Prioritizing Interventions – Targeting IRS to Maximize Effectiveness

Prioritizing Interventions – Targeting IRS to Maximize Effectiveness

By Annie Martin on October 30, 2018 in Malaria, News

A team of IRS spray operators prepare for the 2017 spraying season.

Malaria kills a staggering number of people every year — nearly half a million. That number is unacceptable given malaria is both preventable and treatable and somewhat surprising given donors and governments spend hundreds of millions of dollars each year attempting to control malaria.

So why is that number still so high? Well, first of all, malaria is primarily in countries with largely rural and hard to reach populations. Getting to those populations is logistically complicated and costly. Secondly, the mosquitos that transmit malaria quickly adapt to resist insecticides and to evade interventions. Thirdly, the scale of the problem is massive. While there are half a million deaths and over 200 million cases annually, the population at risk is even larger – half of the global population. Half of seven billion people are at risk for malaria.

With this context, hundreds of millions of dollars in control efforts begins to sound like a drop in the bucket. In order to make the most of the resources at hand, we must maximize the impact of each dollar spent. For example, interventions like indoor residual spraying (IRS) – where spray operators move household to household spraying the walls of homes with insecticide in order to kill the malaria transmitting mosquitoes – are very effective at killing mosquitoes and reducing malaria. However, IRS is expensive. We need to ensure we are distributing IRS resources in the most strategic and likely most impactful way.

In 2017, Akros worked with the Zambia National Malaria Elimination Centre (NMEC), the Africa Indoor Residual Spray (AIRS) Project implemented by Abt Associates, and the U.S. President’s Malaria Initiative (PMI) to conduct a comparison control trial of IRS prioritization strategies. The question was simple: If we do not have enough resources to spray every house, where should we spray to see the greatest decreases in malaria incidence? Should we spray one condensed geographic area? Should we spray the areas near the health centers with the highest burden of malaria? Or, should we spray the areas predicted to have the most mosquitoes? Each of these questions defined an arm of the study; one arm targeted IRS by concentrating it in one geographic area, one arm targeted IRS by prioritizing its delivery by health facility-measured malaria burden, and one arm targeted IRS by prioritizing its delivery by predicted mosquito density due to ecological factors. The NMEC implemented each arm in two districts of Eastern Province during the 2017 IRS operations.

USAID Awards Global Contract to PSI and Partners to Advance Malaria Service Delivery in 28 Countries

USAID Awards Global Contract to PSI and Partners to Advance Malaria Service Delivery in 28 Countries

By Akros Media on February 26, 2018 in Malaria, News

We are excited to announce that PSI has been successfully awarded a new contract by USAID to support the President’s Malaria Initiative (PMI) to Advance the Progress of Malaria Service Delivery (APMSD) in 28 malaria-affected countries and selected Akros as an implementing partner. The project, worth over $160 million USD over five years, will be delivered by a consortium of core partners, led by PSI and including JHPIEGO, Medical Care Development International (MCDI) and University of California-San Francisco.

The project will focus on supporting national malaria control programs in USAID-supported Malaria Endemic countries including 25 in Africa and three in Asia. The interventions aim to improve quality of and access to malaria case management and malaria in pregnancy interventions. They will also improve quality of and access to other malaria drug-based approaches and provide support to pilot/scale-up newer malaria drug-based approaches. Global technical leadership, support for operational research, and advances in program learning are priorities as well. In addition to the core team, private sector partner Akros and University of Oslo and Medicines for Malaria Venture will support.

Akros will lean into its experience working with national ministries by leading efforts on strengthening capacity building of Ministries of Health (MoHs) for HMIS and executing a central strategic plan around data use within the MoHs and communities.

Globally, the world has made remarkable progress in controlling malaria; halving the burden of disease between 2000 and 2015, but progress is stalling. The WHO’s most recent World Malaria Report highlights the current state of case management of children under five years and delivery of intermittent presumptive treatment for pregnant women as major concerns.

The President’s Malaria Initiative, led by USAID and implemented with the U.S. Centers for Disease Control and Prevention, is the U.S. Government’s primary vehicle for assisting malaria affected countries to scale up proven malaria control and elimination interventions.

The PMI Strategy for 2015-2020 accounts for much progress over the past decade and offers a strategy for new and emerging challenges. Malaria prevention and control remains a major U.S. foreign assistance objective and PMI’s strategy fully aligns with the U.S. Government’s vision of ending preventable child and maternal deaths and protecting communities from infectious diseases. By working with PMI-supported countries and partners, the U.S. Government aims to further reduce malaria deaths and substantially decrease malaria morbidity, towards the long-term goal of elimination.

This new contract comes as PSI launches its new global strategy for consumer-powered healthcare. APMSD will innovate ways to bring healthcare closer to the consumer in developing countries. PSI is proud to be associated with USAID and its partners to achieve this goal.

Akros joins Nonprofit Organizations Knowledge Initiative in webinar for their series on DHIS2 for NGOs

By Akros Media on November 28, 2017 in News, Water and Sanitation Health

If you missed the webinar we did with the Nonprofit Organizations Knowledge Initiative, take a look at the full recording below. Akros team members Dr. Robert Ntalo, Rabson Zimba, and Bethany Joy Larkin share some of the things Akros learned while implementing CLTS across Zambia. The title of the webinar is “Data Empowers Decisions – How Traditional Zambian Leaders are Making Decisions using DHIS2 Mobile Platforms.”

Akros GHC crew hosts webinar on what it’s like to be a GHC fellow at Akros

Akros GHC crew hosts webinar on what it’s like to be a GHC fellow at Akros

By Akros Media on November 21, 2017 in Capacity Building, News

On November 16, current and former Akros GHC fellows shared their experiences and fielded questions from hopeful GHC candidates. Each year, GHC a diverse group of young leaders with a vested interest in health equity joins GHC to complete a 13-month fellowship with partner organizations in five countries: Malawi, Rwanda, Uganda, Zambia, and the U.S.

Below is a full recording of the webinar in case you missed it!

Akros featured in recent reports

Akros featured in recent reports

By Akros Media on August 28, 2017 in Capacity Building, Health Data Systems, Malaria, News, Uncategorized, Water and Sanitation Health

We strive to be consistently on the cutting edge of the development and technology sector. And the cutting edge does not form without a stalwart commitment to research and a collecting of best practices. We are excited to have been mentioned in several recent pieces of independent research as having implemented technologies and systems that are furthering development work around the world.


Mobile Solutions for Malaria Elimination Surveillance Systems: A Roadmap

The first is in a report titled “Mobile Solutions for Malaria Elimination Surveillance Systems: A Roadmap” funded by the Gates Foundation and carried out by Vital Wave. The study was done to “develop key recommendations regarding appropriate, scalable strategies to promote further innovation and coordination among technology partners” and to “Develop specific recommendations for a coherent and effective Foundation strategy for strengthening data collection systems and associated platforms.” Our mSpray system was featured as a highlight of the geolocation category for the way it increases the efficiency and effectiveness of indoor residual spraying (IRS) campaigns (page 48 of the report).

In its conclusions and recommendations, the report points out that “many of the key elements needed to improve the development and implementation of robust mobile tools for malaria surveillance already exist.” It also says that coordination among malaria program implementers will be key to success and will help keep current the list of necessary features within these digital tools.

Akros entries selected in photo competitions

By Akros Media on May 31, 2017 in News

Over the past few months, two photos by Akros Communications Lead Andy Prinsen have been selected as winner and honorable mention in their respective photography competitions. The first was the “Picturing inclusive CLTS photo competition” sponsored by the CLTS Knowledge Hub, and Prinsen’s photo titled “School Sanitation: Equal and Proud” was selected as one of three winners.

Female students from Maunga School in Zambia’s Southern Province stand in front of one of the school’s new improved latrines. When the girls were menstruating, they would often stay home for lack of sanitation facilities at school. Now, with funds from UNICEF, the girls’ latrines are built with a privacy enclosure and a specially built water-channeling floor so they can wash properly before returning to class. Through sanitation tracking done by Akros, the school has seen a significant decrease in the young women missing school for days at a time.

The CLTS Knowledge Hub is a collection of news and information on the Community-Led Total Sanitation Movement and is a great resource for professionals working in the field or those interested in learning about CLTS.

Another of Prinsen’s photos was selected as the honorable mention for the category of mHealth and Communications Technology in the 12th annual Photoshare contest.

An Akros surveillance officer sits with Community Champions from Nyimba, Zambia, to map the villages they serve. In this innovative mapping process, the surveillance officer uses Google Earth’s satellite imagery to navigate these community members’ villages “like a bird in the sky.” Most community champions have never seen satellite imagery before, but they know their communities so well that the mapping process works amazingly well. This is the first time decision makers at the national level will have detailed location data on these villages, allowing them to make more informed decisions and reach villages in times of emergency.

Photoshare is a service of the Knowledge for Health (K4Health) project, based at Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP). Photographers submit images to Photoshare for free, public use by nonprofits and for educational purposes. Photoshare is a leading source for public health and development communication, focused on demonstrating the value and impact of photography in global health efforts to improve health and save lives.

Mobile Platform Enables Unprecedented Sanitation Uptake in Zambia

Mobile Platform Enables Unprecedented Sanitation Uptake in Zambia

By Akros Media on February 15, 2017 in Health Data Systems, News, Water and Sanitation Health

CLTS has been shown to be an effective method to combat malnutrition and stunting in children under five. In this study, a mobile-to-web platform increased the uptake of CLTS even further, allowing for greater community feedback, a reduced cost per new user of sanitation, and increased data transparency.

Akros, in partnership with Zambia’s Ministry of Local Government and Housing (MLGH) and UNICEF, layered a unique mobile-to-web application over traditional CLTS delivery methods, resulting in an innovative service delivery and monitoring system dubbed “CLTS M2W.”

CLTS M2W uses mobile phones, automated data feedback loops, and engagement of traditional leaders to provide communities with the ability to clearly see their progress towards sanitation goals. CLTS M2W paved the way for unprecedented CLTS uptake in Zambia, facilitating the creation of over 1,500,000 new users of sanitation in 18 months. In short, CLTS creates the demand, and CLTS M2W creates the critical transparency necessary to drive sustained behavior change.

Read the full study in PLoS Neglected Tropical Diseases.

Read this and more CLTS-related news on the CLTS Knowledge Hub.

Gavi Pacesetter organizations

Gavi Pacesetter organizations

By Akros Media on February 8, 2017 in Health Data Systems, News

GAVI is an international organization – a global Vaccine Alliance – bringing together public and private sectors with the shared goal of creating equal access to new and underused vaccines for children living in the world’s poorest countries. It is backed in part by the Bill and Melinda Gates Foundation.

GAVI held its first INFUSE workshop (Innovation for Uptake, Scale and Equity in immunization) in Geneva. Around 60 organizations and companies applied to the program, and 18 of these projects were selected for a final round of vetting in front of a panel with representatives from the organizations and companies like the World Health Organization (WHO) and UNICEF. At the end of the workshop, the panel selected seven “pacesetter” organizations who will work with GAVI to scale up their ideas and projects and bring them to new countries.

We are excited to announce that Akros has been selected as one of these seven pacesetter organizations for a concept that follows in-line with our approach of gathering village level information to inform decision making. The approach takes existing monitoring tools in the country, like stock monitoring and commodities tracking, and merges them into a single vaccine-tracking database using a platform called DHIS2. In the database, Rural Health Clinics (RHCs) log immunizations delivered using simple feature phones. Parents of children due for their next immunization receive SMS appointment reminders along with a list of clinics that have the vaccine in stock. The RHC also receives a list of patients in the area who are due for follow-up vaccination appointments.

“Vaccine coverage has made big leaps, but until we reach the last mile of care, we won’t see disease elimination,” said Akros Portfolio Lead, Laurie Markle. “We are excited what this partnership could mean for reaching the ‘fifth child,’ not just in Zambia but around the globe.”

Akros shares its designation as a 2016 Gavi Pacesetter with six other organizations: Shifo, IRD, KhushiBaby, Energize the Chain, Broadreach, and Nexleaf Analytics.

As part of the partnership, Akros and GAVI will work closely over the coming year to identify resources and partnerships that will enable both implementation of the program and maximum impact.

Akros-led consortium to develop Elimination 8 regional malaria database

Akros-led consortium to develop Elimination 8 regional malaria database

By Akros Media on August 19, 2016 in Malaria, News

We are excited to announce that an Akros-led consortium has been selected to develop a regional malaria surveillance platform for a coordinated, eight-country effort to achieve the historic goal of eliminating malaria in eight southern African countries. The Southern African Malaria Elimination 8 (E8) is a partnership between Botswana, Namibia, South Africa, Swaziland, Angola, Mozambique, Zambia, and Zimbabwe. The first four of these countries (frontline countries) have an elimination goal of 2020, and the later four (second line countries) hold a goal of elimination by 2030. Consortium members working with Akros include HISP-SA and Compre Health.

E8 countries reported a tremendous reduction of malaria cases of more than 50% since 2004. However, the closer we get to elimination, the better surveillance we must have. Malaria does not respect borders, meaning the four eliminating countries cannot eliminate as long as high transmission remains within the region, and human migratory patterns facilitate parasite movement from more highly endemic countries. Therefore, new regional strategies are needed to support the surveillance and control efforts by the second line countries in order to reduce the reservoir of malaria parasites which have a potential for cross border spread of infections that could re-establish infection in the frontline four countries. As frontline countries progress towards malaria elimination, second-line countries are intensifying their malaria control efforts in order to achieve pre-elimination status.

The knowledge of malaria trends between countries will be one of the main factors influencing the success of malaria elimination. To facilitate the ease of information sharing, the E8 working with the consortium have developed a regional database, which will sit within the District Health Information System (DHIS 2), a system already familiar to many of the 8 countries. The regional database will not be a parallel system — no new malaria data elements or indicators will be collected. Rather several malaria data indicators already captured in countries will be shared amongst countries via the regional database. This is in-line with E8 country-level commitments to malaria data sharing in efforts to eliminate the disease. The more data we have consistently and accurately, the better we can plan and target relevant interventions that will drive the malaria burden in southern Africa down to zero.