SHIELD Project - Sierra Leone

Concept note
Glossary
BCC Behaviour Change Communication
DOT Directly Observed therapy
GPS Global Positioning System
LLINs Long lasting insecticide treated nets
PCR Polymerase chain reaction (test)
RDTs Malaria rapid diagnostic tests
VMW Village Malaria Worker

Project goal

The overall goal of this project is to contribute to the control and elimination of malaria in Sierra
Leone through identification of hot-spots of parasite dispersion, and increase practice of
preventative behaviours by high-risk populations.

Objectives and main activities

A Active surveillance and mapping

• Surveillance posts will be set up at key junctions to conduct a ‘rapid assessment’ of the
malaria burden in the population, the risk factors for malaria infection and possible origins
of infection.

• Use existing surveillance data to identify high transmission areas, which can then be
verified in the field at a fine-level via consultations with communities and local health
facilities.

• Create a database with GPS mapping that highlights key areas of focus and share with
Ministry of Health and partners.

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B Prevention of spread of malaria transmission
• Recruitment of 100 community champions: members of affected communities will be
recruited and trained to act as ‘community champions’, encouraging their community to
take up more effective preventative measures.

• Directing delivery of interventions and commodities including (RDTs and LLINs) to target
areas by informing existing malaria programmes and delivery platforms about findings
related to position of ‘hot-spots’ in order to ensure targeted delivery of interventions
where they are most needed.

• Work with local businesses to establish a supply-chain to stock RDTs in pharmacies at

locally affordable prices.

• Conduct a survey with communities involved at the end of the 6-month pilot period.

C Coordination and communication

• Radio campaign aired on local community radio stations which will promote the use of
RDTs as a way to effectively diagnose malaria.

• Advocacy meetings held between stakeholders and partners to encourage collaboration

and data sharing.

• Annual meetings will be held to bring together districts to discuss malaria issues and
activities, to harmonise approaches and share knowledge of successful interventions.

D Monitoring and Evaluation (M&E) and impact measurement

• Surveys and assessments will be carried out at baseline and end line to measure pre-
defined performance indicators and allow a thorough understanding of impact of the
activities on malaria transmission and related measures in the target regions.

• A “lessons learned” workshop at the end of the project

• Activities for M&E capacity building—training workshops, mentoring and support

supervision, etc.

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Project log-frame
Description
Contribute to the control and elimination
of malaria in Sierra Leone through
identification of hot-spots of parasite
Goal
dispersion, and increased practice of
preventative behaviors by high-risk
populations.
1. Active surveillance & mapping: identify
and map hotspots of transmission and
hot-channels of parasite dispersion
Outcomes
along border regions
2. Prevention of spread of transmission:
increase malaria awareness and
practice of preventive behaviors in
high-risk subpopulations.
Parasitological tests provided for suspected
malaria cases that pass through
surveillance posts in hotspots
Outputs
DOT provided to confirmed cases
Radio campaign aired on local community
radio stations
Community champions trained
Sustainable supply-chain to stock RDTs in
10 pharmacies
Activities
Treated mosquito nets distributed to
village champions
5 businesses selected for market trial
receive shipment of 1000 RDTs each
Tracking database created.
Indicators
By end of year 1:
- Identify four hot spots per region and
reduce falciparum incidence to
<1/1,000 in 50% of hot spots
- 50% reduction on number of K13
mutant cases in target areas
By end of Year One
- 50% of cases identified through
modified day-0 alert system by VMWs
- 95% of cases identified cases identified
through modified day-0 alert system
are reported within 24 hours
- 60% of populations practicing malaria
preventive behaviors
- 25% of suspected cases in 1st
semester; 50% in 2nd.
- DOT provided to 20% of confirmed
malaria cases in 1st semester; 55% in
2nd.
- 50 hours of radio content completed
and transmitted
- 100 community champions trained by
2nd semester
- 100% of community dispensaries
report uninterrupted supply chain for
RDTs
- 100% of community champions report
uninterrupted supply chain for nets
Means of Verification
Positivity rate recorded by RDT
and PCR
RDT and PCR screening points
identify hotspots.
Blood samples from PCR P.
falciparum positive infections will
be tested for K13 mutations.
Analysis of server data for
number of cases reported using
day-0 system within 24hours,
compared to paper-based records
quality and coverage markers for
each of the BCC messages
Quarterly reports of caseloads
and number of tests
Quarterly reports of confirmed
cases treated by DOT in hot spot
area
Radio station logs
Training Rosters and evaluation
sheets;
Dispensary interviews and
Community champion reports
Assumptions
Malaria prevention activities are
implemented correctly and
consistently;
Communications between VMWs
and surveillance posts are reliable
and maintained.
Raised awareness through radio
will increase adoption of BCC
messages.
Villagers with suspected malaria
cases visit surveillance posts
Medical staff are trained and
committed.
Existing pharmacy vendors
support the project pricing and
distribution model
Champions embrace a voluntary
model
Ministry IT team provides tech
support