By Lee-Ann Gallarano, Sr. Program Manager, GEMS+, PSI
THE BIG PICTURE: THE PRIVATE SECTOR’S CONTRIBUTION TO LAST MILE MALARIA ELIMINATION
In the Greater Mekong Subregion (GMS), 70% of the population first seek fever treatment from the private sector, meaning that private providers potentially see most of the malaria cases in the region. As countries reach the last mile of malaria elimination in the region, comprehensive malaria case and testing data from both the public and private sector is necessary to achieving and sustaining malaria elimination. Despite this, none of the six GMS countries collect complete case data from private sector points-of-care.
OUR GOAL: PRIVATE SECTOR ENGAGEMENT IN QUALITY MALARIA CARE AND INTEGRATION INTO NATIONAL SURVEILLANCE SYSTEMS
Between 2016 and 2019, the Bill and Melinda Gates Foundation-funded GMS Elimination of Malaria through Surveillance (GEMS) program, implemented by Population Services International (PSI), supported national malaria programs (NMPs) in Cambodia, Lao PDR, Myanmar, and Vietnam to execute elimination strategies by engaging the private sector in malaria case management, reporting, testing and case identification numbers, and integrating these data points into national surveillance systems.
GEMS enrolled nearly 22,000 private sector outlets, covering up to 80% of the private sector in targeted geographies, which were trained and equipped to perform rapid diagnostic tests (RDTs) and report malaria case data. By 2019, the diverse network of private providers tested over 3.5 million suspected cases and reported over 96,000 confirmed malaria cases into national surveillance systems, representing 8-25% of the national caseload in these countries. Thus, demonstrating that with comprehensive support, such as training, provision of free or subsidized RDTs, first-line treatments, and routine supportive supervision, private providers can provide quality malaria case management and achieve high reporting rates.
WHAT WE LEARNED: PUBLIC-PRIVATE COLLABORATION AND SUPPORT ARE NECESSARY
A recent publication on the GEMS program in the American Journal of Tropical Medicine and Hygiene presents case studies in Cambodia, Lao PDR, Myanmar, and Vietnam, which describe approaches to integrating the private sector into national surveillance systems and present results of private sector surveillance activities in those countries. Key learnings highlighted in the article include:
- As countries shift from malaria control to elimination, the value of timely, case-based data from all sectors in areas of local transmission is increasingly important to ensure that every case is detected, investigated, and classified to inform timely response.
- Integration of private sector data into national malaria surveillance systems is possible when interventions are designed with NMPs and aligned with existing operational procedures in place for routine public sector and community-based service data.
- In the GMS, the private sector is capable of achieving high reporting rates of malaria testing and case data when incorporated into a holistic support program for malaria case management that includes training, affordable access to RDTs and first-line treatments, and supportive supervision.
- In settings where the public sector alone cannot adequately cover the population at risk and where high-risk populations face barriers to accessing care at public facilities, the private sector may be a crucial partner in the malaria elimination end game.
- The need for management capacity and demand for data to inform decision-making is crucial not only at national levels, but for district health offices. At the last mile, establishing linkages between private providers and health facilities may facilitate more sustainable reporting flows.
GEMS+, the 3-year follow-on to GEMS, represents an ambitious investment with the primary objective of transitioning private sector malaria programs to government oversight by 2023. Programming has pivoted from direct implementation to providing technical assistance to the national and subnational malaria programs. GEMS+ also developed a legacy suite of tools for additional technical guidance, including standard operating procedures 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 and with informed government oversight.
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 Ministries of Health in Cambodia, Lao PDR, Myanmar, and Vietnam to strengthen the Public Health Emergency Operations Centers. PSI 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.
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Photo credit: PSI Vietnam