In 2016, there were approximately 216 million cases of malaria worldwide. Approximately 445,000 people died, including close to one child every two minutes. In order to achieve the ambitious goals of the World Health Organization’s Global Technical Strategy for malaria 2016-2030, US$8.7 billion is needed for a 90% reduction in malaria incidence and mortality rates by 2030.
In 2017, CRS implemented a $315 million portfolio of 18 malaria programs worldwide reaching more than 105 million beneficiaries in 14 countries.
CRS is a key partner of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Currently, CRS serves as principal recipient for malaria programs in Congo-Brazzaville, Guinea, Niger, Nigeria, and Sierra Leone and as a sub-recipient in Benin, Cambodia, and Mali. In 2017, CRS reached 68 million people through 19 Global Fund grants (including 11 malaria grants) across 11 countries with annual expenditures totaling $74 million.
Across the Sahel, CRS is supporting National Malaria Control Programs across five countries to scale up access to seasonal malaria chemoprevention to save children’s lives. In 2017, 15 million doses were distributed, reaching 3.7 million children. In 2016, malaria cases were reduced by 49% in Mali and 57% in The Gambia.
Our malaria programs focus mainly on children under five and pregnant women — the most vulnerable to malaria-related morbidity and mortality. 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 has the unique ability to integrate malaria activities within other programs such as emergency response, food security and livelihoods, and immunization throughout malaria endemic countries.
CRS actively participates in the Roll Back Malaria partnership, both globally and regionally. At the country level, CRS participates in national fora to establish guidelines and standards for malaria treatment and prevention. CRS also engages with technical and financial partners such as the World Health Organization, USAID’s Presidential Malaria Initiative, UNICEF, and national research institutions at the country level to coordinate support to national malaria programs.
CRS promotes the use of long-lasting insecticide-treated bed nets (LLINs) 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 45 million insecticide-treated bed nets in The Gambia, Ghana, Guinea, Madagascar, Niger, Nigeria and Senegal as part of nation-wide and universal mass distribution campaigns, and routine distributions.
- CRS has supported National Malaria Control Programs (NMCPs) in the scale-up of SMC in Guinea, Mali, Niger, and The Gambia distributing 15 million SMC doses reaching 3.7 million children in 2017. CRS has also provided technical support to Cameroon in 2017, and will continue its support to all these countries for the 2018 SMC distributions and beyond. We have also committed to raise $5 million to continue to fight malaria with SMC through the Crush Malaria campaign.
- CRS delivers malaria programming through integrated maternal and child health (MCH) programs, for example in Ghana, where CRS supported 240 communities in the Northern Region of East Mamprusi district to bridge gaps preventing women and mothers from using essential health services. Using a combination of eight different strategies, East Mamprusi advanced from being the worst-performing district in the Northern Region in 2010 to the best-performing district overall in the region in 2014 and the best-performing district for MCH indicators in 2015. Antenatal registrants increased from a baseline of 52% to 82%, four plus antenatal visits increased from 47.7% to 84%, uptake of IPTp (3+) improved from 52% to 78%, and LLIN use also increased from 48% to 79%.
CRS also has extensive experience conducting social behavior change communication 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, otherwise helping to improve prompt access to appropriate treatment, particularly for populations in remote or difficult-to-access areas. CRS also works closely with in-country partners and regulatory agencies to procure and distribute medicines, laboratory supplies and equipment.
- In Sierra Leone, CRS conducted training for Ministry of Health staff who in turn trained 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 also recruited, trained and deployed a team of 35 field agents and four coordinators who work with local health authorities, hospitals and district stores to improve commodity management and support nearly 1,200 health facilities. CRS leads similar programming in Benin, DRC, Guinea, Niger, Nigeria and Senegal.
- In the DRC, Senegal and Kenya, CRS trained community health workers in community-based integrated management of childhood illness, a protocol that is used to diagnose, treat and refer sick children 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.
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.
CRS and the Government of Sierra Leone conducted a national malaria indicator survey in 2013 using iPhones equipped with iFormBuilder software. With technical assistance from ICF International, 28 four-person teams surveyed 6,614 households over the course of six weeks. This is in sharp contrast with more than year-long efforts to compile, clean and analyze results for a similar paper-based survey in another West African country. By using mobile technology, CRS was able to have a relatively clean dataset at the end of data collection, allowing initial results within two months of the survey. USAID’s mHealth Compendium featured this innovation in its Second Volume.
Surveillance, monitoring and evaluation
In all of 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.