feasible, the results will be used to identify the best approach for introducing and supporting use of RDTs in drug stores.
Supporting laboratory systems.MalariaCare works with the NMCP to strengthen laboratory systems through the development of a microscopist proficiency program and a national archive of malaria slides.
Improving malaria treatment. The project is building the capacity of clinicians to provide appropriate treatment through refresher training in case management of malaria and other febrile illnesses. MalariaCare also trains clinical supervisors to conduct onsite quality assurance and mentoring for malaria diagnosis and treatment.
Strengthening health systems. MalariaCare is working to strengthen health systems by improving access to timely and useable data for national and local decision-makers across the DRC. The project supported the NMCP to install a user‐friendly database program to monitor onsite training and supervision visits.