20 Apr Three Questions with Dr. Tinah Atcha-Oubou: Responding to malaria control challenges in Togo
Dr. Tinah Atcha-Oubou is the coordinating director for the National Malaria Control Program (NMCP) in Togo. HRH2030’s Capacity Building for Malaria activity supports countries such as Togo to achieve their malaria control and elimination goals.
Question 1: Tell us about the malaria situation in Togo. What are your program’s biggest challenges in the fight against malaria?
Malaria is the leading cause of morbidity and mortality in Togo and the entire Togolese population is at risk, however children under 5 years of age and pregnant women are the most vulnerable. Since the launch of the Roll Back Malaria initiative in 1998, Togo has developed and implemented National Strategic Plans (NSP) to strengthen the fight against malaria; the current NSP covering the 2017-2023 period. With support its partners and the commitment of the Togolese government, the Togolese NMCP has made tremendous progress in scaling up its antimalarial interventions and implementing them on a universal access basis. The achieved results, although still below expectations, give hope. According to national surveys, parasite prevalence among children aged 6-59 months fell from 36% in 2013 data from the Enquète Démographique et de Santé Togo (EDST 2013-2014) to 28% in 2017 Malaria Indicator Survey (MIS 2017); and per the 2016 World Malaria Report, malaria incidence declined between 20 and 40% between 2000 and 2015, and mortality has declined by more than 40% over the same period. Although we have made progress in malaria control, Togo still faces challenges with regards to insecticide resistance vectors; malaria related research and development; resource mobilization and organizational governance, increasing malaria control ownership in local communities, and implementing complementary strategies, like larval control and indoor spraying.
Question 2: Partnering with HRH2030’s Capacity Building for Malaria activity, and in coordination with the U. S. President’s Malaria Initiative, you’ve been working since 2018 to improve the effectiveness and efficiency of Global Fund grant implementation, contributing to the shared goal of reducing malaria related morbidity and mortality. Tell us about the progress you have made over the last 3 years?
The Togolese NMCP has been in partnership with HRH2030-CBM program since 2018, through the support of Dr. Jean-Emmanuel Julo-Reminiac, a Long Term Technical Advisor (LTTA) embedded within the NMCP to support our capacity-building needs. CBM’s technical assistance is based on a self-assessment of the NMCP’s capacity which identified the areas in which we needed support and enabled the CBM program to create a capacity-strengthening plan to improve outcomes. HRH2030-CBM also initiated and supported an NMCP organizational capacity assessment, which identified organizational and managerial bottlenecks within the organization. The results helped the NMCP to respond to the identified challenges and implement more efficient organizational management measures. As a result of this collaboration, the NMCP has demonstrated improved agility when implementing Global Fund grant-financed activities and improved use of antimalarial services and long lasting insecticide treated nets (LLINs). It has also helped us increase our grant performance rating from B2 in 2018 to A2 in 2019. The Togolese NMCP has also introduced a number of innovative strategies in the fight against malaria, including the digitization of their 2020 LLIN campaign, strengthened partnerships with the private sector, and partnership with the Togolese army to logistically support LLIN mass distribution campaign since 2017.
Question 3: In 2019, you and your team worked with HRH2030 to co-develop a direct-to-government fixed amount award to finance the implementation of 18 malaria control activities in Togo. This is the first time that HRH2030 CBM awarded this kind of grant and the first time the NMCP Togo has received such a grant. Tell us about how the skills gained in the grant development and management and the implementation of the activities are helping the NMCP achieve its malaria control objectives. What are some of the lessons learned and best practices after going through this process?
In 2019, we developed a direct-to-government grant with support and guidance from HRH2030 CBM. This process not only strengthened our skills in developing and implementing grant activities and managing finances, but also improved our ability to adhere to grant requirements and provide back-up documents and justify the receipt of deliverable-based funds.
Thanks to this direct-to-government grant, the NMCP has been able to strengthen our collaboration with partners by organizing technical group meetings to share information and make decisions about malaria interventions; strengthen our presence in the field to encourage operational actors to comply with guidelines; and improve data quality and input traceability – which was identified by the Global Fund’s Inspectorate General as a major problem in Togo. For example, in preparing for the 2020 mass LLIN distribution campaign, meetings with the prevention technical group helped build consensus on which methods are to be used for bednet distribution, validate the technical specifications of the nets to be used, map the resistance of vectors to certain insecticides, and advocate with partners to acquire of piperonyl butoxide (PBO) nets for two regions where resistance is the most extreme. In view of the results obtained, such as the ability to implement stricter directives to the health center management teams to sufficiently use available guidelines for managing malaria cases, strengthen stakeholder relationships through increased meetings with technical groups (prevention, care, monitoring-evaluation, communication, private sector) and increased traceability missions have enabled us to correct deficiencies (such as limited traceability of medicines at the district level) noted in Global Fund’s Inspector General audit report from 2018. Some of the grant’s activities were proposed to the Global Fund, who will acquire those activities at the end of the Grant.
The lessons learned from the implementation of these grant activities have yielded results that have strengthened the NMCP’s capacity to fight malaria nationwide through the best practices of regular grant activity-monitoring and regular use of the Capability Maturity Model (CMM) model to evaluate the NMCP’s work. The CMM survey provides insight on institutional capacity by assessing how organizational units work together to implement essential NMCP functions, including M&E; strategic planning; supply chain; leadership, management, and governance; and human resources for health.
Photo: Dr. Tinah Atcha-Oubou. As the NMCP Togo’s coordinating director, he is in charge of the implementation of the national strategic plan to reduce malaria.