Interview with Karin Källander, Senior Research Advisor, Malaria Consortium

How is Malaria Consortium involved in humanitarian and development sectors? 

Malaria Consortium began as a malaria-focused non-profit organisation in 2003 and has grown to implement programmes across sub-Saharan Africa and southeast Asia. We believe efforts to control malaria can, and should, be linked with other similar or integrated approaches in public health interventions for greater impact on disease control and as a result, have expanded our remit to include community based health delivery to support the case management of other childhood diseases – pneumonia and diarrhoea, as well as management of malnutrition and control of neglected tropical diseases, including dengue. 

How is Malaria Consortium represented in East Africa?

Malaria Consortium’s presence in the East Africa region spans Uganda, Ethiopia and South Sudan. In Uganda, we work closely with the Ministry of Health to support malaria prevention and control interventions and the promotion of child and maternal health. In southern Ethiopia, we partner with both Federal and local health authorities to reduce the burden of malaria through improved diagnosis and case management, strengthening epidemic detection systems and by monitoring the changing epidemiology of the disease. Our work in South Sudan aims to improve access to prevention, diagnosis and treatment for malaria and includes integrated community case management (iCCM) and nutrition interventions for children under five, operational research and the treatment and mapping of neglected tropical diseases (NTDs). 

What are the key initiatives/programmes/projects being implemented in the region?

We are currently the largest implementer in Uganda of iCCM, an approach where community-based health workers are trained to identify, treat and refer complex cases of children with pneumonia, diarrhoea and malaria. Since 2010, our iCCM programme has resulted in a 40 percent increase in the proportion of children under five treated for malaria with artemisinin-combination therapies in areas where we work. Current activities build upon the lessons of previous iCCM programmes and aim to further reduce under-five deaths through a combination of routine iCCM and maternal and neonatal care interventions.

In 2013 to 2014, we worked with the Ugandan government to distribute over 22 million long-lasting insecticidal nets (LLINs) to achieve country-wide universal net coverage for the first time ever, reaching more than 34 million people. We are currently supporting the government on a second universal net campaign. In addition to prevention and treatment, we undertake extensive operational research, providing evidence of innovative approaches that can work at scale, including an economic evaluation on the cost of rolling out and sustaining iCCM, improving health worker performance and retention, and the use of mobile technology.

What does your role as Senior Research Advisor at Malaria Consortium entail?

I work with the technical directors to provide strategic and technical leadership to Malaria Consortium’s research portfolio, particularly in the areas of maternal, neonatal and child health (MNCH), mHealth and health systems strengthening in the Africa and Asia regions. My role also involves building internal capacity to further develop the organisation’s research portfolio through the securing of grants or funding, protocol design, quality assurance of implementation and dissemination of findings. I lead the organisations’ research group and work to develop, support and manage collaborations with research partners, stakeholder agencies and donors.

What initiatives/programmes/projects are you involved in?

I have extensive experience in operational research, design-, implementation-, management- and evaluation of programmes, health systems strengthening, health workforce development, quality of care assessment, health policy development, behaviour change and community-based care. My current projects include The Acute Respiratory Infection Diagnostic Aids (ARIDA) project, which evaluates community health workers' use of automated respiratory rate counting aids on children under five in Ethiopia and Nepal, the upSCALE project which evaluates the impact of a large scale digital health system strengthening platform in Mozambique and the Chest Indrawing study in Nigeria, which establish whether it is safe and feasible to treat children with symptoms of possible severe pneumonia at community level in Nigeria. 

Which are your main priorities for 2017/2018?

My main priorities are to ensure that the research projects that I lead are implemented with high quality and on time as per expected deliverables; to lead the internal research group and support research group members to ensure that technical assistance requests are met on time and that the deliverables are of high quality; to further the organisations’ work in Health Systems Efficiency and Effectiveness by generating funding for research in this field; to generate learning materials and publications from the organisations’ research projects for internal and external dissemination; and to develop my teams’ roles and build research capacity, including academic supervision of post graduate studies if embedded within specific research projects.

What will your presentaion/speaker panel at the Aid & Development Africa Summit address and why is it important for those attending to engage in this topic?

I will present the learnings and experiences from the early evaluation of upSCALE, a digital health platform for effective health systems, which is implemented in several provinces in Mozambique by the Ministry of Health, with technical support from Malaria Consortium and UNICEF. From 2009 to 2016, Malaria Consortium tested a number of interventions to improve the quality of care provided by community health workers in Mozambique, locally known as agentes polivalentes elementares (APEs), including a smartphone application introduced in Mozambique’s Inhambane province through the inSCALE project. Building from this success and in order to link APEs with the national health information system, Malaria Consortium worked in collaboration with the Ministry of Health and UNICEF to develop the upSCALE platform – a digital strategy to strengthen health systems and community health delivery. The platform collects real time data entered by APEs who deliver health services in the remote areas in which they live. The upSCALE platform is currently being implemented in the Mozambique provinces of Inhambane, Cabo Delgado and soon in Zambezia. The upSCALE platform is to be scaled up in all provinces to create a national mHealth system led by the Ministry of Health. By doing so, it will be the first country to scale up a digital health strategy to this extent.

Malaria Consortium believes that scientific and technological innovations are central to enhancing the outcomes of global health efforts. Effective digital health strategies can help governments manage malaria and disease control programmes better. In the countries we work in, we have explored areas where technology can play an important role, particularly to improve the motivation and supervision of community health workers, the quality of care provided, to provide effective diagnostic tools, and to strengthen surveillance and data management. Innovations in global health technology can make health care more affordable, accessible, and effective for all people and accelerate the pace at which life-saving interventions reach those in need. 

What trends and challenges do you see in health systems and health policy development in Africa?

One of the major trends we are seeing is increasing integration of health interventions, particularly in community-based primary healthcare programmes. Where mechanisms are already in place, for example for the community-based diagnosis and treatment of malaria, it can make sense to add complimentary components, such as treatment for NTDs, pneumonia, nutrition or maternal health. This can increase the impact and cost-effectiveness of interventions. However, integration brings new challenges. CHWs are increasingly being burdened with new tasks. Also there is limited research regarding the effectiveness of ever increasing integration. Finally, what integration involves is not always well defined, leading to inconsistencies and varying levels of expectation. 

What are your lessons learned related to tackling malaria and the development of health systems?

Malaria Consortium use malaria as an entry point for strengthening the health system in the countries where we operate. In highly endemic countries, reducing the burden of malaria is a necessary step to help over-stretched health systems operate properly – freeing up resources for other health needs. However we also operate in low burden countries, such as the pre-elimination countries of Thailand, Cambodia and Myanmar in South East Asia. Here we face the challenge of maintaining malaria on the political agenda even though the case load is now very low. However it is crucial that surveillance systems and diagnosis and treatment services are maintained – until we find every last case. We know from experience that malaria can resurge extremely quickly if efforts are reduced before the disease has been eliminated. In Myanmar, therefore, we have been retraining Malaria Volunteers to prevent, diagnose and treat other childhood illnesses, such as pneumonia and diarrhoea, and treat acute malnutrition. This has the double benefit of maintaining crucial malaria programmes, while also extending services for tackling the remaining health burdens facing remote rural communities. 

What is your impression of the upcoming Aid & Development Africa Summit 2018 so far?

It is going to be a very interesting mix of speakers, covering a wide and relevant mix of topics that are all key to the success of the Sustainable Development Goals.

Why is it important for you and Malaria Consortium to engage in such events?

Whilst Malaria Consortium has and develops capacity to lead programmes and research projects in many areas, it also promotes the collaboration with ministries of health and national authorities, academic and research institutions, other NGOs and implementing partners, communities, donors, and commercial organisations, to ensure the relevance, understand local norms and conditions, engage with the people who will eventually be using the research, and create opportunities to build capacity through training and skills practice. Collaborating and networking with others, partly through events such as the Aid & International Development Forum, is therefore key to our way of working.

To summarise, what is the key message or learning from your work that you’d like to share with the AIDF audience prior to the Summit?

Innovations in global health technology, and integration of digital strategies within current health systems can make health care more effective, available, and affordable and can increase the speed at which essential care interventions reach the people who need them. Now is a good time to start looking forward and question old norms, invest in innovative solutions, be open to change and modernise obsolete approaches. The result can potentially improve quality of lives and prevent millions of deaths around the world.

Karin Källander, PhD, Senior Research Advisor, Malaria Consortium will take part in a session on Mixed Technologies at the 3rd Aid & Development Africa Summit on 27-28 February 2018 at the Safari Park Hotel in Nairobi, Kenya.

For more information on Malaria Consortium, visit www.malariaconsortium.org. For more information on the Aid & Development Africa Summit, visit www.africa.aidforum.org or email Alina O'Keeffe, Head of Marketing, AIDF at marketing@aidforum.org

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