Tracking Malaria Cases One by One

MEASURE Evaluation provides training to strengthen surveillance in Senegal. 

Progress in the fight against malaria means the world is now able to think less about how to control the disease and more about how to move toward suppressing transmission. This effort will necessarily focus on sub-Saharan Africa, home to 90 percent of the world’s malaria cases and, often, where national health systems are weak.

The World Health Organization (WHO) notes that malaria control efforts take place on a national scale—to educate the public on prevention and mount efforts to reduce the habitat for the mosquito vector. However, as the number of malaria cases decreases and malaria-endemic locales shrink in size and number, it is necessary to take a more precise approach to combatting the disease. MEASURE Evaluation, funded by the United States Agency for International Development (USAID) and the President’s Malaria Initiative (PMI), works globally to strengthen health systems—especially health information systems (HIS). Through the HIS, this fight will be won or lost.

The theme for World Malaria Day, April 25, is “end malaria for good.” Senegal illustrates how this goal may be possible. There, under-five mortality has fallen from 121 deaths per 1,000 live births in 2005 to 59 in 2015—a 51 percent drop. The WHO global technical strategy for malaria sets ambitious but achievable targets for 2030:

• Reduce malaria case incidence by at least 90 percent.
• Reduce malaria deaths by at least 90 percent.
• Eliminate malaria in at least 35 countries by 2030.
• Prevent a resurgence of malaria in all countries that are malaria-free.

The trend is promising. Between 2010 and 2015, malaria incidence among at-risk populations fell by 21 percent globally. In that same period, malaria deaths among populations at risk fell by 29 percent globally among all age groups and by 35 percent among children under age five. According to the latest WHO estimates, released in December 2016, there were 212 million cases of malaria in 2015 and 429,000 deaths.

Surveillance in low-transmission settings

The task now falls to country health information systems. As incidence decreases, it becomes more important to accurately record and follow up on each malaria case to treat an infected person and also to stop onward transmission. A malaria surveillance system within an HIS includes tools, procedures, people, and structures that generate information on malaria cases and deaths that can be used for planning, monitoring, and evaluating malaria programs. Senegal is making great strides in that effort.

Each confirmed case is immediately reported to a national malaria registry and a full investigation determines transmission mode, risk factors, and optimal control strategies.

WHO has determined that effective surveillance such as this is required on the path to malaria elimination. Strong surveillance empowers programs to advocate for investment, appropriately allocate resources to those most in need and to interventions that are most effective, account for the impact of funding received, and evaluate what works in order to improve programs and decision making.

Surveillance workshops in Senegal

MEASURE Evaluation is assisting the Senegal National Malaria Control Program (PNLP) to provide country-specific monitoring and evaluation (M&E) and surveillance workshops to build the country’s capacity to conduct and maintain rigorous surveillance.

Workshop participants develop district-level M&E and surveillance plans, including goals and objectives, relevant indicators, evaluation methods, and budgets. Yazoumé Yé, a technical director in charge of MEASURE Evaluation’s malaria portfolio, helped develop the curriculum. “When participants finish the training,” he says, “they can take the plans back with them to implement in their district.”

Part of the training is hands-on. PNLP visits health facilities where workshop participants investigate and respond to malaria cases identified the previous day and present their findings, discuss challenges, and propose recommendations to strengthen M&E.

Twenty-four district health officials attended the first workshop in spring 2016 at the Institut Santé et Développement (ISED). MEASURE Evaluation delivered a second workshop in January 2017 and plans a third later this year. PNLP expects to train additional personnel at national and subnational levels in the coming years.

Next steps

This practical cooperation helps ensure that lessons learned during the training are practiced in the field. PNLP and ISED can continue the training and analyze results in the health districts. They will check that district program managers document program activities and surveillance results.

“Senegal has been working to strengthen its M&E system for some time,” Yé says. “A leading PNLP member sits on an M&E working group that’s part of the WHO Global Malaria Programme. This makes us more confident that global decisions will translate in Senegal. This is part of our mission at MEASURE Evaluation: to implement quality M&E systems on the ground.”