Fighting Malaria Through Innovative Training -- UPDATE

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Malawi , Nigeria , Sub-Saharan Africa , Topic: Intervention/Prevention , Uganda

[NOTE: This is an UPDATE to a case study initially published in 2009. Read the original case study for appropriate context.]

Since its inception in 2005, the Joint Uganda Malaria Program (JUMP) has become a model, both in the efficacy of its programs and the strengths of the partnership behind it. As of late 2011, those partners are the Accordia Global Health Foundation, ExxonMobil and the Infectious Diseases Institute (IDI) at Uganda’s Makerere University.

ExxonMobil has funded JUMP from the outset at $500,000 annually, as part of its global commitment to fighting malaria. “ExxonMobil’s 125-year business presence in Africa has forced us to face first-hand malaria’s devastating health and economic impact. Looking at the success of our own workplace malaria programs, guided by international and local best practices, we committed to help African countries meet their targets in eliminating malaria through effective programs and interventions,” said James M. Jones of ExxonMobil’s public and government affairs department. “JUMP is a great example of such a program. It promotes health and increases economic and social development—key elements for a successful and productive business climate.”

In context of other malaria initiatives, the company sees JUMP as unique in the breadth of its partnership. Jones added, “Making a demonstrable difference in reducing the burden of a disease like malaria in Africa requires all sectors—public, private, NGOs, academic—to play an appropriate role in building capacity among African health care workers.”

Accordia has also been a core partner in JUMP from the start, helping guide its growth from a fledgling initiative at IDI to combat malaria to its standing now as a health professional training model that can be applied to other diseases. Citing just one example, Kelly Willis, MBA, Accordia’s senior vice president for global health programs, said, “The approach adopted for malaria at IDI has directly influenced and shaped other IDI programs.”

IDI, a center of excellence in Uganda, continues to lead the implementation of JUMP’s innovative training courses, supported by Accordia, to build lasting capacity among health care workers of all types.

Measuring the Effectiveness of Training

To date, scant research has been done to gauge the effectiveness of the many approaches for improving health care service delivery in global health. To help address that gap, the Bill & Melinda Gates Foundation awarded Accordia a three-year, $12.5 million grant to lead the Integrated Infectious Disease Capacity-Building Evaluation (IDCAP).

Accordia is working on IDCAP in partnership with the Ugandan Ministry of Health, IDI and others to, first, create an optimal capacity-building program for integrated care and prevention of infectious disease, based on a core training curriculum and on-site support services, and, second, to evaluate that approach for its impact on clinical skills and patient health.

IDCAP builds on JUMP’s approach and WHO’s Integrated Management of Adult Illnesses program. IDCAP began in 2009 at 36 facilities in Uganda, training mid-level practitioners for tasks conventionally assigned to doctors and training non-professionals in less technical tasks—benefiting patients, nurses and mid-level practitioners in Uganda and potentially throughout Africa. Evaluation using patient-level outcomes collected from the facilities will help determine the most effective and cost-effective blend of training, enabling others to replicate it around the world.

Sustaining and Expanding a Successful Model

The JUMP initiative continues to add layers onto its initial activities. Accordia’s Willis notes that, while percentages vary by country, roughly half of malaria sufferers directly seek medication without visiting a medical professional. With that in mind, JUMP is training community health workers to conduct rapid diagnostic tests and deliver anti-malarial treatments, and also training private-sector pharmacists to better recognize malaria and understand differences between anti-malarial treatments.

Looking at month-to-month data on the training’s impact, Accordia found that ingrained clinical behaviors took time to change. Willis observed, “We found a need to conduct the training for longer than anticipated and to keep at it.”

The persistence is paying off. An economic study (at press time, being prepared for publication) has demonstrated the cost-effectiveness of JUMP’s training interventions and the number of lives saved. Accordia found that, in comparison to other malaria interventions—such as bed net distribution—which typically cost many hundreds of dollars per life saved, the JUMP training activities reduced cost per life saved to under $200. This remarkable finding is expected to help guide policy-makers’ decision-making to ensure malaria prevention funds are spent in the most effective manner.       

“We’re delighted that our work with Accordia and IDI in the JUMP program has shown clearly that training health care professionals in Africa and improving the skills of clinicians is an effective model to build a sustainable system of improved treatment for people who suffer from malaria,” said ExxonMobil’s Jones. “We never have and we never would underestimate the power of Africans to manage their health care needs.”

Indeed, Accordia is seeing progressive circles of interest in adopting JUMP’s approach. Discussions continue outside Uganda, with national malaria programs in Malawi and Nigeria for instance, to create programs modeled on JUMP.

Further, the U.S. Agency for International Development and the President’s Malaria Initiative are translating JUMP’s concepts to a larger scale. Dr. Umaru Ssekabira of IDI noted, “The best practices from the JUMP collaboration have been scaled-up using funding from the Stop Malaria Project, a USAID-funded five-year project ending in 2013, and from IDCAP.” The lessons learned from JUMP have been instrumental in training the staff of health centers in 13 districts of Uganda to be more proactive in protecting these vulnerable populations from malaria. The Stop Malaria Project seeks to obtain 85 percent coverage of children under five years of age, pregnant women, and people living with HIV/AIDS using preventive and therapeutic interventions.

Looking ahead, the JUMP partners continue to identify further opportunities to use the approach and lessons learned from JUMP to address even more of Uganda’s most challenging health issues. 

By Heather Jameson

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