With funding provided from donors interested in widening AMF’s impact, we have agreed
to fund the expansion of the malaria control capacity of our partner in Malawi,
Concern Universal (CU). The resulting Malaria Unit has the simple, broad aim to
reduce malaria prevalence in Malawi.
The Malaria Unit aims to achieve this in the following ways:
1. Pilot interventions to improve sustained net coverage levels
The higher the sleeping space coverage level with viable nets the better the protection
against malaria. We are examining different net distribution profiles and mechanisms to
see if higher levels of sustained sleeping space coverage can be achieved cost effectively.
Although some nets can be effective for four or more years, data shows the average
useful life is usually between two and three years, often close to two. Across a
large quantity of nets this means sleeping space coverage levels decline gently
in the first 18 months after a universal coverage campaign and more quickly thereafter.
This can leave a significant proportion of a population unprotected for a material
part of the three-year period between universal coverage campaigns.
Coverage levels over 80% are generally considered a good target. Although we have
found that coverage levels immediately after a universal coverage campaign (UCC)
can be 95% and above, levels decline over time as nets become damaged or worn out.
We have found in many of our distributions that coverage levels fall to around 80%
after 18-24 months (a decline of about 0.5 percentage points per month) and decline
further to nearer 50% after 30 months (a steeper decline rate of 2 to 3 percentage
points per month). This means coverage levels are below the 80% target for at least
a year of a three-year cycle before a subsequent UCC takes place.
One method being discussed is an injection of nets two years after a universal coverage
campaign to take coverage levels back up towards 90%. We would also like to consider
a continuous distribution of nets whereby gaps in next coverage are filled on a
rolling basis from appropriately located stockpiles.
There are challenges and different costs associated with each method of distribution
and trialling a new approach will help with future decision making.
2. Achieve greater efficiency in existing operations
This can be achieved through more efficient staffing of the rolling malaria control
activities associated with the distributions and post-distribution check-ups in
the four districts in which AMF and CU partner.
The non-nets costs associated with the distributions and monitoring AMF/CU carry
out are between $1.10 and $1.40 per net. These compare favourably with other organisations
carrying out similar work and we believe are already very efficient.
Further costs efficiencies can be achieved through the use of permanent rather than
temporary staff. The scale of our operations, now covering four districts with a
combined population of 2.7 million, and the ability to stagger distributions and
follow up means there is sufficient work to justify permanent staff throughout the
year. We expect to achieve about a 25% cost saving in moving from
temporary to permanent staff.
We also anticipate additional efficiencies from both the experience and innovation
a permanent team can bring to bear through repeatedly carrying out distributions
and follow up activities as well as performance-based management.
3. Support the NMCP team
In the last three years, a number of AMF’s operating procedures have been embraced
by the National Malaria Control Programme (NMCP) in net distributions carried out
in the districts beyond the four in which AMF/CU operate and AMF/CU support has
been requested by the NMCP. The enlarged resource of the Malaria Unit will allow
greater support to be given to the NMCP to share learning and practices.
4. Improve the reliability of malaria case rate data
Currently the reliability of malaria incidence data across the 107 Health Centre Areas (HCAs) in the four districts is mixed.
There is benefit in having accurate malaria incidence data. We will be working with Health Centre staff to support testing, stock management and recording activities to improve data reliability.
We will be writing more about specific actions and developments in the coming months.
Malaria Unit budget (to which actual costs will be added
in due course)
Malaria Unit agreement