Tracking the fight against malaria: dealing with data
That feeling of relief when your GPS is instantly able to find a new route to your destination, even if you made a wrong turn — again — is priceless. Data has become omnipresent in our daily lives, seamlessly integrated into our day-to-day activities. We are willing to pay extra to live stream sports events, download movies during flights, and even request our next meal for delivery. But, despite all of this connectivity, gaps remain.
Progress in data connectivity and utilization has been uneven — while consumer-facing companies have been quick to integrate data into their processes and offerings, health systems have not enjoyed the same acceleration. According to the new World Malaria Report, the data indicates that reductions in malaria cases have stalled after several years of decline globally. Dr. Tedros said it very clearly at the May 2018’s World Health Assembly: we need to drive impact through the strategic use of information.
But, what does that look like?
The Global Technical Strategy for Malaria 2016–2030 calls for the transformation of malaria surveillance into a core intervention both in malaria-endemic countries and in those countries that have eliminated malaria but remain susceptible to re-establishment of transmission. Surveillance systems should comprise myriad tools and resources, including the people, procedures, tools and structures necessary to generate information on malaria cases and deaths. For all public health services, the most effective surveillance systems include the adequate allocation of resources to planning, implementing, monitoring, and evaluation.
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Regrettably, according to the World Malaria Report, malaria surveillance is weakest in countries with the highest burden making accurate assessment and intervention planning even more difficult. On average, 60 percent of countries report adequate malaria surveillance. However, these numbers are likely to be overestimated in several countries due to unreliable measurements. And, compounding the issue, on the extreme end, many of the countries with lower reporting rates also demonstrate some of the lowest confirmation and treatment seeking rates.
So, what are we doing about it?
Initially, we must identify key data gaps. Data from hotspot mapping is being used to help pinpoint areas of most need. One study found that human movement played a significant role in the risk of hotspot membership. Another determined that parasitic prevalence in the blood was predictive of infection a year later using geospatial models. This implies that better understanding of human dynamics could help mitigate malaria. With this in mind, the Global Fund has also provided further funding to support surveillance systems through its catalytic funding mechanisms. They have designated $20 million alone for project with the objectives to: strengthen health information systems and surveillance; enable country systems to collect, report on and use data; support program impact and thematic evaluations and epidemiological reviews. Additionally, the United States President’s Malaria Initiative has included improving countries’ capacity to collect and use information as one of its five core areas of strategic focus, and it has since scaled up funding support in this area.
While these efforts from public and multilateral partners are encouraging, the private sector’s support will ultimately be critical: private sector partners can assist in facilitating and informing reporting efforts and smoothing referral and training linkages between the public and private sectors. Additionally, the private sector can invest in data management and tracking systems to make supply chains more efficient and more secure, ensuring increased coverage of parasitological testing and the removal of non-artemisinin therapies from the marketplace. Private sector providers can also be organized and better engaged through social franchising, effective regulation, professional organizations and government outreach. This multifaceted approach is endorsed by the WHO in partnership with RBM, which offers its new country-driven “high burden to high impact” approach to get the global malaria response back on track.
The current climate of goodwill between public and private sectors offers an opportunity that should not be missed; it can be used not only to foster new partnership but to ensure that partnership is truly in the interests of international public health. Engaging private sector stakeholders early and consistently in the development of malaria elimination including the work of data gathering and surveillance will lead to successfully decreasing its burden. After all, knowledge and understanding are the foundations from where opportunities for interventions can flow. Together, we can do it.
