In 2018, there were approximately 228 million cases of malaria worldwide. Approximately 405,000 people died, including close to one child every two minutes. In 2019, total global malaria spending was $2.7 billion. In order to reduce malaria mortality rates by 75%, the annual global investment will need to increase to $ 7.7 billion by 2025.
In 2019, CRS's $154 million portfolio of 17 malaria projects reached 86 million people in 12 countries. Our programs focus on the people most vulnerable to malaria-related morbidity and mortality – children under 5 and pregnant women. We address the illness at household, community and facility levels. And we emphasize prevention, community and facility case management, procurement and supply chain management, along with advocacy at national, regional and international levels.
As a multi-sectoral organization, CRS can integrate malaria activities within other programs such as emergency response, food security and livelihoods, and immunization throughout malaria endemic countries. This allows CRS to quickly adapt and maintain its malaria outreach activities during disease outbreaks, such as Ebola and COVID-19. In Benin, for example, CRS prepared training modules that will help 3,000 community health volunteers to remain safe when treating sick children and provide advice to parents on preventing COVID-19.
CRS actively participates in the RBM Partnership to End Malaria, through the Alliance for Malaria Prevention, the Vector Control Working Group, the Case Management Working Group, the Strategic Communication Committee, and the Seasonal Malaria Chemoprevention working group. Through these global and regional leadership roles, CRS works with technical and financial partners to ensure continued evidence-based interventions and sustained introduction and scale-up of new interventions. At the country level, CRS participates in national fora, with national research institutions and national malaria control and elimination programs (NMPs) to establish guidelines and standards for malaria treatment and prevention.
CRS is also a key partner of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Through our 12-country Global Fund portfolio, which includes five malaria grants as Principal Recipient, we provide technical assistance to NMPs in assessing, developing, updating and disseminating malaria policies and guidelines. CRS also works closely with in-country partners and regulatory agencies to procure and distribute medicines, laboratory supplies and equipment.
CRS promotes the use of insecticide-treated nets (ITNs) through both routine and mass distributions, indoor residual spraying, intermittent preventive therapy for pregnant women (IPTp) and seasonal malaria chemoprevention (SMC) in the Sahel region.
To date, CRS has distributed more than 113 million ITNs in The Gambia, Ghana, Guinea, Madagascar, Niger, Nigeria and Senegal as part of nation-wide and universal mass distribution campaigns, and routine distributions. From 2017 to 2019, CRS supported the distribution of over 50 million ITNs in Nigeria alone.
CRS has supported NMPs in the scale-up of SMC in six countries, distributing 22 million SMC doses over the last five years. In 2020, CRS will support SMC for more than 11 million children in Guinea, Mali, Niger, Nigeria and The Gambia.
CRS delivers malaria programming through integrated maternal and child health (MCH) programs. In Ghana, CRS supported 240 communities in the Northern Region’s East Mamprusi district to bridge gaps preventing women and mothers from using essential health services. Using a combination of eight strategies, East Mamprusi advanced from being the worst-performing district in the Northern Region to the best-performing district in only five years.
CRS also has extensive experience conducting social behavior change strategies at the household and community levels through a variety of channels such as participatory community programs, face-to-face discussions, working with influential and religious leaders, community festivals, local radio and television programs.
Testing, Diagnosis and treatment
At the local level, CRS has a strong understanding of the challenges that malaria programs need to address, including working with hard-to-reach demographics such as young mothers as well as community members with limited education and other marginalized groups. CRS provides training and support to community health workers to test, diagnose, treat, and track malaria cases, helping to improve prompt access to appropriate treatment, particularly in remote or difficult-to-access areas.
In Guinea, CRS conducted training for Ministry of Health staff who in turn trained 3,357 community health workers to diagnose malaria in children under age five, provide treatment for uncomplicated cases and refer complicated cases to the nearest health facility. CRS led similar programming in Benin, DRC, Niger, Nigeria, Senegal and Sierra Leone.
In Benin, CRS supported the Ministry of Health in training 3,168 community health workers in integrated community case management , a protocol that is used to diagnose and treat children with malaria, pneumonia and diarrhea, and refer other illnesses to health centers for immediate care.
In The Gambia, CRS trained more than 2,300 community volunteers to conduct household behavior change communication visits on malaria control and prevention. They have since conducted more than 230,000 home visits. In Sierra Leone, CRS promotes malaria, COVID-19 and other health messages through 2,236 community health clubs and 780 school health clubs.
Mobile technology for rapid data collection
Over 60% of CRS’ malaria programs use mobile technology to improve speed and accuracy of data collection, enable simple analysis and use of complex data, or increase adherence to malaria treatment guidelines.
In 2019, CRS supported the first synchronized, cross-border LLIN distribution in Senegal and The Gambia. CRS supported GIS mapping of 1,454 communities along the 748-km border and used mobile technology to register participants, monitor distribution and validate data. Mapping and data collected during the campaign is now available to NMPs and local health facilities to plan future malaria interventions. After jointly distributing more than 9.5 million nets, the two countries are now discussing ways to align their SMC campaigns using digital technology.
In April 2020, Benin will distribute 8 million LLINs to 2.28 million households nationwide. CRS is working closely with the NMP to digitize the campaign. Preparation included developing a robust population database, which is similar to conducting a national census and provided a rich dataset that can be used in planning and implementing other health campaigns. CRS also recruited and trained 150 technical trainer administrators to use digital tools digital tools, provide technical assistance, train and build the capacity of thousands of household enumeration and distribution teams. Due to the COVID-19 pandemic, ITNs will be distributed door-to-door rather than at fixed points. Some training was modified to virtual sessions and a GIS dashboard and CAT platform enabled remote supervision.
Knowledge gained from supporting national malaria programs since 2015 to digitalize their SMC and net campaigns has enabled CRS to collate a list of 11 success factors to consider during pre-campaign, mid-campaign, and post-campaign.
Surveillance, monitoring and evaluation
In all its malaria programs, CRS works with existing national health management information systems (HMIS) to collect high quality and timely data, ensure consistent and verifiable reporting and, as needed, strengthen the capacity of these systems. In several countries, CRS is supporting the roll-out of the District Health Information System 2 to streamline reporting from the district to national levels. In Guinea, CRS specialists worked closely with Ministry of Health staff to develop a costed national strategic plan for HMIS, which included the scale-up of DHIS2. CRS trained district health teams and facility-based staff in the use of DHIS2 and provided them with the necessary hardware, software and internet connectivity. As a result, DHIS2 is functional in all eight regions of the country, including 45 hospitals and 38 districts.
CRS conducts regular data quality assessments to ensure that data is accurate, reliable, meaningful and timely. Often assessments are conducted jointly with government health partners and sub-recipients in order to build their capacity. CRS staff also meet with implementing partners at least once a quarter to jointly analyze and reflect on project monitoring data, which takes into account observations from field visits and informal monitoring activities. These types of meetings help to inform project decision-making and adjust project activities as needed based on evidence.
CRS recognizes the need for mechanisms that ensure accountability to project beneficiaries. For example, through its Global Fund Sub-Recipient grant in Cambodia, CRS is assisting the local government to improve the client-provider interface and strengthen mechanisms for community participation (Village Health Support Groups, Health Center Management Committees) to improve responsiveness and accountability of the health system to its clients. Feedback and response mechanisms, such as community scoreboards, telephone hotlines and suggestion boxes, give community members a voice and facilitate effective dialogue, which results in projects that are more responsive to community needs. CRS ensures that feedback systems are appropriate and sensitive to the local culture; feedback and response mechanisms are only established after initial consultations have taken place with the community members to elicit local preferences and priorities.
In its programs, CRS emphasizes the need to document, analyze and apply learning at the project, sector and agency level, and share that learning with stakeholders, practitioners and policymakers. The CRS Monitoring, Evaluation, Accountability and Learning (MEAL) community has developed a learning framework that fosters intentional learning. Under the MEAL policies and procedures, new staff are required to know the basic principles and practices of learning, and all country programs develop and implement learning agendas. CRS regularly organizes learning events and participates in workshops, working groups, communities of practice and other learning networks at country, regional and global levels.