Date Published: October 5, 2017
Publisher: Public Library of Science
Author(s): Andrew A. Lover, Kelly E. Harvard, Alistair E. Lindawson, Cara Smith Gueye, Rima Shretta, Roly Gosling, Richard Feachem
Abstract: Andrew Lover and colleagues discuss regional malaria initiatives, the strengths and challenges.
Partial Text: Well-coordinated efforts are needed to prevent the flow of malaria parasites across international borders, to find solutions for tackling malaria in the final stages of malaria elimination, and to ensure political and financial support once malaria becomes a comparatively rare disease . Regional approaches to malaria elimination and subsequent eradication provide unique solutions to these key challenges (Box 1).
Among the 10 RIs reviewed here (Table 1), a number of key activities came to light (Box 2). Most RIs prioritize building a region-specific evidence base to better inform national policies. Some initiatives, such as the Asia Pacific Malaria Elimination Network (APMEN) sponsor operational research based on individual country needs (APMEN has subsequently transitioned into a secretariat within the Asia Pacific Leaders Malaria Alliance (APLMA) with major changes expected in 2017–2018). Others, like the Amazon Malaria Initiative (AMI), partnering with the Amazon Network for the Surveillance of Antimalarial Drug Resistance (RAVREDA), monitor drug efficacy using standardized protocols throughout the Amazon Basin and Central America. These initiatives all focus on providing local answers to local problems; for example, the AMI developed entomological guidance for the unique malaria vectors within the region .
One demonstration of the importance of RIs is in the sharing of epidemiological data and subsequent coordinated responses (Box 3). However, challenges remain in creating regional databases due to sensitivities over data sharing. To address this issue, increasing human resources within programs to support data sharing (as in the E8), increasing financing to help target high-risk groups (as in the RAI and E8), plus providing additional financing for new activities in areas identified as important through a regional database (MOSASWA) may be effective.
RIs must be actively designed and managed to ensure they are well aligned with the partnership’s aims. Once an RI has well-delineated goals, several components should be considered to operationalize the partnership (Table 3).
Institutional donors and foundations are generally not well structured to support the development, implementation, or monitoring of regional grants, and challenges with grant-writing materials and project administration have been highlighted before . A review of challenges for RIs across all 3 Global Fund disease areas (HIV, tuberculosis [TB], and malaria) concluded that while there has been some progress in streamlining application materials, important barriers remain in design of grant materials, points of contact, and cooperation between country coordinating mechanisms (CCMs) and national programs .
While a comprehensive evidence review was undertaken for this policy forum, it is not without limitations. Many documents were unindexed “grey” literature, and documentation from the 10 identified RIs, or information related to other initiatives, may have been overlooked. The second major gap is a lack of budgetary information for any of the RIs examined—the costs associated with RI incorporation and management has not been reported in publicly available documentation. This gap could hamper budget discussions for new initiatives, and addressing it should be a high priority for all current RIs.
RIs have an important role to play in the malaria elimination landscape but require careful design, implementation, and evaluation to ensure alignment with outcomes. In particular, efforts must be made to assist new partnerships in setting up impactful and sustainable RIs through the design, financing, and evaluation stages. The current leader in this area is the Global Fund, which is financing several RIs, namely E8, EMMIE, MOSASWA, and RAI. The APLMA/APMEN co-secretariat is funded through the Australian Government and the Bill & Melinda Gates Foundation and is attempting to attract other donors who traditionally fund bilateral partnerships. Funders can lead and support the systematic changes necessary to better incorporate RIs into the existing aid architecture by improving guidelines for grant proposal and grant management processes and by commissioning research on suitable indicators. Impact may be easier to demonstrate where RIs can directly invest in targeted interventions, as compared to impact assessment of RIs focused on advocacy and data sharing. Finally, existing RIs must provide evidence for their successes in coordinating multicountry partnerships for malaria elimination to ensure both their own sustainability and further investments in the future.