Millions (of mosquitoes) at a time

Now that I have as many tagged entries about my one month trip to the States as I have about 10 months of professional life in Uganda, how about a work entry?

For anyone that doesn't get the title, I refer you to Saving lives, millions at a time for further explanation. I'm still in the business of overestimating the human impact of my work through idealistic slogans, but we've shaken things up a bit for my second year here. Whereas I used to split my time between HCP and AFFORD, I'm no longer working on AFFORD, am still with HCP, and have picked up two other USAID-funded projects: Stop Malaria, and Health Initiatives for the Private Sector (which would be called, yes, HIPS).

Stop Malaria is a newly awarded, 5-year project that just began in October. As such, we've been heavily immersed in project start-up activities....office set-up, hiring our local staff, developing our logo and letterhead and road sign, writing our annual workplan, determining our indicators and targets for our Performance Monitoring Plan, officially introducing the project to the National Malaria Control Program (NMCP) at the Ministry of Health, and embarking on our rapid district assessments with the District Health Officers (DHOs), District Malaria Focal Persons, and the in-charges at the hospitals and the health center IVs, for instance. We do not yet have our Chief of Party, the Deputy Chief of Party, an Admin Assistant, or several of those other crucial positions, which has turned the few of us that are on staff into the proverbial headless chickens.

Malaria, for the record, is the leading cause of morbidity and mortality in Uganda, accounting for up to 50% of outpatient visits, 20% of hospital admissions, and 14% of hospital deaths*. The malaria parasite is transmitted by that blasted female Anopheles mosquito, which typically feeds between the hours of 10pm and 5am. Contrary to popular belief, malaria-carrying mosquitoes do not buzz.

Malaria used to be easy to treat with chloroquine or SP, the two most common antimalarial drugs, but the malaria parasite has since developed resistance to both, and they are no longer effective. A new treatment policy is in place, but hasn't been very successful, given problems with drug supply, low provider adherence to the new protocol, and low public awareness of the new recommendations.

That said, Stop Malaria is designed to reduce malaria-related mortality by working closely with the National Malaria Control Program in three major areas:

Malaria prevention, e.g. increasing use of long lasting insecticide treated nets (LLINs), especially by children under five, pregnant women, and people living with HIV, who are most at risk of malaria given their low immunity, and increasing uptake of 2 or more doses of intermittent presumptive treatment (IPT) by pregnant women to prevent malaria in pregnancy.

Malaria treatment, e.g. strengthening the capacity of labs to implement parasitological diagnosis of malaria (as opposed to just treating everyone with a fever with antimalarials, which is in part responsible for the stock-outs), improving health worker's recognition of danger signs and ability to provide referrals/treatment for severe malaria, and assisting districts to roll out home-based management of fever (HBMF) with the new recommended treatment for malaria.

Strengthening the capacity of the NMCP, particularly in the areas of monitoring and evaluation, support supervision for the districts, and coordination of malaria partner activities.

In this first year, we're implementing Stop Malaria in 13 districts. By Year 5, we should be fully operational in 45 of Uganda's ~87 districts (new districts seem to form every other Thursday). Like most USAID-funded projects, Stop Malaria is a partnership between several organizations, in this case, CCP, Malaria Consortium, Community for Development Foundation Uganda (CDFU), Infectious Diseases Institute (IDI), and the Uganda Health Marketing Group (UHMG). Props if you recognize UHMG as the NGO created out of the AFFORD Health Marketing Initiative that I've worked with in various capacities over the last couple years.

My plan was to delve into HIPS and HCP in this entry, too, but I'm plumb tuckered out. Time to go tuck me in under my LLIN.

Stop, malaria!

*Source: President's Malaria Initiative FY 2008 Malaria Operational Plan