The Presidents Malaria Initiative:

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• The Presidents Malaria Initiative
• Opportunities for Eliminating Malaria in
  Pregnancy

• Scott Filler, MD, DTMH
• Malaria Branch
• Presidents Malaria Initiative
• Centers for Disease Control and Prevention
• Atlanta, GA, USA
• smf5_at_cdc.gov

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Presidents Malaria Initiative

• 30 June 2005, President Bush announced a new
  5-year, 1.2 billion initiative to rapidly scale
  up malaria control interventions in high burden
  countries in Africa
• Challenged other donors to increase their funding

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Funding Levels and Coverage
Possible plus-up of 25 million
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PMI Goal and Targets

• Goal To reduce malaria-related mortality by 50
  in 15 selected countries
• Targets To achieve 85 coverage of vulnerable
  groups with four key interventions

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PMI Interventions

• Artemisinin-based combination therapy (ACTs)
• Insecticide-treated bed nets (ITNs)
• Intermittent preventive treatment in pregnancy
  (IPTp)
• Indoor residual spraying (IRS) (where appropriate)

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Country Selection Criteria

• High burden of malaria
• National leadership / political will and
  commitment of host government to control malaria
• Willingness to partner with US government
• National malaria control policies and practices
  consistent with WHO recommendations

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Countries Selected
First Year (FY06) Angola, Tanzania, Uganda
Third Year (FY08) Benin, Ethiopia, Ghana,
Kenya, Liberia, Madagascar, Mali, Zambia
Second Year (FY07) Malawi, Mozambique, Rwanda,
Senegal
Ethiopia limited to Oromia Region
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PMI Strategy and Approach

• Commitment to work closely with host government
  and to support activities contained in national
  malaria control plan
• Close coordination with international and
  in-country partners (WHO, GFATM, PEPFAR) to
  ensure efforts are complementary
• Support for an integrated approach to malaria
  control and strengthening national capacity
• Overall impact will include the contributions
  from other programs and donors

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What will PMI fund? (1)

• Commodities
• Antimalarial drugs for treatment of uncomplicated
  malaria (ACTs) and for severe malaria
• Sulfadoxine-pyrimethamine (SP) for IPTp
• ITNs, especially long-lasting ITNs (LLINs)
• Equipment and supplies for IRS

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What will PMI fund? (2)

• Technical support to strengthen national malaria
  control capabilities and ensure effective program
  implementation
• Monitoring and evaluation

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PMI Challenges

• USAID under close scrutiny
• Keep footprint small (i.e. not be seen as
  staffing-up using PMI budget)
• Focus on provision of commodities
• Focus on IRS (despite expense and lack of data on
  how best to use in combination with ITNs)
• No ability to address poor human resource
  capacity in health care system, or inadequate
  health care infrastructure
• Insufficient resources available for operational
  research

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Malaria In Pregnancy Beyond SP

• Train, support and supervise front line health
  workers
• Promote ANC attendance
• Provide insecticide-treated mosquito nets
• Prompt diagnosis and treatment

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Malaria In PregnancyContinuing needs

• First ANC visits still occur late, and many women
  do not make recommended number of visits
• Service integration remains an elusive goal
• Quality of ANC services is variable, and many
  recommended services are not available (e.g.
  routine supply of iron/folate)

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PMI from 60 to 85

• Initial gains will be relatively easy
• Increasing supply of commodities and initial
  efforts at training will result in rapid
  expansion of services
• Increasing coverage from 60 to 85 will be much
  harder commodities will not be the limiting
  factor
• Behavior Change
• Demand Creation
• Community Ownership
• Sustainability of PMI will also depend on these
  same factors

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PMI Malaria In Pregnancy EffortsUganda Example

• Revise national SP IPTp guidelines
• Integrate supportive supervision at the district
  level to ANC health workers
• Provide safe water and cups
• Support community level awareness and behavior
  change
• Provide ANC registers

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Harmonization

• Major international partners
• Global Fund
• World Bank
• Multiple other bilateral and multilateral
  organizations
• Principles for coordination
• Monitoring and evaluation
• Unified plan
• Stakeholders forum