J.3_U.S._Presidents_Malaria_Initiative.pdf

U.S. President’s Malaria Initiative:

Liberia scale-up plan for nationwide coverage

Introduction

• In 2008, Liberia became a PMI country to rapidly scale up national coverage of three of the four priority interventions: artemisinin-based combination therapy (ACT), intermittent preventive treatment for malaria in pregnancy (IPTp), and insecticide-treated mosquito nets (ITNs). Liberia briefly supported indoor spraying (IRS) with residual insecticides but, due primarily to cost, discontinued this support.

• In 2012-13, the Liberia Mission, including PMI, shifted focus of Malaria Case Management, IPTp, HMIS & SBCC to three USAID-focus counties (Bong, Lofa, Nimba) but continued to provide nationwide support for malaria commodities, ITNs, and national malaria indicator surveys.

• In October 2017, PMI/Liberia began scaling-up interventions in response to limited national progress in malaria reduction.

• By October 2018, PMI in collaboration with the World Bank, will provide nationwide support to all the 15 counties of Liberia.

• PMI will continue to support population-based household surveys and routine data collection and will continue to adapt its program based on new information.

October 2017: PMI/Liberia scaled-up malaria case management and IPTp up to 8 Counties FARA & PACS in 3 counties: Bong, Lofa, Nimba MCSP-EMS in 5 counties: Gbarpolu, Grand Cape Mount, Sinoe, Grand Gedeh, River Gee

Jan -2019: PMI/Liberia & WB will support nationwide malaria case management and IPTp FARA (plus MCSP-EMS TA) in 6 Counties: Bong, Lofa, Nimba, Grand Cape Mount, Grand Gedeh, River Gee, PACS: iCCM in 3 counties (Bong, Lofa, Nimba), SBCC nationwide MCSP-EMS in 6 counties: Margibi, Grand Bassa, Bomi, Montserrado, Grand Kru, Maryland plus TA to the 6 FARA counties WB in 3 counties: Sinoe, Gbarpolu, River Cess

October 2018: PMI/Liberia & WB to scale up malaria case management and IPTp to reach all 15 counties (nation-wide)

FARA (plus MCSP-EMS TA) & PACS in 3 counties: Bong, Lofa, Nimba

MCSP-EMS in 8 counties: Bomi, Montserrado, Margibi, Grand Bassa, Grand Kru, Maryland, Grand Cape Mount, Grand Gedeh, River Gee plus TA to the 3 FARA counties

WB in 3 counties: Sinoe, Gbarpolu and River Cess

2012-2017: PMI/Liberia scaled down direct support for case management and IPTp service delivery to 3 counties to align with CDCS (March 2013-June 2019) Mechanisms: FARA & PACS: 3 counties: Bong, Lofa, Nimba with CSH Activity TA (2015-17)

July -2019: PMI/Liberia & WB support 15 counties; FARA Scales up to 8 counties FARA in 8 counties: Bong, Lofa, Nimba, Grand Cape Mount, Grand Gedeh, River Gee, Margibi, Grand Bassa TBD/HSS Bilateral in 4 counties: Bomi, Montserrado, Grand Kru, Maryland plus TA to all 8 FARA counties WB in 3 counties: Sinoe, Gbarpolu, River Cess

2008-2011: PMI/Liberia provided nation-wide support for malaria case management and Intermittent Preventive Treatment in pregnancy (IPTp) core service delivery interventions plus Health Management Information system and social and behavior change communication (SBCC) , through IMaD, MalariaCare, and RBHS

Milestones for PMI/Liberia support: Malaria Case Management, IPTp, SM&E, & SBCC

2012-Sept 2017: PMI/Liberia scaled down malaria case management, IPTp, SBCC service delivery to three counties

In 2012 PMI/Liberia scaled down to 3 counties of Bong, Lofa, Nimba, to align with Health Office and Mission CDCS (March 2013-June 2019).

Population covered: 1,351,447 (31% of 2017 total population)

Mechanisms:

● FARA provided service delivery for malaria case management and IPTp in the 3 counties

● CSH provided TA to FARA in the 3 counties

● PACS supported the 3 counties with iCCM and SBCC

Oct 2017-Sept 2018: PMI/Liberia scaled up Case Management & IPTp support to five additional counties

Oct 2017, PMI/Liberia scaled up malaria case management and MiP service delivery to 8 counties Population covered: 1,987,745 (45% of 2017 total population)

Mechanisms:

● FARA in 3 counties: Lofa, Bong, Nimba (CSH TA until June 2018)

● MCSP-EMS in 5 counties:

Gbarpolu, Grand Cape Mount, Grand Gedeh, Sinoe, River Gee

● PACS continued with iCCM and SBCC in the 3 counties

October 2018- Jan 2019: PMI/Liberia & World Bank (WB) will scale up Case Management, IPTp, & SBCC to all 15 counties (nationwide)

By October 2018: PMI/Liberia & WB will scale-up support to all 15 Counties (PMI 12, WB 3)

• PMI in 11 counties. Population covered 4,144,223 (93% of 2018 projected population)

• FARA (plus MCSP-EMS TA) in 3 counties: Bong, Lofa, Nimba

• MCSP-EMS in 9 counties: Bomi, Montserrado, Margibi, Grand Bassa, Grand Kru, Maryland, Grand Cape Mount, Grand Gedeh, and River Gee plus TA to the 3 FARA counties

• PACS: to continue with iCCM in original 3 counties and scale up SBCC nationwide

• WB in 3 counties: Sinoe, Gbarpolu and River Cess. Population covered 331,200 (7% of 2018 projected population)

January 2019 Sept 2019: PMI/Liberia & WB will support nation-wide coverage for Case Management, IPTp, SM&E, & SBCC

By January 2019, PMI/Liberia & WB will support malaria case management, MiP, SM&E, SBCC to all 15 counties (nation-wide), as follows:

• PMI in 11 Counties. Population covered 4,231,252 (93% of 2019 projected population)

○ FARA (plus MCSP-EMS TA) in 6 counties:

Bong, Lofa, Nimba, Grand Cape Mount, Grand Gedeh, & River Gee

○ MCSP-EMS in 6 counties: Margibi, Grand Bassa, Bomi, Montserrado, Grand Kru, & Maryland plus TA to the 6 FARA counties

○ PACS: to continue with iCCM in original 3 counties and scale up SBCC nationwide

• WB in 3 counties: Sinoe, Gbarpolu and River Cess. Population covered 338,154 (7% of 2019 projected population)

July 2019 and beyond: PMI/Liberia & WB will continue support for Case Management, MiP, SM&E, SBCC to all 15 counties (Nationwide)

By mid -2019: PMI/Liberia & WB will support all 15 counties of Liberia

• PMI in 12 Counties. Population covered 4,144,223

(93% of 2018 projected population)

• FARA II will support 8 Counties: Bong, Lofa, Nimba, Grand Cape Mount, Grand Gedeh, River Gee, Margibi, Grand Bassa

• TBD/HSS Bilateral will take over from MCSP 4 counties: Bomi, Montserrado, Grand Kru, and Maryland plus TA to the 8 FARA counties

• PACS: to continue with iCCM in original 3 counties and scale up SBCC nationwide

• World Bank in 3 counties: Sinoe, Gbarpolu, River Cess. Population covered 338,154 (7% of 2019 projected population)

Other Donor support and Opportunities

Global Fund support for commodities, training, HSS, and iCCM:

• Supporting integrated community case management (iCCM) for malaria, pneumonia and diarrhea in

4 counties and SBCC in : Lofa, Nimba, Bomi and Margibi

• Contributing to procuring malaria commodities (LLINs, ACTs) for Liberia

• Partially funding MOH and NMCP for training and supportive supervision and HMIS, and electronic Logistics management information system

WHO contributes to ACT therapeutic efficacy monitoring and provides policy and strategic guidance to NMCP

Various donors support iCCM in all counties except rural Montserrado:

• USAID through PACS: Bong, part of Lofa, part of Nimba

• Global Fund through Plan Liberia: Bomi, Margibi, part of Lofa and part of Nimba

• World Bank through UNICEF and CHTs: Grand Kru, Grand Gedeh, River Gee, Gbapolu, Grand Cape Mount, Sinoe, and Maryland

• Private funding through Last Mile Health : Grand Bassa and River Cess

Integrated Community Case Management Coverage by Donor/Implementer

Source: Liberia NMCP presentation at MOP

FY 19 meeting, May 2018

Threats and Risk of the Scale up plan

Success is contingent on the following assumptions:

• Continued availability and access of malaria commodities (e.g. mRDT, malaria drugs, ITNs)

• Continued availability and adherence to the national guidelines at health facilities

• Government of Liberia will continue to pay salaries of health workers to fully implement highly effective malaria interventions

• Donors contributing to malaria prevention and control in Liberia will continue their investment at the current or increased funding level

PMI scale up monitoring in Liberia

• The PMI Team and the AOR/Activity Managers will lead the monitoring of the scale-up plan and will provide regular updates to the Health Office Director, the Mission Director, and PMI senior leadership

• Some of the indicators PMI/Liberia will use to monitor the effectiveness and progress of the implementation of the scale up plan include:

i. Number of health workers trained in malaria case management, IPTp, SBCC, SM&E/HMIS (disaggregated by type of training, sex, county, cadre)

ii. Number of and proportion of suspect malaria cases tested with RDTs or microscopy (malaria test rate)

iii. The proportion of pregnant women given ITP1, IPTp2, IPTp3+

iv. IPTp1-IPTp3 drop out rates

v. Number and proportion of health facilities reporting, on a timely manner in HMIS and DHIS2

vi. will be some of the indicators to monitor the effectiveness and progress of the scale up plan

• The Health Office will conduct a SBCC assessment in 2019 to inform the scale-up plan

• The Health Office will conduct an end-line evaluation of the FARA program in Oct-Dec 2019 to assess the effectiveness of the scale up plan and inform the service delivery for future designs

• PMI/Liberia will use the mid-year review and MOP planning process to assess progress and reevaluate assumptions