In line with the Mozambique Ministry of Health’s decentralized approach, MalariaCare works closely with the National Malaria Control Program (PNLP) and the National Institutes of Health to provide high-quality malaria diagnosis and treatment nationwide. In addition, the project provides targeted support to two provinces with the highest burden of malaria, Zambezia and Nampula. In these provinces, MalariaCare facilitates capacity-building, quality assurance for case management, and other technical support activities across all levels of public health facilities, while strengthening public sector capability to provide high-quality case management services. The project is also exploring opportunities for collaboration with private sector health providers.
CONTEXT FOR MALARIACARE IN MOZAMBIQUE
Malaria is endemic throughout Mozambique, with transmission occurring year-round. In Zambezia, malaria accounts for nearly 30 percent of all deaths and 42 percent of deaths in children under five. Throughout the country, Plasmodium falciparum accounts for 90 percent of infections. The PNLP’s strategic plan and national treatment guidelines call for all patients suspected of malaria to have a confirmatory diagnostic test prior to receiving treatment with an artemisinin-based combination therapy (ACT).
As the availability of high-quality laboratory-confirmed malaria diagnosis via microscopy is limited in Mozambique, rapid diagnostic tests (RDTs) are used in most facilities.
The PNLP has taken significant steps toward strengthening the quality of malaria diagnosis and improving access to testing. For example, in 2011 the PNLP trained nearly all laboratory staff in the country in both microscopy and RDT use. However, as this was a one-time training, new staff now require additional training to update their skills. Unfortunately, Mozambique has only a dozen local trainers who have been accredited in malaria microscopy by the World Health Organization.
MalariaCare is working hand in hand with the PNLP to enhance training, facilitate supervision and mentoring, and strengthen the overall health system.
Activities in Mozambique aim to achieve the following objectives:
- Improve the accuracy of diagnostic testing for malaria to greater than 90 percent.
- Increase the percentage of patients suspected to have malaria or febrile illnesses 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.
Building diagnostic capacity. To improve knowledge and skills related to malaria diagnostic testing, MalariaCare is supporting the PNLP to provide refresher training on malaria diagnostics for laboratory supervisors. This activity is helping to develop a pool of accredited experts to perform diagnostic testing and to supervise and train others. In areas where microscopy services are not available, MalariaCare provides targeted support to health facilities to strengthen alternative diagnostic approaches, including strengthening staff ability to use and store RDTs and training supervisors to ensure the quality of RDT testing at community level. This helps provide quality services closer to where patients live.
Linking high-quality diagnosis and treatment services. To further strengthen clinical practice in Zambezia and Nampula, MalariaCare supports refresher-training workshops to build the capacity of health workers to identify malaria and provide appropriate testing and treatment.
Enhancing supervision and mentoring. To help ensure that trained health providers are able to use what they have learned in practice, the project supports local supervisors to conduct frequent onsite supportive supervision and on-the-job mentoring at health facilities. This approach strengthens case management services in health facilities by identifying areas that require improvement, providing onsite feedback, and supporting front-line clinicians and laboratory staff in their day-to-day work.
Strengthening feedback and information systems. MalariaCare also supports workshops for supervisors from both Zambezia and Nampula, to ensure lessons learned from supervision visits can be shared and applied within and between provinces. The project also is facilitating the implementation of an electronic data collection tool that interacts with Mozambique’s existing health information system to ensure that project data can be used for decision-making.
Mozambique 1: A quality assurance approach: improving malaria case management at Mocuba Rural Hospital in Mozambique pdf (254K)
Mozambique 2: Improving case management of severe malaria pdf (286K)