I. EXECUTIVE SUMMARY
When it was launched in 2005, the goal of the President’s Malaria Initiative (PMI) was to reduce malaria-related mortality by 50 percent across 15 high-burden countries in sub-Saharan Africa through a rapid scale-up of four proven and highly effective malaria prevention and treatment measures: insecticide-treated mosquito nets (ITNs); indoor residual spraying (IRS); accurate diagnosis and prompt treatment with artemisinin-based combination therapies (ACTs); and intermittent preventive treatment of pregnant women (IPTp). With the passage of the Tom Lantos and Henry J. Hyde Global Leadership against HIV/AIDS, Tuberculosis, and Malaria Act in 2008, PMI developed a U.S. Government Malaria Strategy for 2009-2014. This strategy included a long-term vision for malaria control in which sustained high coverage with malaria prevention and treatment interventions would progressively lead to malariafree zones in Africa, with the ultimate goal of worldwide malaria eradication by 2040-2050. Consistent with this strategy and the increase in annual appropriations supporting PMI, four new sub-Saharan African countries and one regional program in the Greater Mekong Subregion of Southeast Asia were added in 2011. The contributions of PMI, together with those of other partners, have led to dramatic improvements in the coverage of malaria control interventions in PMI-supported countries, and all 15 original countries have documented substantial declines in all-cause mortality rates among children under five years of age.
In 2015, PMI launched its next six-year strategy, setting forth a bold and ambitious goal and objectives.
The PMI Strategy for 2015-2020 takes into account the progress over the past decade and the new challenges that have arisen. 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 ending extreme poverty. It is also in line with the goals articulated in the RBM Partnership’s second-generation global malaria action plan, Action and Investment to defeat Malaria 2016-2030: for a Malaria-Free World and the World Health Organization’s updated Global Technical Strategy: 2016-2030. Under the PMI Strategy 2015-2020, the U.S. Government’s goal is to work with PMI-supported countries and partners to further reduce malaria deaths and substantially decrease malaria morbidity, towards the long-term goal of elimination.
In 2017, consistent with an increase in annual appropriations, PMI again launched new country programs in Cameroon, Côte d'Ivoire, Niger, and Sierra Leone, and expanded an existing program in Burkina Faso to PMI focus country status. With the addition of these new focus countries, PMI now has programs in 24 countries in sub-Saharan Africa, in addition to two bilateral programs and targeted support in the Greater Mekong Subregion in Asia.
Burkina Faso began implementation as a PMI focus country in FY 2017.
This FY 2019 Malaria Operational Plan presents a detailed implementation plan for Burkina Faso, based on the strategies of PMI and the National Malaria Control Program (NMCP). It was developed in consultation with the NMCP and with the participation of national and international partners involved in malaria prevention and control in the country. The activities that PMI is proposing to support fit in well with the national malaria control strategy and plan and build on investments made by PMI and other partners to improve and expand malaria-related services, including malaria grants from the Global Fund to Fight AIDS, Tuberculosis, and Malaria. This document briefly reviews the current status of malaria control policies and interventions in Burkina Faso, describes progress to date, identifies challenges and unmet needs to achieving the targets of the NMCP and PMI, and provides a description of activities that are planned with FY 2019 funding.
The proposed FY 2019 PMI budget for Burkina Faso is $23 million. PMI will support the following intervention areas with these funds:
Entomologic monitoring and insecticide resistance management: Burkina Faso has strong entomological capacity and history of malaria vector research including insecticide resistance monitoring. Resistance to DDT and pyrethroids is widespread and reduced susceptibility to bendiocarb has been detected in two sites. PMI plans to support monitoring at entomological sentinel sites to assess species composition, density, behavior, and infection rates; insecticide susceptibility testing; and IRS quality and residual efficacy of insecticides. In addition, PMI will assist the country to implement a comprehensive plan for resistance monitoring.
ITNs: The national strategy for Burkina Faso uses ITNs as the principal tool for malaria prevention, and employs three approaches for ensuring that ITNs are available to the entire population: free distribution of ITNs via nationwide campaigns, free distribution of ITNs through routine antenatal care and expanded programs on immunization at all public health facilities, and the sale of ITNs by the private sector. Burkina Faso has benefitted from three mass campaigns in 2011, 2013, and 2016, and will benefit from another in 2019. With FY 2019 funds, PMI will provide technical assistance for this mass campaign as well 120,000 ITNs for the routine distribution system. With FY 2019 funds, PMI will continue to conduct durability monitoring on nets distributed during the 2019 campaign.
IRS: Burkina Faso’s national strategy includes IRS, along with ITNs and larval source management, as vector control interventions to prevent malaria. USAID supported a pilot IRS program in Diebougou District from 2010 to 2012, covering around 35,000 structures and protecting approximately 115,000 people annually. However, aside from this pilot, the Government of Burkina Faso has not been able to secure additional resources to support IRS. FY 2017 funding restarted IRS in Burkina Faso in three districts. With FY 2019 funds, PMI will continue to support IRS in three to four high-burden districts with long-lasting non-pyrethroid insecticides, in an effort to mitigate resistance and drive down the burden of malaria.
Malaria in pregnancy: All pregnant women in Burkina Faso benefit from free antenatal care services, including prevention and treatment of malaria, with guidelines stating that at least three doses of sulfadoxine-pyrimethamine be given during pregnancy, along with a free ITN. An operational research study on the delivery of sulfadoxine-pyrimethamine to pregnant women by community health workers (CHWs) is underway. Depending on the results of this pilot, PMI plans to fund the rollout of this intervention with FY 2019 funds. Additionally, PMI plans to continue funding training and supervision of malaria in pregnancy activities as part of the integrated malaria case management training package.
Seasonal malaria chemoprevention: The NMCP’s strategy is to provide seasonal malaria chemoprevention for children 3-59 months of age across the country. USAID malaria funds have supported seasonal malaria chemoprevention implementation in two districts in 2017 and logistics support for a national campaign. For the 2018 campaign, PMI supported training-of-trainers, purchased non-medical consumables, and is currently training stakeholders at the district level. In FY 2019, PMI will support seasonal malaria chemoprevention activities for 417,555 children 3-59 months of age.
Case management: PMI supports Burkina Faso’s goal of testing 100 percent of suspected cases and correctly treating 100 percent of confirmed cases of malaria with an appropriate antimalarial at all levels of the health system. Burkina Faso, along with partners, is rolling out a nationwide CHW program, with two CHWs per village who are responsible for a wide suite of activities, including malaria case management. With FY 2019 funds, PMI will support the training and supervision of CHWs and health workers in malaria case management. PMI will also procure RDTs, ACTs, and drugs for severe malaria treatment. PMI will also support the expansion of rectal artesunate into districts in the north where malaria mortality is highest. Finally, PMI will fund a therapeutic efficacy study as well as send a laboratory technician to train in Atlanta through the PARMA network.
Social and behavior change communication: Part of the NMCP strategy emphasizes the key areas of advocacy, social mobilization, and behavior change communication, and serves as a guideline for all malaria partners in Burkina Faso. A new national communications strategy for 2016-2020 was finalized in February 2017 and includes seasonal malaria chemoprevention, IPTp, and the administration of prereferral rectal artesunate at the community level. PMI and USAID malaria funds have supported a range of social and behavior change communication activities in Burkina Faso to increase the uptake of malaria interventions and contribute to reductions in malaria morbidity and mortality. In FY 2019, PMI plans to conduct a malaria behavior survey to provide data on prevalence and determinants of malaria behavioral outcomes. PMI also plans to work with the NMCP to focus on tailoring messages to address barriers to preventive behaviors.
Surveillance, monitoring, and evaluation: PMI will work with NMCP to strengthen the quality of malaria data and improve data use at all levels. To that end, PMI will support periodic data review activities at the district level to allow health facility and district staff to meet and jointly analyze malaria data collected using the health management information system.
Operational research: PMI does not have plans to support operational research in Burkina Faso with FY 2019 funds. Other health systems strengthening: Health systems strengthening is integral to the success of malaria programming in Burkina Faso. PMI works in close collaboration with the NMCP, Ministry of Health, Global Fund, and other malaria donors to ensure collaborative and coordinated support for sustainable systems and national guidelines that serve as a platform for successful malaria interventions. Together, PMI and the Global Fund supported the 2017/2018 malaria indicator survey. Additionally, PMI provides support to supply chain strengthening and forecasting, health worker training, and capacity building for the NMCP. PMI plans to continue to support the NMCP through courses and learning opportunities as well as training national staff in the advanced regional Field Epidemiology Training Program.