By Katherine Kemp, PMI Impact Malaria Communications Coordinator. Editorial and content contributions from Lorina McAdam, Jacob Odentz, and Anne Bulchis, all with PMI Impact Malaria.
This piece was originally published on the PMI Impact Malaria blog.
In March, when the World Health Organization (WHO) declared the COVID-19 outbreak a global pandemic, PMI Impact Malaria (IM)-supported countries had just detected their first cases of COVID-19. By May, IM’s mandate began to include supporting Cameroon, the Democratic Republic of the Congo (DRC), and Ghana in their pandemic response efforts. Now, nine months into the pandemic, the three countries and IM have learned key lessons from responding to COVID-19, namely the importance of thinking innovatively to adapt standard training approaches, collecting and using data to inform decision making, and rapidly creating and sharing updated guidelines.
In April, an analysis from WHO and partners estimated that malaria deaths in sub-Saharan Africa could double as a result of commodity shortages, disruption of essential malaria interventions, and delayed healthcare-seeking behavior for fear of exposure to the virus. IM and partner countries suddenly faced the new twin challenge of confronting malaria and COVID-19 both quickly and safely, while knowing that a strong pandemic response is key to fighting malaria and saving lives.
As immediate work, IM provided technical and operational support to the ministries of health in partner countries, incorporated COVID-19 into supportive supervision checklists used to improve health provider competencies, and updated clinical and laboratory guidelines and tools.
Most recently, IM developed a series of publicly available COVID-19 e-learning modules for health workers. The six modules cover pandemic response topics that include safety hygiene and personal protective equipment (PPE), handling COVID-19 specimens, and conducting laboratory work in the COVID-19 context.
To access IM’s COVID-19 e-learning modules in English and French, click here.
IM’s COVID-19 Response by the Numbers
With IM’s support, Cameroon, the DRC, and Ghana trained 1,522 health staff on COVID-19 response and reached over 1,300 health facilities, all in seven months’ time.
Innovative Hybrid Training in the DRC
In the DRC, the ministry of health needed to quickly roll out training on new COVID-19 guidelines for clinicians and lab technicians from the national level down to the provincial level. However, travelling to all nine provinces was not logistically feasible because it was unsafe to meet in large groups. At the same time, many provincial participants had insufficient internet access on their own for online trainings.
Confronted with these challenges, IM supported the DRC to develop an innovative hybrid training approach. National facilitators provided training through webinars to small groups of provincial participants that gathered in person while wearing masks and respecting social distancing. After each session of the webinar, provincial-level facilitators led in-person discussions and answered participant questions, which they shared with national facilitators and other provinces in real-time. This fostered an inter-provincial dialogue that was not the norm, prompting participants to create a WhatsApp group to share their experiences and challenges in implementing COVID-19 guidelines. This platform allowed for immediate troubleshooting, with participants readily sharing and receiving advice and encouragement.
Through hybrid training, the DRC overcame internet and time constraints and was able to reach hundreds of people with training directly from national facilitators. In addition, participants could work as a group to adapt national messages to their provinces and make immediate decisions. These decisions provided real-time feedback on how COVID-19 guidelines were being received and adapted throughout the country, thereby strengthening ties between the national and provincial levels. Through this method, the DRC was able to roll out training faster and more affordably than was traditionally the case. In recognition of IM’s contribution to fighting COVID-19, the province of Haut-Katanga awarded IM and the national malaria control program (NMCP) a “Diploma of Excellence.”
COVID-19 Data Collection & Guideline Creation in Ghana
IM supported the Ghana Health Service (GHS) to rapidly assess COVID-19 preparedness of health facilities and the impact of the pandemic on service delivery. The first assessment found a lack of key infection prevention control supplies and PPE, as well as a need for training and preparation of health facilities and health workers. From this assessment, the GHS identified geographic priorities, particularly at the district level, and highlighted urgent gaps.
The service delivery assessment found a 90% change in frequency of health facility visits due to fear of COVID-19, namely a decline in outpatient attendance, patient admissions, suspected malaria cases, and antenatal care (ANC) attendance compared to the same period in prior years. Additionally, there was an increase in malaria deaths and severe disruption to surgery, immunization, ANC, child illness care, and malaria case management.
Using the data collected from the assessments to inform decision making, Ghana needed to rapidly adapt laboratory and case management guidelines to the COVID-19 context. Until Ghana developed these updated guidelines, no trainings could take place. Under intense time pressure, the GHS brought together the right stakeholders using lessons learned from the Ebola response and assembled a 39-member technical working group. With technical and operational support from IM, the group worked tirelessly over the span of two weeks to develop the necessary guidelines and tools such as training materials, job aids, and standard operating procedures, all of which Ghana’s government quickly approved and implemented.
Creative Country-Driven Adaptations in Cameroon
In Cameroon, IM supported the NMCP to reach over a million children with seasonal malaria chemoprevention (SMC) campaigns that minimized COVID-19 exposure for children, their families, and health workers. No COVID-19 cases were reported among more than 14,000 distributors involved in the campaign, a success made possible through innovative COVID-secure trainings and other country-led adaptations. For more information, read IM’s blog post: Protecting Those Most at Risk of Malaria: Child Health and the COVID-19 Response.
The Work Continues
With updated guidelines in place, innovative training methods established, and e-learning modules in use, IM and partner countries are continuing to respond to COVID-19 to promote good health and save lives.
Header Photo Caption: Midwife Franca Fianuke at the VRA Hospital in Akosombo, Ghana. Photo Credit: Emmanuel Attramah, PMI Impact Malaria Ghana