update on the high burden to high impact (hbhi) approach

Update on the High burden to high

impact (HBHI) approachMalaria Policy Advisory CommitteeGeneva, Switzerland14 May 2020

High Burden High Impact2

HBHI Approach

Effective Health System

Multisectoral response

Output Output Output Output

Po

litic

al w

ill

Str

ate

gic

in

form

atio

n

Be

tte

r g

uid

an

ce

Co

ord

ina

ted

re

spo

nse4 mutually

reinforcing response elements

I II III IV

OutcomeImplementation of prioritized operational plans derived from

evidence-informed national malaria strategic plans

Impact

Reduction in mortality & morbidity


Guiding principles for the HBHI approach

Highest burden countries1 are the focus of the first wave of the approach

1 11 countries with highest burden of malaria concentrate 70% of cases and deaths2 All of the 10 highest burden African countries reported increases in malaria cases over the previous year, ranging from an estimated 131,000 more cases in Cameroon to 1.3

million additional cases in Nigeria. Only India marked progress in reducing its disease burden, registering a 24% decrease compared to 2016.

Burkina Faso

Cameroon

DRC

Ghana

Mali

Mozambique

Niger

Nigeria

Uganda

Tanzania

India2

Better coordinated support from in-country and external partners paired with increased transparency to ensure efficient responses

Commitment from partners to

share and jointly analyse data

Support for enhanced domestic and international resource

mobilization

Country-owned, country-led approach, aligned with the GTS, SDGs, national health goals, strategies and priorities

Guiding principles


2019 2020

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Global Fund

applications

HBHI meeting

GF application

deadline

Activities

Preparation in progressNational high-level HBHI meeting

▪ Creation/Acceleration of a national malaria data repository

▪ Global Fund Missions▪ Malaria Programme Review (MPR)▪ Mid-term Reviews▪ Stratification, analysis▪ National Strategic Plans (NSPs)▪ Technical support on key areas identified based on

the four response elements

Country specific follow up activities

Uganda

Nigeria

Cameroun

Burkina Faso

Ghana

Mozambique

DRC

Niger Mali

TanzaniaIndia

Ethiopia

iCCM- HBHI meeting

Country-led HBHI meeting and follow-up activities

Nigeria

• reflect new paradigm shift in malaria control; not business as usual

• right mix of interventions based on local evidence and stratification

• link to health sector plan; contribute to health system strengthening


Pillar 1. Political will

PoliticalMalaria receiving high political attention and movement at country levelPartners have rallied behind the approach Political and advocacy mechanisms: Presidential initiatives, Malaria council,

etc▪ In some countries, focal persons for health at presidential level (Niger)

What remains:▪ Effective communication on malaria burden to ensure high level

engagement ▪ Translation of political will to domestic resources ▪ Subnational level and community engagement


Advocacy to keep political commitment and translate into

increased domestic resources

Mass Action Against Malaria (MAAM)

Sustaining the partners’ buying in

based on comparative

advantage

Uganda: Political will –Core findings and key action points

Ghana Burkina Faso Ethiopia, ICCM-HBHI


Pillar 2. Strategic use of information for action

▪ Malaria Repository Database (MDRB):– Bringing all data together to one hub at the NMCP

▪ Stratification:– Macro-stratification with modelled mix of interventions conducted in all

countries except Mali– Support MPRs and NSP: guided by stratification

▪ What remains: – Capacity building at national and subnational level for micro-

stratification and routine use of data


Pillar 3. Better guidance

Global: Self assessments are helping pick▪ areas currently lacking global guidance – SMC (epidemiological settings, age limits and types of

drug, etc)– Case management – private sector engagement

strategies▪ global guidance that require more clarity– Vector control: Simultaneous deployment of LLINs & IRS

vs single VC intervention,, Insecticide resistance and its impact

National level adaptation, dissemination and uptake:▪ Subnational: inadequate capacity and access to national

guidelines▪ Treatment fees and their impact on access▪ Larviciding: Its role and impact

Other challenges: ▪ Optimize interventions to reduce mortality (subnational

level)▪ Scale-up of iCCM


Pillar 4. Coordination

Structures/ mechanisms: – Existing dysfunctional mechanisms revitalized (Cameron, Ghana), – Thematic, RBM, Malaria Foundation for Res mob (Ghana)– Malaria Council, Parliamentarian Committee

Capacity building: – Suboptimal capacity at subnational level in terms of HR and knowledge,

resources, access to guidelines, supervision, etc.

M&E activities: – Programmes being empowered through strong use of data

Collaboration and partnership– Strong and empowered NMCPs have better in-country partner support and

coordination (Ghana, Uganda, Cameroun)


HBHI India

• Sustained reduction of malaria cases and deaths since 2015

• Key drivers of success: community-based interventions using ASHAs, support from Federal and State governments through National Health Mission (NHM) and Global Fund; better targeting of interventions based on stratification

• HBHI approach adapted in 4 high burden States (Chhattisgargh, Madya Pradesh, Jharkhand, West Bengal); strategic and operational plans drafted

RAJASTHAN

ORISSA

GUJARAT

MAHARASHTRA

MADHYA PRADESH

BIHAR

KARNATAKA

UTTAR PRADESH

JAMMU & KASHMIR

ASSAM

TAMIL NADU

TELANGANA

CHHATTISGARH

ANDHRA PRADESH

PUNJAB

JHARKHAND

WEST BENGAL

ARUNACHAL PR.

HARYANA

KERALA

UTTARAKHAND

HIMACHAL PRADESH

MANIPUR

MIZORAM

MEGHALAYANAGALAND

SIKKIM

GOA

A&N ISLANDS

D&N HAVELI

PONDICHERRY

LAKSHADWEEPN

EW

S

API - 2015<1

>1-2

>2-5

>5-10

>10 & Above

RAJASTHAN

ORISSA

GUJARAT

MAHARASHTRA

MADHYA PRADESH

BIHAR

KARNATAKA

UTTAR PRADESH

JAMMU & KASHMIR

ASSAM

TAMIL NADU

TELANGANA

ANDHRA PRADESH

PUNJAB

JHARKHAND

WEST BENGAL

ARUNACHAL PR.

HARYANA

KERALA

UTTARAKHAND

HIMACHAL PRADESH

MANIPUR

MIZORAM

SIKKIM

A&N ISLANDS

D&N HAVELI

PONDICHERRY

LAKSHADWEEPN

EW

S

API - 2018<1

>1-2

>2-5>5-10

>10 & Above


Challenges and Solutions

Anticipated challengesHBHI countries could face extreme difficulty in maintaining malaria services should theyexperience widespread COVID-19 transmission

• majority of them have community transmission• lockdownsdisruption of facility-based services«no treatment» or

«home/self treatment»• high burden rural communities: malaria and malnutrition could be deadlier

than COVID-19

Proposed solutions (Country-level responses)• Country level quick assessment and prioritization of vulnerability (subnational)• Quantification and pre-positioning of commodities and food to most

vulnerable populations • Coordination of partners’ support for harmonized and multi-faceted response• Engage national/local institutions to support countries to maintain malaria

services during COVID-19 pandemic and to strengthen national capacity


Key activities (April - December 2020)

• Advocacy and technical support for continuity of malaria services in the context of COVID-19 response

• Technical support to conduct MPR, update NSPs, develop GF funding requests, GF grant negotiations

• High level meetings in Mali, Nigeria and Tanzania postponed for post-COVID-19 pandemic

• Develop tracking tool for monitoring and for proactive response• Training workshop for NPO and Program Managers if the situation permits• Documentation and dissemination of best practices

In view of COVID-19 pandemic, GMP and AFRO:• continue to provide remote technical support • engage national institutions to support countries

update on the high burden to high impact (hbhi) approach

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