Importance of gender empowerment to reducing malaria mortality in Zambia – Evidence Brief

Gender equality and women’s empowerment are key to achieving universal health coverage. They are also important in their own right as a means to achieve sustainable development. Building on a successful gender mainstreaming approach used in three earlier projects, MAM@Scale integrated a focus on gender into the design of a severe malaria intervention in Zambia. Community health volunteers (CHVs) were trained to administer quality assured 100 mg rectal artesunate to children with severe malaria danger signs at community level and to refer patients to the health facility for further treatment. The project’s gender strategy aimed to address the wide range of social norms and gender stereotypes that prevented rural households from responding promptly to severe malaria and other child health emergencies.

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Adapting a severe malaria intervention in Zambia in the context of COVID-19 – Evidence Brief

In early March 2020, coronavirus (COVID-19) was declared a pandemic by the World Health Organization. Many countries had started to take steps to isolate suspected cases, ban mass gatherings and public events, close schools and universities and impose social distancing. At the time, MAMaZ Against Malaria at Scale (MAM@Scale) was implementing a community level intervention to address severe malaria targeted to young children in five districts of Zambia, working in partnership with district health teams. Responding to an urgent request by the Ministry of Health (MOH) for development partners to help build community preparedness and resilience, the project swiftly pivoted its activities to integrate a COVID-19 focus.

This evidence brief looks at how MAM@Scale adapted a severe malaria intervention in Zambia in the context of COVID-19.

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Scaling up rectal artesunate in Zambia – Evidence Brief

Over 7,500 malaria deaths occurred in Zambia in 2018 and children under six are the most susceptible due to their lack of immunity. MAM@Scale empowered Zambian families in five districts (Chitambo, Serenje, Chama, Manyinga and Vubwi) to reduce their mortality risk from severe malaria by introducing artesunate rectal capsules (known locally as rectal artesunate or ‘RAS’), a cutting-edge pre-referral intervention given at community level to children aged six months to six years old. The MAMaZ Against Malaria (MAM) pilot project (2017-2018) reported a reduction in severe malaria case fatality from 8% to 0.25% in intervention sites in Serenje district.

Building on this evidence base, MAM@Scale began implementation in December 2018 with funding from Grand Challenges Canada, Medicines for Malaria Venture and Transaid. Originally an 18-month intervention, additional funding from FIA Foundation, Grand Challenges Canada and a private donor extended the project by six months and enabled the inclusion of a COVID-19 focus. MAM and MAM@Scale built on a longer-term investment in community health systems strengthening by two earlier projects.

This evidence brief looks at scaling up progress so far and highlights some key lessons to guide wider national scale up of the innovation.

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Case study: Chitambo District Health Office (DHO) partnering with MAM@Scale in the COVID-19 response

The collaboration between Chitambo District Health Office (DHO) and MAM@Scale has been very effective, not only in the treatment of severe malaria at community level using rectal artesunate, a pre-referral drug, but also developing strong preventative measures against COVID-19 in this transit town.

MAM@Scale uses a strong community engagement approach by establishing and strengthening community systems to uplift health standards at community level. It is an inclusive approach that engages people at all levels, from traditional leadership to members of the community. People who volunteer to work for the community are trained in health education and become the providers of basic health services at community level. Food banks and savings schemes are formed in the communities to fight affordability barriers. This has not only raised demand for health services in the facilities that MAM@Scale is supporting in Chitambo district, but it made it much easier to put up preventative measures against COVID-19.

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Case Study: Baron educates people on malaria, emergency transport systems and COVID-19 on air

Fwanta is a community in the Kabamba area of Serenje District, Zambia.  In the past, many people in Fwanta who developed medical complications, be it maternal or malarial related, died because people wrongly interpreted the danger signs.

A turning point happened when MAMaZ Against Malaria at Scale (MAM@Scale) began working with this community and the Kabamba Rural Health Centre. They trained Community Health Volunteers (CHVs) on the management of severe malaria at community level through the administering of a Rectal Artesunate Suppository (RAS). MAM@Scale also provided an emergency transport system (ETS), in the form of a bicycle ambulance, to Fwanta.  Baron Mupeta was one of the people selected to be trained as an ETS rider.

Click below to read Baron’s testimonial.

Case Study: Brenda Kundo

Community Health Volunteers (CHVs) are the backbone of the health system in rural Zambia, where they provide invaluable health advice to their communities, which are located prohibitively far from health facilities. Before the pandemic, CHVs were a vital part of our MAM at Scale programme, combatting malaria in their community by educating families on the danger signs of severe malaria and administering RAS (rectal artesunate suppositories), a pre-treatment for children with suspected severe malaria.

CHVs are a trusted voice in their communities, so it was natural that they would form the cornerstone of MAM at Scale’s COVID-19 response. To meet the challenges of the pandemic, the MAM at Scale team has orientated nine Community Facilitators on COVID-19, who have in turn trained 1,379 CHVs, who will help keep their communities safe during the pandemic.

Brenda Kunda is a Community Facilitator with MAM at Scale. A tragic experience in Brenda’s life eventually led to a positive change, not only for her, but for her family and her entire community.

Click below to read Brenda’s story.

The potential role of mobile phone technology in rural motorcycle and three-wheeler taxi services in Africa

Over the last two decades, motorcycle and motorised three-wheeler taxis have become important means of transport in many sub-Saharan African countries, including in rural areas. However, the emerging role of mobile phone technology in improving mobility in rural areas is currently under-explored in the literature.

This paper presents the findings of a small-scale research study that was undertaken into the use of mobile phone technology in the context of motorcycle and three-wheeler taxi use, and its potential to improve rural access. Informed by a literature review, the research focuses on four countries: Kenya, Rwanda, Tanzania and Uganda. Semi-structured interviews and focus group discussions were conducted with riders of motorcycle and motorised three wheeler taxis and the developers of mobile phone-enabled transport technologies.

Mobile technology linked to the utilisation of motorcycle and three-wheeler taxis is increasing, but ‘ride hailing’ applications (apps) are likely to be limited to urban areas for the foreseeable future due to various disincentives to their use in rural areas. The study identifies several promising innovations that combine the use of motorcycles and three-wheelers with mobile technology to increase rural people’s access to essential services and opportunities. These have the potential to be scaled up or expanded to other countries.

To read the full the article, click below.

Article – How MAM@Scale adapted to tackle COVID-19 whilst maintaining momentum in the fight against malaria

2020 marked the start of the Decade of Action on Sustainable Development, which aims to accelerate progress towards achieving the UN Sustainable Development Goals by 2030. However, this year also saw the emergence of a new coronavirus disease, COVID-19, which has had devastating effects on health systems globally and has the potential to put a halt to much of the progress made against specific Goals. This global pandemic also poses a serious threat to the broader social, economic, and political security of entire populations worldwide, disproportionately impacting communities in low-income countries and resource-constrained settings.

In the wake of the pandemic, the MAM@Scale programme had to quickly and effectively adapt in order to tackle the spread of COVID-19 while continuing the fight against severe malaria as well as other lifesaving work to enhance maternal health outcomes. Thanks to funding from the FIA Foundation for the Automobile and Society, together with Grand Challenges Canada and MMV, we were able to integrate COVID-19 prevention into our work and support the government of Zambia’s COVID-19 response.

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GAVI Study – Outsourcing the Distribution Component of Vaccine and Medicine Supply Chains (2016)

Many government supply chains operate with limited transport capacity, which limits their ability to make last mile deliveries, and results in health workers collecting commodities from the next tier in the supply chain. Outsourcing is often used as a means to improve efficiencies, access new capabilities or access additional capacity, which has yielded successful results in some cases. Outsourcing is also an option when financing for an asset is not available which this is becoming an increasingly important issue now as donors are reluctant to pay for warehouses and trucks for Central Medical Stores (CMS).

This report focuses on how to outsource the physical distribution of vaccines and medical products to a private sector Logistics Service Provider (LSP) in sub-Saharan Africa. It analyses existing approaches to outsourcing, the challenges encountered and lessons learned. A number of outsourcing examples have been identified within the focus countries of Uganda, Zambia, Mozambique, Senegal, Nigeria, Ghana, Kenya, Tanzania and Malawi. These primarily focus on the distribution of ambient medical products, and incorporate many elements of vertical supply chains such as those part of the government operated CMS supply chain. There are just two examples of outsourced vaccine logistics that have been identified, a public private partnership in South Africa, and one in Nigeria.

The framework has been designed specifically to assist government operated CMS vaccine and medical supply chains in outsourcing distribution services. The report uses templates and documents to describe how to manage an outsourcing in a structured manner.  It also includes a practical toolkit to assist government operated CMS vaccine and medical supply chains in the outsourcing of distribution services. The Outsourcing Framework begins with a list of considerations for outsourcing and explains the process from creating a project plan and RFP, through contracting to implementation and business as usual.

Please click below to download the full report.

GAVI Study – Outsourcing the Distribution Component of Vaccine and Medicine Supply Chains

Many government supply chains operate with limited transport capacity, which limits their ability to make last mile deliveries, and results in health workers collecting commodities from the next tier in the supply chain. Outsourcing is often used as a means to improve efficiencies, access new capabilities or access additional capacity, which has yielded successful results in some cases. Outsourcing is also an option when financing for an asset is not available which this is becoming an increasingly important issue now as donors are reluctant to pay for warehouses and trucks for Central Medical Stores (CMS).

This report focuses on how to outsource the physical distribution of vaccines and medical products to a private sector Logistics Service Provider (LSP) in sub-Saharan Africa. It analyses existing approaches to outsourcing, the challenges encountered and lessons learned. A number of outsourcing examples have been identified within the focus countries of Uganda, Zambia, Mozambique, Senegal, Nigeria, Ghana, Kenya, Tanzania and Malawi. These primarily focus on the distribution of ambient medical products, and incorporate many elements of vertical supply chains such as those part of the government operated CMS supply chain. There are just two examples of outsourced vaccine logistics that have been identified, a public private partnership in South Africa, and one in Nigeria.

The framework has been designed specifically to assist government operated CMS vaccine and medical supply chains in outsourcing distribution services. The report uses templates and documents to describe how to manage an outsourcing in a structured manner.  It also includes a practical toolkit to assist government operated CMS vaccine and medical supply chains in the outsourcing of distribution services. The Outsourcing Framework begins with a list of considerations for outsourcing and explains the process from creating a project plan and RFP, through contracting to implementation and business as usual.

Please click below to download the full report.

Guide Des Formateurs Des Transporteurs

Le programme MAHEFA Miaraka (juin 2016- juin 2021) vise à renforcer les capacités du secteur public à planifier, fournir et gérer les services de santé communautaire, tout en redynamisant l’engagement communautaire et l’appropriation de la santé. 

Dans le cadre de la mise en œuvre du Plan de Développement du Secteur de la Santé à Madagascar (PDSS 2015-19), le programme Mahefa Miaraka soutient les moyens de transport d’urgence existants dans ses zones d’intervention, afin d’améliorer l’accessibilité de la communauté aux soins de santé en cas d’urgence sanitaire ou orientation des patients. L’objectif est de donner aux communautés les moyens d’améliorer et d’utiliser efficacement leurs propres plans d’évacuation médicale vers les centres de santé de base (CSB), les hôpitaux de district et les hôpitaux régionaux de référence. 

Ce guide servira d’outil aux formateurs. Il découle de la politique nationale de santé communautaire et a été conçu à partir de l’expérience antérieure du programme et de ses partenaires. 

Pour consulter le manuel en francais ou en malgache, cliquez sur le lien ci-dessous. 

Manuel Des Conducteurs Des Transports Publics

Le programme MAHEFA Miaraka (juin 2016- juin 2021) vise à renforcer les capacités du secteur public à planifier, fournir et gérer les services de santé communautaire, tout en redynamisant l’engagement communautaire et l’appropriation de la santé. 

Dans le cadre de la mise en œuvre du Plan de Développement du Secteur de la Santé à Madagascar (PDSS 2015-19), le programme Mahefa Miaraka soutient les moyens de transport d’urgence existants dans ses zones d’intervention, afin d’améliorer l’accessibilité de la communauté aux soins de santé en cas d’urgence sanitaire ou orientation des patients. L’objectif est de donner aux communautés les moyens d’améliorer et d’utiliser efficacement leurs propres plans d’évacuation médicale vers les centres de santé de base (CSB), les hôpitaux de district et les hôpitaux régionaux de référence. 

Ce guide servira d’outil aux chauffeurs et chauffeurs assistants sur les précautions à prendre lors d’une évacuation sanitaire communautaire de patients vers le CSB, les hôpitaux de district et les hôpitaux régionaux de référence. Il découle de la politique nationale de santé communautaire et a été conçu à partir de l’expérience antérieure du programme et de ses partenaires. 

Le Guide clarifie les engagements des chauffeurs et leurs rôles pendant et après le transport d’urgence des patients. Ce guide fournit également des détails sur les mesures à prendre pour leur propre protection et pour la protection du patient transporté ainsi que des autres passagers. La formation aux premiers secours doit rassurer et renforcer la confiance des conducteurs dans la réalisation du transport d’urgence des patients. 

Pour consulter le manuel en francais ou en malgache, cliquez sur le lien ci-dessous.