Since 2011, PATH’s Malaria Control and Elimination Partnership in Africa (MACEPA) has been working with Senegal’s national malaria program to plan, implement, and evaluate a tailored package of interventions to reduce the burden of malaria and accelerate elimination efforts with support from the Gates Foundation.
Dr. Yakou Dieye, PATH's West Africa Regional Director for Malaria and Neglected Tropical Diseases, leads MACEPA’s work to combat malaria in Senegal, which has joined 35 other countries in committing to eradicate malaria by 2030. In this edition of PATH Malaria Perspectives, Dr. Dieye reflects on MACEPA’s 13 years of supporting malaria elimination efforts in Senegal, including the power of data to accelerate progress and importance of strong partnerships to succeed against this deadly but preventable disease.
Q: How did MACEPA’s work in Senegal begin?
We launched the first generation of the MACEPA project in 2011 with Scale Up For Impact, or “SUFI”, which aimed to scale up effective, high-impact basic malaria interventions for communities. The second generation, MACEPA 2, strengthened SUFI, particularly by developing an advanced surveillance strategy in the Richard Toll health district in the Saint-Louis region of northern Senegal.
This strategy, known as Focal Test and Treat, or “FTAT”, involves documenting and investigating all malaria cases. Once a confirmed case is identified, all members of the index case's household and those of the five nearest households were systematically tested with standard malaria rapid diagnostic tests, then positive cases were treated with the recommended antimalarial drug.
A malaria case investigator collects data in Mbem Mbem, Senegal. Case investigators follow up on every confirmed malaria case within 72 hours. PATH/Gabe Bienczycki.
We enriched our data with information from healthcare facilities and at the community level, which provided us with sociodemographic data, travel information, clinical data on treatment initiation and discontinuation, care-seeking behavior, and time to receiving care. It was quite a large database, and it allowed us to classify imported and local cases before we started the investigation. All this work was supported by intensive communication activities to ensure that we had community buy-in for this advanced surveillance strategy.
Q: Which of MACEPA’s initiatives in Senegal do you think have had the strongest impact on elimination efforts?
The good results we've achieved over the years with the implementation of the FTAT strategy have allowed us to mobilize additional funds, first from the US President’s Malaria Initiative (PMI) with Fara financing, and then from the Islamic Development Bank, allowing us to consider the deployment of the advanced surveillance strategy known as Focal Drug Administration (FDA) in the Diourbel, Fatick, and Thiès regions. This strategy, adopted by the National Malaria Control Program (Programme national de lutte contre le paludisme, PNLP), involves treating members of the households of the index case without testing and raising awareness of preventive measures among members of the five surrounding compounds. For three years, we worked in 35 districts to document and investigate cases and respond to outbreaks.
A key initiative in speeding up the elimination process was our partnership with the parasitology laboratory at Gaston Berger University in Saint Louis. Thanks to funding from the Gates Foundation, we can take advantage of technical capabilities in molecular biology, a key success factor in the fight against malaria. I'm convinced that in two or three years, the laboratory will be even more efficient, and we'll be able to document certain areas where we haven't had a case of malaria for three years. Molecular surveillance has a fundamental role to play and will help us prepare Senegal for the elimination and certification of the elimination of this scourge.
Mosquitoes processed by PATH for molecular analysis. Photo by: PATH/Enoch Kavindele Jr.
Q: You've just returned from a site visit in the provinces where MACEPA works. What did you learn?
As the person in charge of this project, this visit was important; it was a tour to meet and share information and knowledge. During our visits to Kaffrine, Kolda, Matam, Saint Louis, Tambacounda, and Thiès, we saw extraordinary progress and real ownership at the decentralized level.
The regional departments are my first clients. My first objective was to ensure their satisfaction. The regional health directors particularly appreciated MACEPA's logistical and financial support, which enabled them to make quick decisions, especially in emergency situations. They found it useful to have technical assistance available within their directorates to support data management and ensure data quality, to set up dashboards, and to build the capacity of other national programs.
When we make decisions, we rely on the quality of the data; if the data is not of good quality, the decision won't be the right one. So, my second goal was to improve the quality of malaria data. In addition to weekly monitoring, data quality was audited every three months.
In a village in the Fatick region, mosquito nets are hung on the bed frames in family compounds where families sleep outside at certain times of the year due to high temperatures. Photo by: PATH/Babacar Junior Fall.
Q: What has stuck with you the most from your work over the last 13 years?
One thing to remember is that if we don't work together with the same vision, we won't achieve our goals. If the teams in the field don't follow protocol, if the PNLP is not guiding the process from conception—we won't succeed! It's a collective effort with partners who think things through—those who are in the regions and who often work day and night, whether they are drivers or zone coordinators.
It's to all these people that we owe the credit for our past and future successes.
