By Jennifer Wheeler, Head, Strategic Research & Learning, PSI; Lee-Ann Gallarano, Sr. Program Manager, Malaria, PSI; Kemi Tesfazghi, Mekong Malaria Elimination Technical Director, PSI; Mahesh Paudel, Research Advisor, Asia, PSI; and Hoa Nguyen, Country Director, Vietnam, PSI
Leveraging Private Sector Provider Networks to Contribute to National Malaria Elimination Efforts
The Big Picture: Strengthening Mixed Health Systems Through Public-Private Partnerships for Malaria Elimination
Vietnam, and other countries in the GMS region, have set a goal of eliminating malaria by 2030. While possible, it will take commitment, coordination, and creativity to make this a reality, as well as strong partnerships between the public and private sector health systems.
The Greater Mekong Sub region Elimination of Malaria through Surveillance (GEMS+) project supports the transition of private providers to national malaria programs in Vietnam, as well as in Cambodia, Lao PDR, and Myanmar, to integrate private providers into national malaria elimination strategies, surveillance systems, and planning & management structures. With this model in place, the government will leverage the private sector as complementary to the public facilities and community channels to achieve the “last mile” to malaria elimination.
Our Goal: Sustainable Transition
Built on the strong foundation of GEMS (2016 – 2019) private sector engagement, GEMS+ represents an ambitious three-year investment with the primary objective of transitioning private sector malaria programs to government oversight by the end of 2022. A successful transition and integration would entail private provider networks becoming part of national policies and strategies, allocation of resources by the government dedicated to the private sector program, and sustained engagement of transitioned providers.
How Are We Measuring Success? The Evaluation
In order to identify the extent to which the private sector network is sustainably transitioning, we commissioned an independent evaluator to conduct an evaluation on GEMS+ in Vietnam using Outcome Harvesting. Outcome Harvesting is recommended by USAID’s Health Systems Strengthening Practice Spotlight Series as a method well-suited to generating evidence on the effects of health system strengthening interventions. This evaluation method examines the role of a project in contributing to expected and unanticipated outcomes. It factors in the complexities of context, the multiple stakeholders involved in systems change, and sheds light on the process of systems change.
How Well Are We Doing? What We Learned
Throughout its implementation, the GEMS+ program in Vietnam has strengthened commitments from national governments for inclusion of the private sector in the malaria elimination strategy, achieved coordination between private and public sectors, and introduced creativity through innovations in digitization.
The Outcome Harvesting evaluation found that GEMS+ facilitated change toward project goals at all levels of the health system, including these key achievements towards a sustainable transition:
- Building trust among healthcare decision makers through evidence regarding the feasibility and effectiveness of the private sector in malaria detection and treatment, as well as their contribution to malaria reporting at the national level.
- Facilitating integration of malaria case data from the private sector into national reporting systems through an MoU signed between NIMPE and PSI Vietnam in March 2019. In June 2020 the Ministry of Health also recognized the private sector as an official actor in malaria control in Vietnam.
- Ensuring the availability of quality malaria case data from the private sector by making private sector case reporting more timely, complete, and reliable. Working jointly with provincial Centers for Disease Control and Prevention (CDC) and Departments of Health (DOH)s, GEMS enhanced the malaria case reporting by developing an electronic reporting system and a verification process of private sector malaria case reports prior to integration into the national health system.
- Improving the care available to consumers by building the skills/capacity & confidence of the private sector in providing testing and counseling before referring them to the commune health station for treatment.
- Changing health seeking behavior of and reducing out-of-pocket expenses for consumers by enabling consumers to seek malaria testing through clinics/pharmacies rather than paying for ineffective treatments without a correct diagnosis. This increased awareness and community behavior change was highlighted in the evaluation as one of the main contributors to the reduction of malaria cases in Vietnam.
GEMS+ in Vietnam will pivot programming from direct implementation to providing technical assistance to the national and subnational government. We also developed a legacy suite of tools for additional technical guidance, including standard operating procedures (SOPs) for private sector engagement in malaria case management that leverage 6+ years of findings, case studies, and best practices. With this shift, private sector networks created under the GEMS+ program will continue to contribute to malaria elimination efforts sustainably.
The Final Word
As countries in the GMS reach the last mile of malaria elimination, sustained engagement from the private sector integrated into a strong public health system is necessary for achieving and sustaining malaria elimination goals. PSI’s groundbreaking work in GEMS is now being leveraged to support the MoH in Vietnam to strengthen the Public Health Emergency Operations Centers. PSI Vietnam is working with partners to ensure that private sector surveillance data is available and integrated into the wider health system to facilitate the early warning of possible outbreaks of malaria and other diseases and contribute to timely action to contain these events.