MalariaCare works closely with Madagascar’s Programme National de Lutte Contre le Paludisme (PNLP, the National Malaria Control Program) to strengthen malaria case management capacity by developing a well-trained, core cadre of clinicians and laboratory technicians to provide case management and supervisor training for local supervisors at the district level. This training will prepare the supervisors to conduct effective outreach training and supportive supervision/mentoring (OTSS) visits to reinforce key case management concepts and provide ongoing quality improvement. The project is active in 25 districts across 10 regions (Alaotra-Mangoro, Amoron’i Mania, Atsimo-Atsinanana, Betioky, Boeny, Bongolava, Menabe, Sava, Sofia, and Vatovavy-Fitovinany).
CONTEXT FOR MALARIACARE IN MADAGASCAR
Malaria is endemic in 90 percent of Madagascar, with year-long transmission. The West Coast zone has the highest number of malaria related illnesses and deaths among children under five and pregnant women. While much progress has been made, a recent nationally representative health facility survey conducted by MalariaCare revealed that only about one-third of health facilities had the capacity to perform some kind of diagnostic testing, limited by lack of trained staff, supplies, and equipment. A 2009 study found that only 6 percent of children with fever received a test to confirm their diagnosis. Additionally, a national survey in 2013 showed that among children under five with fever, only 38 percent of families sought any kind of treatment and only 6 percent of diagnosed children were treated with the recommended medication within 24 hours of fever onset.
Madagascar’s 2013–2017 National Strategic Plan for Malaria affirms that diagnostic confirmation of malaria, via microscopy or rapid diagnostic test (RDT), should be provided for all suspected malaria cases, and appropriate treatment should be provided for all confirmed diagnoses. To help NMCP achieve its goal, MalariaCare continues to strengthen case management by working with the government to improve linkages between diagnosis and treatment services, building the capacity of health professionals to correctly diagnose all suspected malaria cases before treatment and ensuring that appropriate treatment is given to all patients.
MalariaCare’s activities in Madagascar aim to achieve the following objectives:
- Improve the accuracy of diagnostic testing for malaria to greater than 90 percent.
- Increase the percentage of patients with suspected malaria who receive a diagnostic test for malaria.
- Increase the percentage of patients who receive appropriate treatment for malaria or other febrile illnesses, consistent with the result of the diagnostic test.
- Strengthen laboratory systems for detecting malaria and other infectious diseases.
Assessing needs and opportunities. At health facility level, the project conducted a comprehensive malaria and febrile case management survey of public, faith-based, and nongovernmental organization health facilities in all malaria transmission zones. Survey findings are being used to ensure that project activities are responsive to the needs of facilities. At national level, MalariaCare will help the PNLP assess central-level malaria diagnostic capacity, including support to ensure that diagnostic quality assurance policy documents and guidelines are available.
Providing supportive supervision and outreach training. Giving health workers opportunities for training and onsite support helps ensure that more families and communities have access to high-quality malaria diagnosis and treatment at the local level. During project-supported visits, health workers in select health facilities will gain skills in use of RDTs, malaria microscopy, and appropriate treatment. The project will also organize forums for sharing lessons learned from local supervision visits to help inform planning at higher levels of the health system.
A key contribution of the project is to build the capacity of central and regional-level laboratory and clinical supervisors to train, supervise, and mentor others at lower levels of the health system, including:
Building diagnostic capacity. Central and regional-level laboratory technicians will learn to provide accurate malaria diagnosis through microscopy and/or rapid diagnostic testing. Master trainers from the central and provincial levels will provide training and mentorship to district level laboratory technicians.
Improving malaria treatment. Similarly, to further strengthen clinical practice and better link treatment and diagnostic services, the project provides training on case management of malaria and other febrile illnesses. The most accomplished trainees are then recruited to be OTSS clinical supervisors, who mentor and train clinicians at the district-level.