FY 2024 DR Congo MOP

U.S.
PRESIDENT’S MALARIA INITIATIVE
Democratic Republic of the Congo

Malaria Operational Plan FY 2024
Suggested Citation: U.S. President’s Malaria Initiative Democratic Republic of the Congo Malaria
Operational Plan FY 2024. Retrieved from www.pmi.gov
This FY 2024 Malaria Operational Plan has been approved by the U.S. Global Malaria
Coordinator and reflects collaborative discussions with national malaria control programs and
other partners. Funding available to support outlined plans relies on the final FY 2024
appropriation from U.S. Congress. Any updates will be reflected in revised postings.
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TABLE OF CONTENTS
ABBREVIATIONS....................................................................................................................... 3
EXECUTIVE SUMMARY.............................................................................................................6
U.S. President’s Malaria Initiative...........................................................................................6
Rationale for PMI’s Approach in DRC.................................................................................... 6
Overview of Planned Interventions........................................................................................ 6
I. CONTEXT & STRATEGY.......................................................................................................10
1. Introduction...................................................................................................................... 10
2. U.S. President’s Malaria Initiative (PMI)...........................................................................10
3. Rationale for PMI’s Approach in the DRC........................................................................ 11
II. OPERATIONAL PLAN FOR FY 2024...................................................................................14
1. Vector Monitoring and Control..........................................................................................14
2. Malaria in Pregnancy....................................................................................................... 19
3. Drug-Based Prevention....................................................................................................20
4. Case Management...........................................................................................................21
5. Health Supply Chain and Pharmaceutical Management..................................................26
6. Malaria Vaccine................................................................................................................ 29
7. Social and Behavior Change............................................................................................31
8. Surveillance, Monitoring, and Evaluation......................................................................... 35
9. Operational Research and Program Evaluation (PE)...................................................... 38
10. Capacity Strengthening..................................................................................................40
11. Staffing and Administration.............................................................................................41
ANNEX...................................................................................................................................... 42
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ABBREVIATIONS
ACT Artemisinin-based Combination Therapy

AL Artemether-Lumefantrine
ANC Antenatal Care
ASAQ Artesunate-Amodiaquine
AS-PYR Artesunate-Pyronaridine
ASTMH American Society of Tropical Medicine and Hygiene
CCS Community Care Site
CDC Centers for Disease Control and Prevention
CDR Centrales de Distribution Regionales
CHW Community Health Worker
C-IPTp Community Distribution of IPTp
CSO Civil Society Organization
CQI Continuous Quality Improvement
CY Calendar Year
DHIS2 District Health Information Software 2
DHS Demographic and Health Survey
DRC Democratic Republic of the Congo
eLMIS Electronic Logistics Management Information System
EPI Expanded Program on Immunization
EUV End-Use Verification
FBO Faith-based Organization
FETP Field Epidemiology Training Program
FY Fiscal Year
Gavi Gavi, the Vaccine Alliance
Global Fund Global Fund to Fight AIDS, Tuberculosis and Malaria
HMIS Health Management Information System
HNQIS Health Network Quality Improvement System
INRB Institut National de Recherche Biomédicale/National Institute of Biomedical
Research
IPTp Intermittent Preventive Treatment for Pregnant Women
IRS Indoor Residual Spraying
ITN Insecticide-treated Mosquito Net
LMIS Logistics Management Information System
M&E Monitoring and Evaluation
MBS Malaria Behavior Survey
MICS Multiple Indicator Cluster Survey
MOH Ministry of Health
MIP Malaria in Pregnancy
MOH Ministry of Health
MOP Malaria Operational Plan
NMCP National Malaria Control Program
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OTSS Outreach Training and Supportive Supervision
OR Operational Research
PBO Piperonyl Butoxide
PE Program Evaluation
PEDIR PMI-supported Enhanced Detection of Insecticide Resistance
PMI U.S. President’s Malaria Initiative
PNAM Programme National d’Approvisionnement en Médicaments Essentiels
RDT Rapid Diagnostic Test
RA Resident Advisor
SBC Social and Behavior Change
SM&E Surveillance, Monitoring, and Evaluation
SNIS Système National d'Information Sanitaire
SP Sulfadoxine-Pyrimethamine
TES Therapeutic Efficacy Study
TIPTOP Transforming Intermittent Preventive Treatment for Optimal Pregnancy
TWG Technical Working Group
UNICEF United Nations Children’s Fund
USAID United States Agency for International Development
WHO World Health Organization
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EXECUTIVE SUMMARY
To review specific country context for Democratic Republic of the Congo (DRC), please refer to
the country malaria profile located on PMI’s country team landing page, which provides an
overview of the country's malaria situation, key indicators, the National Malaria Control
Program (NMCP) strategic plan, and the partner landscape.
U.S. President’s Malaria Initiative
Launched in 2005, the U.S. President’s Malaria Initiative (PMI) supports implementation of
malaria prevention and treatment measures as well as cross-cutting interventions. PMI’s 2021
– 2026 strategy, End Malaria Faster, envisions a world free of malaria within our generation
with the goal of preventing malaria cases, reducing malaria deaths and illness, and eliminating
malaria in PMI partner countries. PMI currently supports 27 countries in Sub-Saharan Africa
and three programs across the Greater Mekong Subregion in Southeast Asia to control and
eliminate malaria. The Democratic Republic of the Congo began implementation as a PMI
partner country in Fiscal Year (FY) 2011.
Rationale for PMI’s Approach in DRC
Malaria remains the leading cause of morbidity and mortality in DRC with 27.3 million malaria
cases and 24,880 malaria deaths reported in 2022, an increase of 9.2 percent and 11.2
percent respectively since 2021.1 Globally, DRC accounts for an estimated 12 percent of all
malaria cases and 13 percent of all malaria deaths.2 The highest transmission levels are in the
north and center of the country, and the greatest burden of malaria morbidity and mortality falls
on pregnant women and children under five years of age where the estimated malaria parasite
prevalence in children 6 to 59 months of age is 39 percent.3 As one of World Health
Organization’s designated High Burden High Impact countries, DRC continues to struggle to
achieve targets in malaria control and is working with partners to get malaria progress back on
track through tailored and targeted interventions.
Overview of Planned Interventions
The proposed FY 2024 PMI funding for DRC is $48 million. PMI will support the following
intervention areas with these funds:
1. Vector Monitoring and Control
1
District Health Information System 2.
2
World Health Organization, World Malaria Report 2021: Regional Data and Trends. (Geneva, Switzerland, 2021):
https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2021.
3
Institut National de la Statistique, Enquête par grappes à indicateurs multiples, 2017-2018, rapport de résultats de l’enquête.
(Kinshasa, République Démocratique du Congo, December 2019):
https://www.unicef.org/drcongo/media/3646/file/COD-MICS-Palu-2018.pdf.
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With FY 2024 funds, PMI will procure 2,370,415 insecticide treated bed nets (ITNs) for routine
distribution via antenatal care (ANC) and the expanded program on immunization channels,
and support social and behavioral change (SBC) interventions to promote the appropriate use
of ITNs. In previous years, PMI has relied on the Against Malaria Foundation to procure ITN for
mass campaigns where the ITN distribution operational costs were paid by PMI. With FY 2024
funds, PMI will coordinate with the NMCP and the other in-country donors, including the Global
Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) to determine whether PMI can
support mass distributions, in calendar year 2023 and beyond, in one province. PMI's specific
contributions will be updated closer to the planned campaign. PMI will continue to support the
National Institute for Biomedical Research (National Institute of Biomedical Research (Institut
National de Recherche Biomédicale), the Kinshasa School of Public Health and the NMCP to
expand entomological surveillance activities from the current 14 entomological monitoring
sentinel sites to 20 with FY 2024 funds to provide better insecticide resistance data for ITN
selection.
2. Malaria in Pregnancy
PMI will continue supporting DRC's malaria in pregnancy (MIP) strategy through the
procurement of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment of
pregnant women (IPTp) along with kits to implement directly observed therapy, as well as
routine distribution of ITNs for pregnant women at ANC visits. PMI will also support training
and supportive supervision of health service providers in IPTp, and appropriate case
management of malaria during pregnancy as well as SBC targeting women of reproductive
age and their partners to promote seeking prompt treatment of malaria, ANC attendance, bed
net use, and IPTp uptake. DRC also plans to scale up the pilot community IPTp approach,
from the original three health zones (Kenge, Bulungu, and Kunda) to additional health zones in
the High Burden to High Impact and PMI target zones, pending the MIP guidelines update, to
include World Health Organization guidance.
3. Drug-Based Prevention
PMI does not currently support seasonal malaria chemoprevention or other drug-based
prevention in DRC. In its new strategic plan, DRC’s NMCP plans to implement it in 27 health
zones in Haut-Katanga and 16 health zones in Lualaba.
4. Case Management
PMI will support the DRC’s malaria case management strategy through training and supportive
supervision for health facilities and community-based health workers who provide malaria
services, including lab technicians. PMI will also support procurement of essential diagnostic
and treatment commodities; a microscopy quality assurance program; therapeutic efficacy
studies to monitor antimalarial resistance; and central-level support to the case management
technical working group. PMI will also provide travel stipends to incentivize community health
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workers in approximately 4,004 community care sites in PMI focus areas to restock
commodities and report data. With the FY 2024 funding, PMI will support these sites’
expansion and plans to increase stipends for community health workers to harmonize with the
paid stipend in DRC’s Global Fund-supported provinces. Please refer to the artemisinin-based
combination therapy, rapid diagnostic test, injectable artesunate, and artesunate suppository
Gap Analysis Tables in the Annex for details on planned quantities and distribution channels.
5. Health Supply Chain and Pharmaceutical Management
PMI will continue to procure antimalarials and related commodities and to support their delivery
to each of the supported provinces through contracts with centrales de distribution regionales
(CDR) for storage and distribution, including last mile delivery to aires sanitaires being piloted
in some health zones. PMI will also support the logistics management information system for
the procurement, storage and distribution of antimalarial and related commodities to the end
users through the last-mile delivery approach to increase its use for decision making at all
health levels. In addition, PMI supports routine forecasting and supply planning as well as
post-market surveillance of malaria products as integral components of the supply chain and
pharmaceutical management system.
6. Malaria Vaccine
The DRC application to Gavi for the malaria vaccine was approved in April 2023 and the
vaccine introduction is planned for early 2024. In its application, the DRC has requested
3,521,095 doses of malaria vaccine to reach 943,259 children between 2024 and 2026 in 13
provinces, further prioritization will be done once final allotment is shared with the country. With
FY 2024 funds, PMI will provide complementary support in the planning, delivery, and
monitoring of vaccine deployment. The vaccine introduction phase will be led by the national
expanded program on immunization and supported by the NMCP.
7. Social and Behavior Change
PMI supports DRC’s malaria SBC strategy through implementation of tailored SBC
interventions to promote uptake of key behaviors including ANC attendance, IPTp uptake,
prompt care-seeking for fever, ITN use, and health worker adherence to national malaria
guidelines for data reporting, testing, treatment, and prevention of MIP. With FY 2024 funding,
PMI proposes to support implementation of SBC interventions including a mix of interpersonal,
community-based interventions, mass media, and service delivery platforms in the community
and health facilities. PMI will also support the rollout of the service delivery assessment tool to
improve the quality of malaria service delivery, and develop key SBC interventions, including
communications and messaging, that will support the introduction and integration of the
malaria vaccine into routine vaccination in selected health zones. SBC will continue
coordination and capacity strengthening at national and provincial levels and will expand an
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interpersonal training curriculum at pre-service medical training institutions, first launched at
the University of Kinshasa.
8. Surveillance, Monitoring, and Evaluation
With FY 2024 funds and building from key results from the evaluation of the national malaria
surveillance system, PMI will support DRC’s efforts in strengthening the health information
system and malaria surveillance, monitoring, and evaluation to generate high-quality data. To
build capacity and support NMCP ownership, PMI will continue to support the improvement of
malaria data review and analysis by updating guidelines and to develop standard dashboards
and visualization tools (including the Malaria Data Integration and Visualization for Eradication
platform) to inform decision-making at the national, provincial, and health zone levels. Based
on the malaria rapid diagnostic test positivity rate study, PMI is planning to improve malaria
surveillance data by using the Health Pulse application, a digital rapid diagnostic test reader, in
a sample of supported provinces to assess the accuracy of the malaria test positivity rate
compared to the data reported on the DRC health management information system via DHIS2.
9. Operational Research and Program Evaluation
No new operational research or program evaluation is being proposed for FY 2024 funds. PMI,
however, provides technical inputs into operational research and program evaluation activities
through the monitoring and evaluation technical working group.
10. Capacity Strengthening
PMI will continue supporting the NMCP’s objective to strengthen its technical and managerial
capacity at central and provincial levels to effectively implement the national malaria strategic
plan including for the package, coverage, and quality of essential malaria-related services and
data management in health facilities and at the community level.
With FY 2024 funding, PMI will support capacity-strengthening interventions including support
of two participants in the Field Epidemiology Training Program advanced training program,
workforce development through the PMI-supported Antimalarial Resistance Monitoring in
Africa network and the PMI-supported Enhanced Detection of Insecticide Resistance. PMI will
support the NMCP attendance at key malaria scientific meetings and conferences, including
engaging with the private sector via workshop, continued logistic assistance for technical
working groups, and NMCP capacity strengthening in critical technical needs identified by PMI
and the NMCP. In addition, to improve service delivery, data quality and access to mobile
money services, PMI will continue electrification activities to additional health facilities.
11. Staffing and Administration
There are no planned changes in staffing and administration in MOP 2024.
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I. CONTEXT & STRATEGY
1. Introduction
The Democratic Republic of the Congo (DRC) began implementation as a PMI partner country
in FY 2011. This FY 2024 Malaria Operational Plan (MOP) presents a detailed implementation
plan for the DRC, based on the strategies of PMI and the National Malaria Control Program
(NMCP). It was developed in consultation with the NMCP and with the participation of national
and international partners. The activities that PMI is proposing build on investments made by
partners to improve and expand malaria-related services, including the Global Fund to Fight
AIDS, Tuberculosis, and Malaria (Global Fund). This document provides an overview of the
strategies and interventions in the DRC, describes progress to date, identifies challenges and
relevant contextual factors, and provides a description of activities that are planned with FY
2024 funding. For more detailed information on the country context, please refer to the Country
Malaria Profile, which provides an overview of the country's malaria situation, key indicators,
the NMCP strategic plan, and the partner landscape.
2. U.S. President’s Malaria Initiative
The U.S. President's Malaria Initiative (PMI) is led by the U.S. Agency for International
Development (USAID) and implemented together with the U.S. Centers for Disease Control
and Prevention (CDC). Launched in 2005, PMI supports implementation of malaria prevention
and treatment measures – insecticide-treated mosquito nets (ITNs), indoor residual spraying
(IRS), accurate diagnosis and prompt treatment with artemisinin-based combination therapies
(ACTs), intermittent preventive treatment of pregnant women (IPTp), and drug-based
prevention – as well as cross-cutting interventions such as supply chain management,
surveillance, monitoring and evaluation; social and behavior change; and capacity
strengthening. PMI's 2021-2026 strategy, End Malaria Faster, envisions a world free of malaria
within our generation with the goal of preventing malaria cases, reducing malaria deaths and
illness, and eliminating malaria in PMI partner countries. PMI currently supports 30 countries in
Sub-Saharan Africa and three programs in the Greater Mekong Subregion in Southeast Asia to
control and eliminate malaria. Over the next five years, PMI aims to save lives, reduce health
inequities, and improve disease surveillance and global health security.
Under the strategy, and building upon the progress to date in PMI-supported countries, PMI
will work with NMCPs and partners to accomplish the following objectives by 2026:
1. Reduce malaria mortality by 33 percent from 2015 levels in high-burden PMI partner
countries, achieving a greater than 80 percent reduction from 2000.
2. Reduce malaria morbidity by 40 percent from 2015 levels in PMI partner countries with
high and moderate malaria burden.
3. Bring at least 10 PMI partner countries toward national or subnational elimination and
assist at least one country in the Greater Mekong Subregion to eliminate malaria.
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These objectives will be accomplished by emphasizing five core areas of strategic focus:
1. Reach the unreached: Achieve, sustain, and tailor deployment and uptake of
high-quality, proven interventions with a focus on hard-to-reach populations.
2. Strengthen community health systems: Transform and extend community and
frontline health systems to end malaria.
3. Keep malaria services resilient: Adapt malaria services to increase resilience against
shocks, including COVID-19 and emerging biological threats, conflict, and climate
change.
4. Invest locally: Partner with countries and communities to lead, implement, and fund
malaria programs.
5. Innovate and lead: Leverage new tools, optimize existing tools, and shape global
priorities to end malaria faster.
3. Rationale for PMI’s Approach in the DRC
3.1. Malaria Overview for DRC

Malaria continues to be the leading cause of morbidity and mortality in the DRC, with more
than 27 million malaria cases and 24,368 malaria deaths reported in 2022. Globally, the DRC
accounts for an estimated 12 percent of all malaria cases and 13 percent of all malaria deaths.
Approximately 97 percent of the population lives in zones with stable malaria transmission
lasting 8 to 12 months per year. The highest levels of transmission occur in zones situated in
the north and center of the country, and the greatest burden of malaria morbidity and mortality
falls on pregnant women and children under five years of age. The 2017-2018 Multiple
Indicator Cluster Survey (MICS) showed malaria parasite prevalence in children 6 to 59
months of age to be 39 percent for rapid diagnostic tests (RDT) and 31 percent for microscopy,
which is higher than 2013–2014 Demographic and Health Survey (DHS) estimates. Although
the latest MICS (2017-2018) data show concerning declines in ITN ownership since 2013-2014
DHS,4 the under-five mortality rate has decreased, the IPTp coverage and the proportion of
children receiving an ACT among those treated with an antimalarial have increased Malaria
cases have increased over the past several years in DRC, and although there were declines in
malaria deaths between 2016 and 2019, malaria deaths showed an increase of 8.percent with
22,368 deaths in 2021 and 24,378 deaths in 2022.
For more detailed information on malaria indicators, please refer to the DRC malaria profile.
3.2. Key Challenges and Contextual Factors

Access to care in the DRC, particularly malaria services, remains a challenge. Nationwide, it is
estimated that only 30 percent of the population lives within five kilometers of the nearest
4
Ministère du Plan et Suivi de la Mise en œuvre de la Révolution de la Modernité - MPSMRM/Congo, Ministère de la
Santé Publique - MSP/Congo and ICF International. Enquête Démographique et de Santé en République Démocratique
du Congo 2013-2014. (Rockville, Maryland, USA, 2014):
https://dhsprogram.com/publications/publication-FR300-DHS-Final-Reports.cfm.
11
health facility. As a result, the response has been to bring malaria services close to
communities by establishing community care sites (CCS) with the goal to close the gap in
malaria service provision. Currently, an estimated 57,020 additional CCSs are needed to
achieve full coverage (defined as services offered within five km). Approximately 13 percent of
these sites (8,566) have been established to date nationwide. In addition to expanding the
number of CCS, there is also a need to review and update the national community health
policy to provide and harmonize financial and other incentives to community health workers
(CHW).
Another challenge is the insufficient number of health care providers at both the community
and health facility levels; this is especially true in rural areas. Moreover, challenges related to
the availability of antimalarial drugs and the functionality of the DRC supply chain system
remain barriers to malaria interventions. The supply chain system is unreliable due to several
factors, including the distances and costs for transporting commodities, lack of appropriate
infrastructure such as roads and warehouses, and challenges with lead times due to lengthy
and complex customs clearing procedures. According to the last service provision assessment,
completed in 2017-2018, only 22 percent of health facilities had injectable artesunate. Data
reported into the District Health Information Software 2 (DHIS2) and the logistics management
information system (LMIS) are improving but the quality of data collected from health facilities
remains an issue. As such, accurate data to inform supply planning, forecasting, and
distribution continues to be a challenge.
Aside from the above programmatic challenges, DRC continues to experience armed conflicts,
political instability, and sporadic disease epidemics. In addition, flooding in some parts of the
country has been worrisome. These issues slow health service delivery and impact affected
populations’ ability to receive proper care. Lastly, while it is improving, domestic funding for
health is still very low and has not yet reached the Abuja Declaration target of 15 percent of the
national budget.5
3.3. PMI’s Approach for the DRC

Building and strengthening the capacity of DRC’s people and institutions—from the central to
community levels—to effectively lead and implement evidence-based malaria control activities
is paramount to PMI. The majority of PMI’s planned support with FY 2024 funding, across the
areas of vector control, malaria in pregnancy (MIP), case management, and critical cross
cutting support such as social and behavioral change (SBC), M&E, and supply chain
management, contain elements of capacity-building and system-strengthening. PMI
understands it will take time for DRC to fully finance its development priorities, and thus will
work with other partners (e.g., the Global Fund) to jointly track DRC’s progress and funding
commitments across the malaria portfolio.
5
Nyamugira, Alexis Biringanine et al. “Towards the achievement of universal health coverage in the Democratic Republic of
Congo: does the Country walk its talk?.” July 4, 2022
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PMI organizes its investments around the activities below, in line with the DRC National
Malaria Strategic Plan 2024-2028.
● Vector control, including distribution of long-lasting ITNs through phased mass
campaigns and continuous distribution through routine antenatal care (ANC) and
expanded program on immunization (EPI) systems to maintain high coverage levels. In
addition, the strategy includes targeted IRS in pilot health zones (not funded by PMI).
● Malaria in pregnancy, including IPTp with sulfadoxine-pyrimethamine (SP) provided to
pregnant women after starting the second trimester of pregnancy. Pregnant women are
also given an ITN at their first ANC visit and benefit from case management when they
have malaria.
● Case management of malaria using confirmatory diagnostic testing with RDT or
microscopy and treatment with ACT: artesunate-amodiaquine or
artemether-lumefantrine and the introduction of artesunate-pyronaridine (not yet
supported by PMI) for uncomplicated malaria cases and injectable artesunate as the
treatment of choice for severe malaria cases. The strategy also includes rectal
artesunate for pre-referral treatment at CCSs and at first-level health centers for
children under five years of age. RDTs and medicines are free of charge for all age
groups in DRC according to national guidelines.
● Monitoring and evaluation through routine Health Management Information System
(HMIS) with the DHIS2 software, weekly integrated disease surveillance and response,
and sentinel surveillance, including both epidemiological and entomological
surveillance. In addition, household surveys, ad hoc studies, and operational research
(OR) are conducted to respond to specific program gaps and needs.
● Community dynamics and approaches for SBC, including strengthening the capacity
of CHWs as key agents of malaria service delivery and behavior change, supporting the
functionality of community groups, and promoting proper use of health services with
accurate diagnosis, and prompt treatment.
● Strengthening the national malaria program through institutional capacity-building on
leadership, coordination, program management, resource mobilization, and
multisectoral collaboration.
DRC launched the High Burden High Impact initiative on November 14, 2019, to focus malaria
interventions in the 10 most affected provinces (Kinshasa, Sud Kivu, Nord Kivu, Ituri, Kasaï,
Tanganyika, Kasaï Oriental, Kongo Central, Haut Katanga, and Kasaï Central). The National
Malaria Strategic Plan to Control Malaria 2020-2023 tried to align with the High Burden High
Impact micro-stratification as much as possible, although some interventions such as seasonal
malaria chemoprevention and perennial malaria chemoprevention may only reach pilot phases
over the next few years.
In addition to furthering the objectives laid out in the new National Malaria Strategy 2024-2028,
PMI seeks to address the challenges summarized above, which include access to quality
malaria prevention and care, weaknesses in the health system (e.g., supply chain, routine data
quality), and continuity of services in the context of political instability and/or epidemics.
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Strategies to mitigate these challenges align with PMI 2021-2026 strategic focus areas. PMI
investments will continue to focus on improving access and quality of malaria services at
delivery points in the community and in health facilities. PMI will also continue to support
strengthening the health system, including supply chain management, surveillance, monitoring
and evaluation as well as workforce development including PMI’s continued support of the
Field Epidemiology Training Program (FETP). These investments will ensure that malaria
services remain resilient and functional in the face of political or environmental instability.
Moreover, PMI has identified the University of Kinshasa (UNIKIN) and the National Institute of
Biomedical Research (Institut National de Recherche Biomédicale [INRB] as potential
institutions for localization to optimize investments that can be effective, efficient, accessible,
and sustainable specifically when political or public health emergencies threaten the continuity
of health services.
3.4. Key Changes in this Malaria Operational Plan

PMI plans to support the malaria RTS,S vaccine introduction following the country’s successful
Gavi application through further support to SBC messaging, improved M&E and support to
introduction at the health facility level. PMI will also increase the number of community care
sites that were paused in FY 2023 to bring malaria services to the most remote communities.
In addition, PMI will also increase the number of sentinel sites for entomological surveillance to
collect more data on insecticide resistance of the primary malaria vectors in DRC for decision
making and to support the surveillance of invasive Anopheles (An.) stephensi in the city of
Kinshasa. For MOP 2024, PMI will reduce the number of ITN for continuous distribution and
will pause the funding to cover the operational cost for mass distribution due to budgetary
limits. PMI will rely on other donors to fill the gap. PMI plans to implement community IPTp
based on the results and recommendations from the Transforming Intermittent Preventive
Treatment for Optimal Pregnancy (TIPTOP) study, pending World Health Organization (WHO)
guidance, and updated national guidelines.
II. OPERATIONAL PLAN FOR FY 2024
1. Vector Monitoring and Control
1.1. PMI Goal and Strategic Approach

The DRC National Malaria Strategic Plan 2024-2028 promotes an integrated vector control
approach that recommends different vector control interventions including continuous and
mass distribution of ITNs, use of indoor residual spray (IRS), larval source management, as
well as management of insecticide resistance and strengthening entomological surveillance
capacities. Under the National Strategic Plan 2024-2028, the NMCP seeks to achieve high
ownership and use of ITNs among the general population, with the goal that at least 80
percent of the population will sleep under an ITN by 2028. The National Strategic Plan also
proposes piloting IRS in specific zones. Currently, PMI supports the use of all these
interventions except for IRS and larval source management. In previous years, and in
partnership with the Global Fund, PMI supported mass distribution of ITNs every three years.
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This distribution cycle has been revised to 30 months based on PMI-supported durability
studies. Following the reduction in mass distribution intervals, the school-based distribution
has been discontinued by the NMCP. With FY 2024 funds, PMI will strongly explore the
possibility of supporting mass campaigns. PMI is currently discussing the budget and
resources for mass campaigns with the NMCP and Global Fund. If resources across
development partners are sufficient, PMI may support the operational cost for distribution in
calendar year 2024. PMI's specific contributions will be updated closer to the planned
campaign. PMI will continue supporting distribution of ITNs through routine distribution to
pregnant women via ANC and EPI channels nationwide. PMI supports routine vector
surveillance (bionomics) at three sentinel sites and insecticide resistance monitoring in 14
sentinel sites representing key malaria endemicity zones in DRC.
Figure 1. Map of Vector Control Activities in DRC, Location of Sentinel Sites for
Entomological Monitoring in 2025
1.2. Recent Progress (April 2022–April 2023)

● Supported the procurement 2,532,100 piperonyl butoxide (PBO) ITNs for continuous
distribution and distribution of 2,242,538 PBO ITNs to pregnant women and children
under one year old in the nine PMI supported provinces through antenatal and
vaccination clinics.
● Supported mass campaign distribution of 3,057,434 standard PMI procured ITNs in one
province and distribution of 4,530,584 PBO Against Malaria Foundation procured ITNs
in two provinces.
● Supported school-based distribution of 1,360,275 standard Global Fund-procured ITNs
in two provinces.
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● Supported mass campaign digitalization through the collection of ITN distribution data
on mobile devices.
● Supported vector bionomics monitoring monthly in three sites (Kenge, Lodja, and
Karawa) and insecticide resistance monitoring in 14 sites in collaboration with the PNLP,
the INRB and the School of Public Health of the University of Kinshasa. For more
information, please refer to the 2022 DRC Entomological Monitoring Report.
● Provided technical assistance to local research institutions (INRB and University of
Kinshasa) for laboratory training involving molecular analysis of mosquito samples and
training on entomological monitoring including surveillance and identification of the
invasive malaria vector (An. stephensi).
● Supported INRB in conducting all the entomological surveys including routine
entomological surveillance, support to the insectary, and training of regional staff.
● Supported prevention of MIP by providing ITNs to women at their first ANC visit.
● Provided technical assistance to INRB for entomological monitoring through training of
insectary technicians.
● Supported 24- and 28-month streamlined durability monitoring of PBO and
pyrethroid-based nets in Sud Ubangi province.
● Supported monitoring of ITN use and sleeping behaviors of local populations in
Tanganyika province.
● Supported baseline and 24-month streamlined durability monitoring of PBO-based ITNs
in Tanganyika province.
● Piloted community-based entomological monitoring in the province of Kasai Oriental.
● Supported national, facility and community levels SBC activities to improve demand for
ITNs, increase appropriate use, promote care, and mitigate against misuse. For more
information, please refer to the SBC section.
1.3 Plans and Justification for FY 2024 Funding

The FY 2024 funding tables contain a full list of vector monitoring and control activities that
PMI proposes to support.
1.3.1. Entomological Monitoring

PMI will continue to support entomological monitoring activities in DRC as described in the
Recent Progress section above. These activities will include vector bionomics and insecticide
resistance monitoring at different sites, including areas receiving PBO and Interceptor G2 (IG2)
ITNs. With FY 2024 funds, PMI will expand support for entomological monitoring from three
vector bionomics survey sites to four sites to include Kasaï Oriental province (an area where
the High Burden High Impact project is being implemented). With increasing demand for
insecticide resistance data for planning selection of ITNs for the different provinces, PMI is
expanding support for insecticide resistance monitoring from 14 sites to 20 sites to cover 20 of
the 26 provinces in DRC. Data collected will feed into the country's database and will help to
monitor impact of new nets on entomological indices, and to better understand vector-human
interactions and to inform decisions. To reach populations in high insecurity areas or in
geographically hard to reach provinces, PMI has supported the training of the Water Hygiene
16
and Sanitation supervisors which are local health workers of the Ministry of Health to conduct
entomological monitoring with remote supervision until they become independent. In addition,
PMI will support the surveillance of the invasive malaria vector (An. stephensi) in urban
Kinshasa. PMI will also provide technical support to review and update the DRC Plan for
Insecticide Resistance Management and continue to provide technical assistance to
strengthen the capacity of the NMCP, INRB, and the School of Public Health of the University
of Kinshasa.
Summary of Distribution and Bionomics of Malaria Vectors in DRC
As of 2022, An. gambiae s.l. and An. funestus were the main malaria vectors in DRC. An.
gambiae s.l. is predominant throughout the year in Kenge, Lodja, and Karawa while An.
funestus was found mainly in Karawa. An. moucheti is an emerging vector mainly involved in
malaria transmission in Karawa, not found in the other two sites.
The main vector species bite both indoors and outdoors with peak biting periods between 1:00
a.m. and 4:00 a.m. Humans are the preferred host indoors and outdoors at all the sites with
peaks biting periods between July and October. The combined annual entomological
inoculation rate (EIR) was 439.5 infectious bites per person per year in Karawa, 106.5 in
Kenge and 73.1 in Lodja. Peak transmission season is from July to October that coincides with
the rainy season in different sites.
Status of Insecticide Resistance in DRC
Pyrethroid resistance is widespread in DRC. In all sites in 2022, An. gambiae s.l. was resistant
to permethrin, deltamethrin, and alpha-cypermethrin. Resistance intensity varies by site and by
insecticide, but is usually moderate or high. In all sites, bioassays with pyrethroids following
pre-exposure to PBO showed an increase in mortality compared with tested pyrethroid alone,
though mortality was still <90% for permethrin in seven sites (Lodja, Pawa, Kingasani,
Kabondo, Karawa, Kamina, and Rutshuru); for deltamethrin, in two sites (Lodja and Karawa);
and alpha-cypermethrin in six sites (Kenge, Lodja, Pawa, Kingasani, Mikalayi, and Rutshuru).
Overall, PBO significantly increased mortality in deltamethrin (with full restoration at 11 out of
14 sites) compared to permethrin or alphacypermethrin. There was no resistance for
chlorfenapyr at any of the sites when compared to 2021 where chlorfenapyr resistance was
detected in two out of the 12 sites tested including in Karawa, Nord-Ubangi and Pawa, Uele.
1.3.2. Insecticide-Treated Nets

PMI will continue to support procurement and distribution of ITNs through continuous
distribution channels of ANC and EPI and will explore support for mass campaigns with FY
2024 funds, together with partners and other donors, with decisions being made closer to the
planned campaigns. PMI will also support SBC to improve consistent use and proper care of
ITNs.
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Please see the SBC section below for details on challenges and opportunities to improve
intervention uptake or maintenance.
Insecticide-treated Mosquito Net Distribution in DRC
In DRC, ITNs are made available via mass distribution campaigns every three years and
through ANC and EPI continuous distribution channels. PMI, Against Malaria Foundation, and
the Global Fund supported mass distribution of ITNs every three years with campaigns
occurring in alternate years. However, the NMCP’s goal for net replacement is every 30
months based on durability studies showing the average ITN durability in local settings is
under two years. In addition, PMI supports continuous distribution of PBO ITNs through routine
distribution to pregnant women during ANC clinics, and to children under one year of age at
EPI clinics. The NMCP will no longer use school-based distribution as a continuous distribution
approach. The country transitioned from standard to PBO nets for both routine and campaign
distribution and plan to distribute dual AI nets in selected provinces, based on resistance data,
during the GC7 campaigns.
PMI plans in this MOP to procure 2,370,415 PBO nets for continuous distribution, but the type
may change based on insecticide resistance data and results. Please refer to the ITN Gap
Table in the annex for more detail on planned quantities and distribution channels.
Table 1. Streamlined Durability Monitoring

Campaign Date Site Brand Baseline 12-month 24-month 36-month
December 2020 Tanganyika Veeralin (Alpha- April/May February/ February Planned

Cypermethrin + PBO) 2021 March 2022
2022
December 2020 Tanganyika SafeNet April/May February/ February Planned

Alphacypermethrin 2021 March 2022
2022
May 2020 Sud Ubangi PBO Permanet 2.0 August May 2022 October Planned
2021 2022
May 2020 Sud Ubangi PBO Permanet 3.0 August May 2022 October Planned
2021 2022
June 2023* Nord Ubangi Interceptor G2 June 2022 Planned Planned Planned
(Chlorfenapyr +
Alphacypermethrin)
*Delay in ITN distribution has prevented further monitoring.
PBO: piperonyl butoxide.
1.3.3. Indoor Residual Spraying (IRS)

PMI does not support indoor residual spraying in DRC.
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1.3.4 Other Vector Control
PMI does not support other entomological intervention in DRC.
2. Malaria in Pregnancy

The DRC National Malaria Strategic Plan aims to protect all pregnant women from malaria
through the MIP approach which consists of providing all women, over the course of their
pregnancy at least four doses of SP, case management services, and ITNs during ANC visits.
National Malaria Control Program Approach
In addition to providing case management services and an ITN to all pregnant women, the
national guidelines recommend that intermittent preventive treatment during pregnancy (IPTp)
with SP be given to them during ANC visits from the start of the second trimester of pregnancy.
Each woman should receive at least four directly observed doses of SP, one month apart until
delivery as part of their clinical regimen at health facilities. Supportive supervision for MIP is
integrated directly into the broader outreach training and supportive supervision (OTSS) tool
for malaria case management.
PMI Objective in Support of NMCP
PMI supports DRC’s MIP approach through the procurement of ITNs, ACT, and SP along with
directly observed therapy kits for IPTp (clean water, and cups) at health facilities, as well as
training and supportive supervision of health care providers. PMI also supports SBC activities
to promote ANC attendance and plans to support community-based IPTp scale-up, based on
global guidance and the recommendations of the TIPTOP study results.
2.2. Recent Progress (April 2022–March 2023)

During this period, PMI provided support to:
● Procure 8 million SP treatments for PMI-supported health zones.
● Train 3,925 health service providers in IPTp.
● Provide SP to 1,755,455 pregnant women and the SP treatment kits to 198 health
facilities.
● Increase engagement with community structures, such as village outreach committees,
health area development committees, and CHWs to inform elements of the VIVA!
campaign, which focuses on maternal health behaviors, including ANC attendance.
Initial engagements have focused on capacity-building of community stakeholders to
strengthen the links between communities and health structures.
2.3. Plans and Justification for FY2024 Funding

The FY 2024 funding tables contain a full list of malaria in pregnancy activities that PMI
proposes to support.
19
PMI will continue to support MIP activities with a similar package of interventions, including the
change initiated in FY 2023 which is focusing training on MIP supportive supervision to
providers who have already been trained on MIP. With FY 2024 funding, PMI will continue to
redirect funds previously used for MIP training to support MIP supportive supervision, targeting
low-performing facilities.
The community distribution of community IPTp (C-IPTp) pilot study conducted by the TIPTOP
project in 2022 in three health zones (Kenge, Bulungu, and Kunda), recommended
coordinating and advocating for resource mobilization to integrate the C-IPTp approach in the
health system, pending updates of the WHO guidelines and DRC’s national guidelines to
inform C-IPTp scale-up in other provinces. Using data from DHIS2, low performing health
zones and health facilities from High Burden High Impact provinces will be prioritized for the
scale up of C-IPTp. PMI support will include CHW training in MIP including IPTp
administration, strengthening health providers’ capacity for supportive supervision, and
conducting monthly data monitoring meetings.
PMI will also continue to procure SP and consumables to facilitate provision of IPTp as directly
observed preventive treatment. PMI will continue to support SBC interventions focused on
promoting early and regular ANC visits, as well as ANC provider behaviors to address missed
opportunities to provide IPTp for eligible pregnant women at ANC. Current data collection
activities, including the Malaria Behavior Survey (MBS) and a recent study on gaps between
ANC visits and IPTp uptake, provided important insights to shape these interventions,
including interpersonal communication between ANC providers and pregnant women and
recording of data into registers.
Please refer to the SP Gap Analysis Table in the annex for more details on planned quantities
and distribution channels.
Please see the SBC section below for details on challenges and opportunities to improve MIP
uptake.
3. Drug-Based Prevention
In the DRC, Global Fund had offered to support seasonal malaria chemoprevention in 11
health zones in Haut-Katanga with the Global Fund’s GC7. In addition, NMCP has requested
that PMI support two health zones in Lualaba (Dilala and Manyika health zones) with MOP FY
2024 funding, but PMI could not due to resource constraints.
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4. Case Management

The main objective of NMCP case management is to reduce malaria related morbidity by 70
percent and mortality by 50 percent from the 2021 level (National Malaria Strategic Plan
2024-2028). The national malaria case management guidelines recommend that any
suspected malaria case must be tested using a RDT, at the health facility and community
care site (CCS) levels, or at an approved pharmacy in accordance with national guidelines.
Microscopy is recommended for cases suspected of treatment failure to monitor parasite
clearance for severe malaria cases and for identification of parasite species. Microscopy can
only be conducted at facilities with proper equipment and trained laboratory staff; this is
generally limited to the referral health facility level.
All confirmed malaria cases should receive prompt, quality-assured treatment, according to
guidelines. In practice, any case tested positive by RDT should receive an ACT
recommended by the national policy, namely the combination artesunate-amodiaquine or
artemether-lumefantrine regardless of environment (rural or urban). The
artesunate-pyronaridine combination has been adopted as the third first-line formulation by
the national pharmaceutical regulatory authority and will be subject of an introduction plan.
However, PMI has no plan yet to fund procurement of artesunate-pyronaridine. Injectable
artesunate is the treatment of choice for severe cases. In case of unavailability, the country
recommends the quinine-clindamycin combination for simple cases and injectable artemether
or injectable quinine for severe cases. Rectal artesunate is used as pre-referral treatment for
severe malaria cases at the CCS level or health centers.
The CCSs are responsible for providing integrated care of childhood illnesses and gradually
for certain adult pathologies and even certain family planning services under the supervision
of the health area head nurse.
PMI currently supports malaria services in 9 out of the 26 provinces, representing 38 percent
of the total population. In 2023, PMI’s support in the nine provinces include 179 health zones
and 3,122 health areas that include 168 general reference hospitals, 6,775 health centers, and
3,504 CCSs (out of the 21,590 estimated need).
PMI supports the country’s malaria case management strategy by procuring essential
diagnostics and treatments commodities and providing training and supportive supervision for
lab technicians, facility-based health workers, ANC providers, and CHWs. PMI also supports a
microscopy quality control and assurance program, and therapeutic efficacy studies (TES) to
monitor antimalarial resistance and, at the central level, supports the case management
technical working group (TWG) to convene regular meetings and to oversee and coordinate on
malaria case management, including specific questions or new updates. PMI is also providing
support for scaling up the continuous quality improvement in three provinces (Haut-Katanga,
Kasai Oriental and Kasai Central), which aims to improve the quality of malaria case
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management services through improved bi-directional feedback between providers and
supervisors. In addition, PMI supports efforts to improve pre-service training in the DRC by
monitoring the implementation of the updated malaria training curriculum across various
training institutions.
PMI plans to expand the number of CCS with FY 2024 funding, and continue the
implementation of updated community-level service delivery. These services include
expanding the age limit of children served at CCSs to 6–13 years of age (adding to the
children currently served who are under five years of age), PMI will also provide travel stipends
to CHW in support of their efforts to get supplies and report data. PMI supports almost 7,000
community health workers (two per CCS) to deliver community-based case management
services combining iCCM and mCCM, depending on non-malaria commodities availability, for
those aged 2 months to 13 years, using RAS as pre-referral treatment. According to the
National Community Care Site Expansion Plan (2022-2027), the DRC’s MOH plans to expand
CCSs from 10,112 to 15,000 (out of 65,586 needed countrywide). PMI will support the
expansion of CCS by adding 500 CCSs with FY 2024 funds, for a total of 4,004 CCS
supported by PMI.
Figure 2. Map of Case Management, Community Health and Malaria in Pregnancy

Service Delivery Activities in the Democratic Republic of the Congo

National Level Case Management Activities
● Supported national staff to conduct five supervision visits in five provinces.
● Maintained the national slide bank by providing support for replacement of lost or
broken slides for the sustainability of the external quality control and quality assurance.
● Provided support to NMCP to convene and lead four malaria case management TWG
meetings.
● Developed an online knowledge questionnaires tool to track the implementation of the
developed malaria training modules in universities and higher health training institutions,
and supported online repository of higher education training curricula for malaria,
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determining the specifications for targeted technical support to the institutional website
intended to serve as a repository for content, including malaria pre-service training
modules.
● Carried out one round (#6) of microscopy external quality control in November 2022.
● Maintained the National Slides Bank for microscopy external quality assurance and
quality control.
● Coordinated with Global Fund to conduct a joint community health site visit that
discovered similarities and differences in PMI and Global Fund supported activities in
their respectives supported provinces, and took steps to harmonize community health
interventions.
Commodities
During the past period, PMI has supported:
● Procurement of 10,584,025 malaria RDTs and 9,464,310 treatments.

● 1,438,124 vials of parenteral artesunate.
● 232,852 rectal artesunate suppositories.
● Distribution of the following commodities:
Table 2: Quantities of Commodities Distributed

Commodity Quantity distributed
Artemether/Lumefantrine 20/120 mg Dispersible Tablet 1 x 6x1 Blister Pack Tablets 179,064
Artemether/Lumefantrine 20/120 mg Dispersible Tablet 1 x 6x2 Blister Pack Tablets 678,420
Artemether/Lumefantrine 20/120 mg Tablet 1 x 6x3 Blister Pack Tablets 562,344
Artemether/Lumefantrine 20/120 mg Tablet 1 x 6x4 Blister Pack Tablets 750,595
Artesunate (w/ 1 Amp NaHCO3 5% + 1 Amp NaCl 0.9%) 60 mg Vial 1 Set 2,487,052
Artesunate 100 mg Suppository 2 Suppositories/Blister 247,538
Artesunate/Amodiaquine 100/270 mg Tablet 25 x 3 Blister Pack Tablets 2,148,800
Artesunate/Amodiaquine 25/67.5 mg Tablet 25 x 3 Blister Pack Tablets 1,085,325
Malaria Rapid Diagnostic Test (Pf) Cassette 1 Test 10,787,463
Facility Level progress:

● Conducted 434 on-site training and supportive supervision visits in 3,906 health
facilities.
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● Collected key case management quality of service indicators during supportive
supervision Round 6 for malaria microscopy. During OTSS+, laboratory technicians
improved skills on the blood smear preparation, staining slides, and reading to be able
to detect, identify species, and count parasites easily. Testing prior to treatment has
improved, but adherence to diagnostic test results remains a big challenge as providers
still continue to treat suspected malaria cases with negative test results.
● Convened 836 facility level data review meetings to promote data use and improve best
practices.
● Conducted two data quality assessments visits ( two per province) in 61 health facilities
located in 18 health zones. A database is available, but not a report.
Community Level Progress

● Conducted 1,384 on-site training and supportive supervision or mentorship visits
reaching 2,768 community health workers. Conducted a joint site visit between PMI and
Global Fund to assess similarities and differences in their respective provinces.
● Key case management quality of service indicators are collected at health facilities level
during the supportive supervision, by lab or clinicians supervisors, using HNQIS, and at
the community level by health center head nurses during routine supportive supervision
visits.
● Starting with FY 2022 MOP funding, PMI introduced the $10 stipend payment for 3,504
CCSs in recognition of the CHW effort related to malaria commodity replenishment, to
cover costs incurred by CHW to travel for commodity re-supply. Using FY2022 funds,
the eligible age group for community care services was also expanded from children
under five years of age to thirteen years of age. PMI still continues to advocate for the
professionalization of community health workers.
Please note that recent progress with monitoring antimalarial efficacy and the TES approach is
presented in the Plans and Justification for FY 2024 Funding section below.
4.3. Plans and Justification for FY 2024 Funding

The FY 2024 funding tables contain a full list of case management activities that PMI proposes
to support.
National Level Case Management Activities
PMI will continue to support digital data collection and analysis training for new laboratory
OTSS+ supervisors and clinical supervisors in the use of the Health Network Quality
Improvement System (HNQIS). The HNQIS has been handed over to the NMCP and Division
of National Health Information System (Division SNIS) and has become a national tool that
both the Global Fund and PMI plan to support as needed. The HNQIS replaced the
paper-based OTSS tool, and the NMCP plans to extend its use as a national tool for malaria
providers' supportive supervision.
24
PMI will continue to support the NMCP to conduct supervision of malaria control activities at
the provincial level (two national supervisors conduct semi-annual supervision visits to nine
provinces), and to hold the quarterly malaria TWG meetings.
PMI will continue to track the implementation of the malaria training modules in universities
and higher health training institutions, using the online knowledge questionnaires tool. PMI will
also support the online repository of higher education training curricula for malaria. PMI will
also provide technical support for the community health policy update and advocacy to develop
a national strategy for the professionalization of CHW.
Commodities
Please refer to the ACT, RDT, injectable artesunate, and artesunate suppository gap tables in
the annex for more detail on planned quantities and distribution channels.
Facility Level
With FY 2024 funding, PMI will continue to support the OTSS (on-the-job training and
mentoring) of facility-based health workers for the management of both uncomplicated and
severe malaria in public and not-for-profit health centers and hospitals.
PMI will strengthen the continuous quality improvement and extend the approach to two
low-performing PMI-supported provinces as results in the initial three provinces (Kasai
Oriental, Kasai Central and Haut Katanga) showed improvement in key aspects of
uncomplicated malaria case management. Formal classroom training will be replaced by the
on-the-job training approach to allow more funding for the introduction of CQI in the additional
provinces (Tanganyika and Sud Kivu). PMI will still not support the procurement of lab reagents
as patients receive RDT tests free of charge, but patients are still currently charged for malaria
microscopy. Health management teams have been advised to use the profits from these fees
to replenish lab reagents.
Community Level
PMI will continue to support CCSs’ supportive supervisions of malaria and integrated case
management at community level. PMI will continue to provide a stipend to CHWs in recognition
of their efforts related to malaria commodity replenishment. While not a direct form of payment,
this approach serves as motivation for their valuable contribution. With FY 2024 funding, PMI
will continue to focus on improving the quality of community health care services by providing a
flat rate for commodity replenishment to CHWs and supportive supervision. In agreement with
the NMCP, PMI will continue to support expanding the age range of services to children from 5
to 13 years of age in new CCS, aligning with the 16 Global Fund-supported provinces.
PMI is supporting 3,504 CCS out of the total estimated coverage needed of 21,590 CCSs in
PMI-supported provinces. With FY 2024 funding, PMI will continue to support CHW
25
training/refresher training as needed and the procurement of small equipment in the
established CCS. In addition, PMI will create and equip 500 additional CCS, and provide
training to about 1,000 new CHWs (two CHWs/site) after a two-year pause. This will bring the
total number of PMI-supported CCS to 4,004 and contribute to the DRC’s National Community
Health Care extension Plan, aiming to increase CCS coverage from 15 percent to 23 percent
(i.e., from 10,112 to 15,000 CCSs) by 2027. Beginning with the FY 2021 reprogrammed funds,
PMI started paying CHWs a monthly stipend of $10 per CCS and plans to increase this
payment to $20 with FY 2024 MOP funds to harmonize CHW payments with the Global Fund
rate, as a result of the PMI-Global Fund joint site visit recommendations.
Monitoring Antimalarial Efficacy
The 2017, TES results showed decreasing efficacy of ACT in certain sites in DRC.6 Samples
collected in 2020 and 2021 from the six sites (Boende, Kabondo, Kapalowe, Kimpense,
Mikalayi, and Rutshuru) are being analyzed and results will help inform the choice of first-line
ACT in DRC. Given that DRC shows evidence of waning drug efficacy and is a context with
high multiplicity and diversity of infection, regular TES will continue to be a priority of PMI.
From 2022, the number of sentinel sites for TES has increased to eight from the initial six sites.
Four sites will be studied each year (Table 3).
With FY 2024 funds, PMI will continue TES in DRC. The number of TES sites will however
decrease to five sites per year due to budgetary restrictions and also to the increase in the cost
of conducting TES.
Table 3. Ongoing and Planned Therapeutic Efficacy Studies

Ongoing Studies
Year Site name Treatment Plan for laboratory

arm(s) testing of samples
2022-2023 Kabondo (Kisangani/Tshopo), Kapolowe (Haut AL, ASAQ PARMA Hub in Senegal
Katanga), Mikalayi (Kasaï Central), Boende
(Tshuapa), Kalima/Kindu (Maniema), Vanga (Kwilu),
Kimpese (Kongo Centrale), Rutshuru (Nord Kivu).
Planned Studies (funded with previous or current MOP)
Year Site name Treatment Plan for laboratory

arm(s) testing of samples
2021 Kabondo (Kisangani/Tshopo), Kapolowe (Haut AL, ASAQ Ongoing

Katanga), Mikalayi (Kasaï Central), Boende
(Tshuapa)
AL: artemether-lumefantrine; ASAQ: artesunate-amodiaquine; PARMA: Partnership for Antimalarial Resistance Monitoring in
Africa.
6
Schmedes, Sarah E et al. “Plasmodium falciparum kelch 13 Mutations, 9 Countries in Africa, 2014-2018.” 2021.
26
Please see the SBC section for details on challenges and opportunities to improve intervention
uptake or maintenance.
5. Health Supply Chain and Pharmaceutical Management

The National Malaria Strategic Plan 2024-2028 prioritizes strengthening the malaria supply
chain and ensuring availability of anti-malarial products in health facilities and at the
community level. This new plan highlights the importance of coordination among key
procurement and supply chain stakeholders and the importance of regular quality logistics data
to inform decision-making and the strengthening of an electronic LMIS. Antimalarial product
availability over the short term at all levels of the health care system and, in particular at the
last mile, remains a priority for PMI along with investments in long-term supply chain system
strengthening. Also, in collaboration with the MOH and other partners, U.S. Agency for
International Development (USAID) DRC is in the process of creating a ten-year supply chain
roadmap for 2023-2032 of which aims to increase the appropriate use of quality health
products that are available and accessible to end-users through strengthened national
healthcare supply chain and pharmaceutical management.

PMI has continued to support various activities to strengthen the health supply chain and
pharmaceutical management, including annual quantifications, storage and distribution,
strengthening of the eLMIS, and improving data quality. There has also been support for
pharmaceutical management, specifically to strengthen capacity for quality assurance for
medicines and post-marketing surveillance for malaria medicines. The quality of logistics data
reported through District Health Information Software 2 (DHIS2) and analyzed through InfoMed
is improving, and the use of these data for decision-making is increasing at all levels of the
health system.
Product availability continues to be a major challenge for malaria control in the DRC.
Availability at centrales de distribution regionales (CDRs) remained high for all products. At the
health facility level, routine data on availability is reported through a customized DHIS2
system, the Système National d'Information Sanitaire (SNIS) which includes the quality of data
and suboptimal reporting rates. The annual end-use verification (EUV) survey is an important
complement to these data, although care must be taken in ascribing any trend to the data
since they are a single point-in-time measure. Through this system, there was observed
discernible improvement in product availability between the EUVs for September 2020 and
August 2021 (see Table 4).
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Table 4: Stockout Rates and Stock Levels for Various Malaria Products, End-Use
Verification, 2020–2022
Product % HF Stockout on Day of Visit % CDR Stocked according to Plan
(between Minimum and Maximum)
Sep-20 Aug-21 Jul-22 Sep-20 Aug-21 Jul-22
Any WHO prequalified 16% 12% 12% NA NA NA

ACT
No AL presentation 73% 63% 44% NA NA NA
Rectal Artesunate 100 mg 77% 69% 64% 10% 14% 0%
Injectable Artesunate 75% 59% 77% 3% 30% 10%
RDT 20% 12% 13% 12% 40% 25%
SP 19% 13% 18% 20% 8% 0%
ITNs 35% 36% 42% 22% 25% 0%

NB: % of HF with no AL presentation appear very high because even rural HFs were included in the denominator while they
were not supplied with AL til 2021 as was the case for urban HFs. Also AL represents only 30% of ACT procured for the
country. The other 70% are ASAQ.
ACT: artemisinin-based combination therapy; AL: artemether-lumefantrine; ASAQ: artesunate-amodiaquine; CDR: centrales
de distribution regionales; HF: health facility; ITN: insecticide-treated mosquito net; RDT: rapid diagnostic test; SP:
sulfadoxine-pyrimethamine.
The NMCP and PMI are concerned about the quality of medicines––especially that of
commercial products. There are large numbers of commercial malarial products circulating in
the DRC, not all of which are WHO prequalified, and they play an important role in ensuring
access to medicines. Poor quality products can compromise treatment and increase
resistance. PMI is supporting the Autorite Congolaise de Regulation Pharmaceutique and the
Laboratoire Pharmaceutique de Kinshasa to build their capacity to perform post-marketing
surveillance of antimalarial medicines. In 2021, a first round of post–marketing surveillance
was conducted in three provinces, and in 2022 a second round was initiated in five provinces
supported by PMI.
PMI provided technical assistance to the Programme National d’Approvisionnement en

Médicaments (PNAM) to coordinate the national quantification committee and conduct
long-term forecasts and quarterly supply plan reviews for priority health commodities. In March
2023, PMI supported the training of 33 staff from PNAM, MOH and USAID on a forecasting
tool called Quantification Analytic Tool (QAT). QAT is used as the single tool to quantify all
products for different health elements in USAID-supported provinces, including antimalarial
products, and will soon be introduced in Global Fund-supported provinces. Following QAT
training, a six-day workshop was organized to develop forecasting assumptions for malaria,
HIV/AIDS, tuberculosis, family planning and reproductive health (FP/RH), and MNCH
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commodities. Provinces also have their own supply plan with the QAT tool and can update
their respective supply plan in real-time instead of this being centrally managed from Kinshasa.
5.3. Plans and Justification with FY 2024 Funding

The FY 2024 funding tables contain a full list of health supply chain and pharmaceutical
management systems strengthening that PMI proposes to support.
With FY 2024 funds, PMI will support:

● Conducting a national quantification for malaria products using QAT. This includes
individual provincial-level forecasts for each of the nine PMI-supported provinces, which
are then rolled up to the national level. Each province will produce its own supply plan
which is regularly updated based on supply, demand/consumption, and funding.
● Monitoring supply chain stock levels, including the supply plan and stock levels at
CDRs, health zones, and health facilities. CDR stock data are reported through InfoMed
from CDRs warehouse management system (currently APISOFT), and zonal and health
facility data from the SNIS (DHIS2-based system). Data is monitored and assessed for
completeness and quality and used to inform supply plans and distribution plans (from
CDRs to zones and/or health facilities). This includes support for the use and
management of the InfoMed system and dashboard by Programme National
d’Approvisionnement en Médicaments (PNAM) and ensuring its ongoing interoperability
with the SNIS and CDRs warehouse management systems.
● Implementing a national EUV survey.
● Funding for warehousing of malaria products at CDRs (budgeted at 7.5 percent of
product value) and onward distribution to other zones or health facilities using either
CDRs or private sector third-party logistics (budgeted at 7.5 percent).To the extent
possible given financing, integrated delivery of USAID-procured products will be
implemented to health facilities, bypassing zones, but it may not be possible to expand
last mile delivery beyond the zone currently covered in Haut Katanga and Lualaba. In
addition, for instances where products are delivered to zonal level, funding is budgeted
at 2 percent of product value for distribution from zones to aire santaires through the
Integrated Health Program (IHP).
● Supporting the technical logistics management units at the central and provincial levels
to strengthen their capacity to provide direct support for the supply chain.
● Supporting longer-term human resource for supply chain management (HR4SCM)
interventions in collaboration with the Global Fund and other donors. This includes
support for supply chain bachelor’s and master’s degree programs at the University of
Kinshasa School of Public Health and to the national professional association of
logisticians and supply chain professionals.
● Supporting the Laboratoire Nationale de Contrôle de Qualité to achieve and maintain
ISO certification and continue post–marketing surveillance of malaria medicine quality.
29
6. Malaria Vaccine

PMI aims to support the Ministry of Health to strategically deploy the malaria vaccine as a
complementary tool to the existing core interventions. This includes technical assistance to the
NMCP along with the national EPI to strategically use data to monitor vaccine introduction. The
vaccine introduction phase will be led by the national EPI, thus PMI DRC will continue to work
with the NMCP and national immunization colleagues to provide complementary support in the
planning, delivery and monitoring of vaccine deployment. This includes support to maximize
uptake of the vaccine without adversely affecting coverage of other malaria interventions.
Given that the country has successfully applied for the malaria vaccine and will be among the
first countries to receive malaria doses, PMI/DRC will provide funding to existing mechanisms
to support SBC and M&E activities during the introduction phase.

During the past period, the PMI supported the NMCP and EPI teams in developing an
application for malaria vaccine introduction. The DRC application submitted to Gavi in January
2023 was accepted in April 2023 and information on the vaccine allocation to DRC was
received in late May 2023.
Figure 3. Map of malaria vaccine plans in the DRC
30
6.3. Plans and Justification for FY 2024 Funding
The FY 2024 funding tables contain a full list of activities related to other drug-based
prevention that PMI proposes to support..
The DRC plans to introduce the malaria vaccine in early 2024. The choice of the provinces
where the vaccine will be introduced was based on malaria morbidity and mortality routine data
as well as on vaccination rates and provinces with the best immunization performance. As
such thirty eight (38) health zones are targeted in thirteen (13) provinces including Haut Uele,
Kongo Central, Kasai Oriental, Kwango, Kwilu, Kinshasa, Kasai Central, Kasai, Lomami,
MaiNdombe, Mongala, Maniema, and Sankuru. The vaccine will be provided to children aged
6 to 23 months in four doses at 6, 7 ,9, and 24 months. DRC will need 3,521,095 doses of
malaria vaccine to reach 943,259 children between 2024 and 2026.
Pending DRC’s policies and timeline for malaria vaccine roll-out, PMI also plans to support the
introduction of the malaria vaccine into health facilities through the reinforcement of health care
workers’ capacity, supportive supervisions, malaria data (including vaccine administration)
monitoring, and engagement of the health care workers and the community in positive vaccine
introduction messaging.
All malaria vaccine procurement will be supported by UNICEF with Gavi funding. PMI will
provide funding and technical assistance to support SBC and M&E activities through existing
mechanisms in its supported provinces (Kasai Central, Lomami, and Sankuru).
7. Social and Behavior Change

PMI’s SBC support is in full alignment with the NMCP’s National Strategic Communication Plan
(2024-2028). The NMCP’s objective is to strengthen community dynamics and approaches to
SBC favorable to malaria control in the DRC’s 26 provinces. The SBC plan was updated in
March 2023 to include aspects of malaria vaccine, seasonal malaria chemoprevention, and
perennial chemoprevention and is targeted towards health providers, primarily to improve data
reporting and interpersonal communication with pregnant women during IPTp administration to
foster uptake. The SBC plan aims to improve uptake of key malaria behaviors in pregnant
women including appropriate and systematic use of ITNs, prompt care-seeking at the onset of
fever, and IPTp.
PMI conducting extensive formative research to understand determinants of behavior uptake

and tested innovative SBC interventions to inform diagnostics activities. PMI supported a
qualitative study conducted to understand providers’ behavior through a quantitative study to
determine the degree of discordance in test positivity rate of malaria RDT data generated by
automated readers. PMI also introduced a service delivery assessment tool that uses a
socio-ecological model to understand factors influencing provider behavior for patient
assessment, treatment, preventive services, commodity management, and data recording.
31
The NMCP’s SBC activities consist primarily of interpersonal communications (e.g., household
visits), community mobilization (mini campaign, quiz at the market, FBO, CSO) and mass
media. Selection of approaches and channels are intended to maximize interaction with the
community, achieve reach to most of the population, improve accountability, maintain an
effective feedback loop between communities and healthcare providers, and engage
decision-makers. The SBC approaches also consider their efficiency and adaptability to the
rural, urban, and peri-urban contexts. PMI’s SBC activities support the NMCP’s approach by
addressing knowledge gaps about drivers of key behaviors, engaging with stakeholders to
develop innovative interventions based on human-centered design principles, piloting those
interventions, and finlly bringing them to scale through phased implementation approaches.
PMI recognizes that malaria fits into an integrated health package, and health resources can
be leveraged to promote behaviors such as care-seeking and ANC attendance that have
positive health impacts beyond malaria. While PMI focuses SBC implementation in its targeted
provinces, the data and insights generated through formative research (e.g., MBS, ANC/IPTp
gap study, Deki reader analytic study) are shared with other relevant donors such as Global
Fund to inform high-quality SBC implementation throughout the country.

PMI supported the following activities from April 2022 and April 2023:
● PMI developed educational materials in French and local languages to support social
and behavior change during mass campaigns. These materials include a leaflet that
describes and explains through a comic strip how to ventilate ITNs in the shade before
hanging them over sleeping spaces. PMI also developed radio microprogramming that
provides information on campaign dates, when net distribution will be done, and
encourages family members to sleep every night under ITNs. The programs also
include storytelling and poems for school children on the appropriate use and care of
ITNs, regular school attendance, and the negative impact of malaria on school
performance. Programs provide malaria lessons for primary school teachers and school
children’s curricula, and run thematic interactive radio programs to answer questions
from listeners.
● PMI also supported activities to improve health providers' identified behaviors, including
building a prototype quality health center using human-centered design, which consists
of collecting feedback from the community to improve the quality of services and the
performance of health providers.
● PMI supported the implementation of a set of SBC interventions to address community
and individuals behavior: a multi-media campaign targeting urban and peri-urban
populations in four target provinces, the outreach activities under the umbrella
campaign VIVA!, and the mini-campaigns to promote consistent ITN use, ANC
attendance and IPTp uptake, and early care-seeking for fever. Channels include TV,
radio, social media, billboards, household visits by Relais Communautaires (community
32
health extension worker), and information phone lines. These activities are estimated to
have reached over seven million people in PMI-supported provinces.
● Additionally, PMI supported routine monitoring of SBC implementation through quarterly
rapid surveys in four of PMI’s target provinces. These surveys focus on knowledge,
awareness, and practices for various health behaviors including malaria. PMI also
provided technical assistance to the NMCP for the development, validation, and
dissemination of the new National Strategic Communication Plan 2024-2028, and
elaboration of an advocacy plan for fundraising.
Key challenges remain for uptake of key behaviors in some technical areas:
● ITNs: Per the 2017-2018 MICS, the ITN use to access ratio is over 1.0 in the vast
majority of provinces (including PMI provinces) except for Kasaï Central (.59). This
trend was also observed during the 2022 MBS. Overall, the use to access ratio was .88,
indicating that most people with access to bed nets report using them, but there is room
for improvement. But in the Kasaï Central survey zone, the ratio was substantially lower.
The DRC MBS showed that positive attitudes toward ITNs and the belief in consistent
use of ITNs as community norm were less common in Kasaï zone compared to the
other zones.
● MIP: PMI conducted the ANC/IPTp study to explore health facility factors and health
provider characteristics associated with SP provision. The study revealed that data in
the ANC registry are often inaccurate and incomplete and showed the existence of
missed opportunities for SP delivery at ANC. The health provider needs an
improvement of his behavior on communication with clients while administering IPTp to
pregnant women, accuracy of data recorded on the registration tools and the
management of SP stock to avoid commodity stockout.
● Case Management: PMI carried out a study using qualitative methods to explore the
factors that influence providers’ decisions in malaria case management, how they
record data in the health registry regarding actions taken after RDT results and malaria
treatment decision-making. The study also examined how data are recorded in the
registry or synthesized for monthly reporting into the HMIS. The study findings raise
questions about 1) the reasons for differences in TPR based on HMIS versus Deki
Reader data, 2) the degree to which healthcare providers rely on RDT results when
making malaria case management decisions for their patients, and 3) what other factors
influence provider decisions about malaria case management. The conviction of
community members interviewed is that malaria is prevalent in the community, and
some women stated they would not leave the clinic without malaria medication. Health
center patients are not totally confident in the results of RDT mostly if negative and rely
on microscopy, and that the RDT would not pick up all species of malaria parasite.
33
The FY 2024 funding tables contain a full list of SBC activities that PMI proposes to support.
Priorities
While PMI supports SBC activities that promote the uptake and maintenance of all key malaria
interventions, the following three behaviors will be prioritized with FY 2024 funds:
Table 5. Priority Behaviors to Address

Target Geographic Programming to Address Behavior
Behavior Population Focus
Health worker Health providers All 9 ● Continued support for further roll-out of the
adherence to in the public/ PMI-focus communication module syllabus currently being
malaria case non-profit sector provinces introduced at the University of Kinshasa, envisioned
management to be incorporated in other medical training
guidelines for Caretakers/ institutions.
testing and patients seeking ● Community mobilization through CSOs and FBOs.
treatment and services ● Service delivery activities, including pre-service
data reporting. training for providers, in-service training, and
supportive supervision.
● Focused support to health workers on data
recording behaviors.
Consistent IPTp Pregnant All 9 ● Multi-media campaign (e.g., radio, TV, billboards)
uptake (including women PMI-focus targeted to urban and peri-urban areas.
early and regular provinces ● Service communication and counseling from facility
ANC attendance) Spouses/other based providers to pregnant women, care-takers,
head of partners/spouses.
household ● Community mobilization through civil
decision-makers mini-campaigns, society organizations, and
ANC providers faith-based organizations.
● Interpersonal communications from CHWs engaged
in health promotion activities.
● VIVA! activities in the community, including couples’
communication for ANC decisions, interpersonal
communications targeted to market-goers, and
strategies to encourage household health savings
to address cost barriers to ANC attendance.
● VIVA! activities will also engage local leaders to
serve as community mobilizers to promote ANC
attendance.
Prompt care Household All 9 PMI ● Multi-media campaign (e.g., radio, TV, billboards)
seeking for fever decision focus targeted to urban and peri-urban areas.
makers provinces ● Service communication and counseling from facility
based providers to pregnant women, care-takers,
partners/spouses.
34
● Interpersonal communications from CHWs engaged
in health promotion activities.
● Community mobilization through CSOs and FBOs.
● VIVA! activities in the community, including couples’
communication for care-seeking decisions,
interpersonal communication targeted to market
goers, and strategies to encourage household
health savings to address cost barriers to
care-seeking.
● VIVA! activities will also engage local leaders to
serve as community mobilizers to promote
care-seeking.
Additional Support Activities:
PMI will continue to implement activities based on the insights generated from the MBS, the
ANC/IPTp study, human-centered design work to address barriers to ANC attendance and
care-seeking, and a qualitative study on the determinants of RDT result use and malaria
treatment decision-making.
PMI will continue to support the roll out VIVA! light version of the umbrella campaign (less
expensive) as outreach activities and prepare the handover to the DRC MOH as community
strategy by the government and other national and international partners for the promotion of
essential family practices and the use of health services. This appropriation process by
government and NGOs is a step towards long-term sustainability.
The robust M&E strategy will continue to be supported by PMI to ensure these activities are
having the desired impact on behaviors, to inform whether and how these activities should be
scaled/targeted, and to inform changes and adjustments to activities that might be needed.
PMI will continue to support quarterly data collection and analysis to inform reach and recall of
malaria messages. Additionally, PMI will support the implementation of the provider behavior
tool to assess service delivery in health facilities in the behavior lens.
There is a need for continued SBC capacity-building at both the national and provincial levels
with increased support at provincial levels.
To bolster the NMCP programs, PMI will continue to support:

● National-level coordination of the SBC TWG.
● SBC activities related to the vaccine introduction and roll-out which depends on the
timeline, policies, and other key factors.
● Expansion of the communications training curriculum at medical training institutions
building on work done at the University of Kinshasa.
35
8. Surveillance, Monitoring, and Evaluation

Key recent surveillance, monitoring, and evaluation (SM&E) results include the evaluation of
the national malaria surveillance system. It also included an assessment of HMIS data
accuracy via the degree of discordance of test positivity rate of malaria RDT data interpreted
by automatic DEKI reader and reported in the national HMIS. The results included
strengthening the NMCP’s monitoring and evaluation capacity through TWGs focused on
malaria data review, analysis, and validation. PMI also supported joint supervision and malaria
routine data quality assessment to improve data quality and data management systems in
targeted health zones.
PMI supports many components of the DRC NMCP’s SM&E strategy across the nine
provinces and at the national level including:
● Focusing on improving the routine surveillance system, strengthening the M&E capacity
within the NMCP, and improving data quality across the nine supported provinces,
● Supporting national, provincial, health zone and health area data quality meetings and
reviews,
● Supporting printing and disseminating HMIS registers and monthly reporting forms for
the nearly 7,500 facilities within the PMI-supported provinces, and
● supporting standard surveys and other studies and operations research.

In CY 2022, PMI supported the following SM&E activities:
● Provided technical assistance to strengthen the central level NMCP M&E team’s
capacity through regular M&E TWG meetings. These focused on analyzing malaria
trends and mechanisms for improving health information. At the national level, PMI
supported six monthly data review and analysis meetings and three quarterly data
validation meetings.
● Supported the M&E capacity at the provincial level in data quality review and use. This
was accomplished through using nine provincial malaria SM&E advisors to assist with
supportive supervision and coordination of malaria activities around data completeness,
timeliness, compilation, and analysis at the provincial level. PMI/DRC continued to
support the implementation of DHIS2 in nine provinces, including 36 quarterly M&E
TWGs and nine annual integrated primary health care data reviews at the provincial
level.
● Supported joint supportive supervision visits from provincial to health zone level in 73
health facilities, covering 18 health zones across the nine PMI-supported provinces.
● Supported routine data quality assessments in 238 health facilities, covering 79 health
zones across the nine PMI-supported provinces.
● Supported 12 monthly data review meetings at the roughly 836 health areas and 129
health zones to conduct monthly data monitoring meetings.
36
● Supported the reproduction and dissemination of patient registers and monthly reporting
forms for the roughly 7,500 health facilities within the PMI-supported provinces.
● Supported the NMCP to develop and submit two abstracts for the American Society of
Tropical Medicine and Hygiene 2022 annual conference and to participate in person.
● Supported a comprehensive baseline assessment of the malaria system assessment in
250 health facilities covering 21 health zones across 4 PMI supported provinces (Haut
Katanga, Kasai Oriental, Lomami and Sud Kivu). This assessment helped to document
the state of malaria surveillance, identify gaps, define actions for improvement, and
measure future improvements of the malaria surveillance system in the DRC.

The FY 2024 funding tables contain a full list of SM&E activities that PMI proposes to support.
Using FY 2024 funds, PMI will maintain support for SM&E activities in DRC. This will include:
● Data analysis and use for program management, supervision to provincial levels,
coordination of M&E working groups, task force malaria and facilitation of national-level
reviews.
● Training and coaching on data analysis and use as well as general M&E support to the
NMCP provincial health departments.
● Support for implementing partner meetings to discuss SM&E activities and coordination
as well as continued improvement of standard dashboards and visualizations for review
of malaria data (routine and surveillance) at the health zone and provincial levels.
● Continued improvement of standard dashboards and visualizations through Malaria
Data integration and Visualization platform for review of malaria data (from routine
health information system), entomological monitoring, surveys, and climate data at the
health zone, provincial and national levels.
● Enhanced malaria data quality assessments with register comparison and review.
● Continued to support the malaria scientific days and to support the NMCP to develop,
submit abstracts and to attend the American Society of Tropical Medicine and Hygiene
annual conference.
● PMI will also support the production and dissemination of registers and monthly
reporting forms for all health facilities and community care sites within the nine
supported PMI provinces.
● Support 12 monthly data validation meetings at 179 PMI-supported health zones and
nearly 3,000 health areas, as well as transmission of data to the health-zone level.
● Support managing, monitoring, and integrating malaria vaccine introduction data into
the national HMIS.
● Based on the RDT quantitative study results, PMI is planning to strengthen malaria
surveillance through the assessment of the accuracy of the malaria morbidity data using
the Health Pulse application in a sample of supported provinces compared to the data
reported on the DRC health management information system via DHIS2.
37
Table 6. Available Malaria Surveillance Sources
Source Data Collection Activity 2020 2021 2022 2023 2024 2025
Household Surveys Demographic Health Survey P
Household Surveys Malaria Indicator Survey
Household Surveys Multiple Indicator Cluster Survey
Household Surveys Expanded Program on

Immunization survey
Health Facility Surveys Service Provision Assessment
Health Facility Surveys Service Availability Readiness

Assessment survey
Health Facility Surveys Other Health Facility Survey
Malaria Surveillance and Therapeutic Efficacy Studies

Routine System Support
Malaria Surveillance and Support to Parallel Malaria

Routine System Support Surveillance System
Malaria Surveillance and Support to Health Management X X X P P P

Routine System Support Information System
Malaria Surveillance and Support to Integrated Disease

Routine System Support Surveillance and Response
Malaria Surveillance and Electronic Logistics Management X X X P P P

Routine System Support Information System
Malaria Surveillance and Malaria Rapid Reporting System

Routine System Support
Other End-Use Verification Survey X X X P P P
Other School-based Malaria Survey
Other Knowledge, Attitudes and X

Practices Survey, Malaria
Behavior Survey
Other Malaria Impact Evaluation
Other Entomologic Monitoring Surveys X X X P P P
*Asterisk denotes non-PMI funded activities, X denotes completed activities and P denotes planned activities.
38
9. Operational Research and Program Evaluation (PE)

PMI continues to support the two guiding principles of the NMCP’s Malaria National Strategic
Plan 2020-2023: 1) innovation in developing new implementation tools to fight malaria; and 2)
research to maximize progress toward malaria elimination in DRC.
PMI recently completed a quantitative and qualitative study assessing the degree of
discordance in test positivity rate of malaria RDT data generated by automated readers
compared to those reported in the national HMIS.
These results highlighted that health providers over-report malaria RDT diagnostic results and
the presence of an RDT reader can change provider behavior. Through the M&E Technical
Working Group and the Malaria Task Force meetings, future efforts will focus on mitigation
solutions, including strengthening health provider’s communication for behavioral change to
improve the quality of the data reported in the national database.

With FY 2019–2021 funds, PMI completed the “Assessing the Accuracy of Malaria Test
Positivity Rates and Related Indicators Reported into the National Health Management
Information System in the Democratic Republic of Congo” study. This study used an
automated RDT reader to analyze and interpret RDT results. The study is one piece of a larger
effort to understand the breadth and depth of data quality issues related to counts of patients
tested by RDT, positive by RDT, and test positivity rate. These efforts hope to inform important
data quality questions in DRC.
The study measured the differences between the test positivity rates (TPRs) reported by the
Deki readers and routine surveillance data reported in HMIS in 144 health facilities in three
provinces (Haut Katanga, Kasai Central, and Sud Kivu).
The results showed potential over-notification of positive RDTs by 27 percent in South Kivu, 46
percent in Kasai Central, and 118 percent in Haut Katanga. According to the providers
behavior study conducted to identify determinants of providers’ behavior affecting malaria
treatment decision making, the perceived pressure and opinions of peers (other health workers
in the facility, supervisors, and patients) appeared to be a major factor.
PMI also conducted an assessment of the national malaria surveillance system in DRC,
including a diagnostic of the surveillance system, the infrastructures in place such as human
resources, information technology, and the national directives. Other aspects assessed
included data reporting, analysis, quality assurance of data and behavioral aspects including
governance and the staff competence and motivation.
39
The results showed that the quality of malaria surveillance data remains low and DRC faces
several challenges with governance and health system infrastructure. Major recommendations
included improving the infrastructure, data reporting, and governance to improve data quality.
Table 7. PMI-funded Operational Research/Program Evaluation Studies in DRC

Recently Completed OR/PE Studies Dissemination status Start date End date
Exploring barriers to IPTp (ANC/IPTp) Completed Mar. 2021 Feb. 2022
Ongoing or Planned OR/PE Studies Status Start date End date
Assessing the accuracy of malaria test positivity rates Completed Dec. 2021 Dec. 2022
and related indicators reported into the national HMIS
Assessment of the national malaria surveillance system Completed Nov. 2021 Dec. 2022
ANC: antenatal care; HMIS: health management information system; IPTp: intermittent preventive treatment during pregnancy.
Table 8. Non-PMI-funded Operational Research/Program Evaluation Studies Planned/Ongoing in

DRC
Funding Source Implementing Institution Research Question/Topic Current Status/Timeline
UNITAID Jhpiego Feasibility of community IPTp, Ongoing: 2017–2022
four-country study (TIPTOP). 2024 (TIPTOP)
TIPTOP: Transforming Intermittent Preventive Treatment for Optimal Pregnancy

No OR/PE activities are proposed with FY 2024 funding.
10. Capacity Strengthening

PMI supports the NMCP objective to strengthen its technical and managerial capacity at the
central and provincial levels to effectively implement the national malaria strategic plan and
reach its objectives. PMI’s support focuses on:
● Ensuring that the NMCP has an adequate and conducive working environment.
● Managing training for malaria focal points and health zone officers.
● Coordinating malaria activities at provincial and lower levels of the health system.
● Implementing NMCP organizational development and leadership strengthening activity
that follows the 2014 national program institutional audit recommendations.

PMI supported the following capacity strengthening activities in the last 12 months:
● Targeted training and coaching of NMCP’s leadership skills and workforce development.
● Supported the implementation of the FETP program with four FETP trainees working
directly with the NMCP. Specifically, PMI supported the training of two advanced cohort
FETP trainees to strengthen residents’ capacity to correctly complete malaria
40
surveillance tools, analyze malaria data, supervise CHWs, and investigate reported
malaria outbreaks. In addition, funding from PMI supported an NMCP-led training of 22
health zone-level supervisors (Infirmiers Titulaires) to build capacity in malaria
surveillance and monitoring. These trainees will provide training to health facility-level
malaria data managers. PMI also directly engaged with the residents to understand their
needs and determine how they can efficiently support the NMCP.
● Developed annual operational plans for all supported health zones.
● Supported supervision at all levels, including the nine PMI supported provinces by the
central level, and supervision of health zones by the provincial management teams.
● Supported the NMCP to plan and conduct malaria TWG at national and provincial levels
and malaria task force meetings at the national level.

The FY 2024 funding tables contain a full list of capacity strengthening activities that PMI
proposes to support.
DRC will continue to support most capacity-strengthening activities as described in the Recent
Progress section above. The FY 2023 funding tables contain a detailed list of activities that
PMI proposes to support in DRC, including strengthening the capacity of NMCP to:
● Provide support to the MOH/NMCP to engage with the private sector and establish a
private sector TWG. Strengthen the private sector capacity to be involved in malaria
activities support. Support the MOH/Government of DRC to maintain and reinforce the
public-private partnership and identify future opportunities.
● Support the establishment of an enabling environment for identified digital initiatives,
and support the identification and customization of a community-based digital tool, and
support development of standard operating procedures on community-based
surveillance.
● Support the electrification of at least 60 health facilities in two years to improve service
quality and access to networks for ease of digital health data recording and reporting.
11. Staffing and Administration
In most PMI countries, a minimum of three health professionals oversee PMI. The single
interagency team led by the USAID mission director or their designee consists of resident
advisors representing USAID and CDC, and one or more locally hired experts known as
foreign service nationals. In DRC, there are three locally hired experts, two resident advisors
representing USAID and CDC, and the overall management is provided by a malaria and
tuberculosis team lead. The PMI interagency team works together overseeing all technical and
administrative aspects of PMI, including project design, implementing malaria interventions,
including cross cutting interventions that are M&E, SBC, supply chain management. PMI also
provides guidance and direction to PMI implementing partners.
41
ANNEX: GAP ANALYSIS TABLES
42
Table A-1. Routine ITN Gap Analysis Table
Calendar Year 2023 2024 2025
Total country population 123,968,672 127,687,732 131,518,364
Total population at risk for malaria 123,968,672 127,687,732 131,518,364
PMI-targeted at-risk population 47,063,168 48,475,063 49,929,315
Population targeted for ITNs 47,063,168 48,475,063 49,929,315
Continuous Distribution Needs
Channel 1: ANC 1,770,288 1,390,615 1,425,464
Dual AI and Dual AI and
Channel 1: ANC Type of ITN PBO
PBO PBO
Channel 2: EPI 1,550,524 1,597,040 1,644,951
Dual AI and Dual AI and
Channel 2: EPI Type of ITN PBO
PBO PBO
Channel 3: School
Channel 3: School Type of ITN
Channel 4: Community
Channel 4: Community Type of ITN
Channel 5:
Dual AI and
Channel 5: Type of ITN PBO PBO
PBO
Estimated total need for continuous channels 3,320,812 2,987,655 3,070,415
Mass Campaign Distribution Needs
Mass distribution campaigns
Mass distribution ITN type
Estimated total need for campaigns
Total ITN Need: Continuous and Campaign 3,320,812 2,987,655 3,070,415
Partner Contributions
ITNs carried over from previous year 1,475,704 704,992 1,064,143
ITNs from Government
Type of ITNs from Government
ITNs from Global Fund
Type of ITNs from Global Fund
ITNs from other donors
Type of ITNs from other donors
ITNs planned with PMI funding 2,550,100 3,346,806 2,370,415
Dual AI and
Type of ITNs with PMI funding PBO PBO
PBO
Total ITNs Contribution Per Calendar Year 4,025,804 4,051,798 3,434,558
Total ITN Surplus (Gap) 704,992 1,064,143 364,142
ANC:antenatal care; EPI: expanded program on immunization; ITN: insecticide-treated mosquito net; PBO: piperonyl butoxide.
43
Table A-2. Mass Distribution ITN Gap Analysis Table
Population targeted for ITNs 47,063,168 48,475,063 49,929,315
Population targeted for mass distribution
3,171,235 8,914,744 14,433,289
campaigns
Lualaba 3,171,235
Kwango
Kasai-Central 5,876,572
Kasai-Oriental 6,232,019
Kasai
Nord Ubangi
Continuous Distribution Needs
Channel 1: ANC
Channel 1: ANC Type of ITN
Channel 2: EPI
Channel 2: EPI Type of ITN
Channel 3: School
Channel 3: School Type of ITN
Channel 4: Community
Channel 4: Community Type of ITN
Channel 5:
Channel 5: Type of ITN
Estimated total need for continuous channels 0 0 0
Mass Campaign Distribution Needs
Mass distribution campaigns 1,761,797 4,952,635 8,018,494
Mass distribution ITN type
Estimated total need for campaigns 1,761,797 4,952,635 8,018,494
Total ITN Need: Continuous and Campaign 1,761,797 4,952,635 8,018,494
Partner Contributions
ITNs carried over from previous year 2,295,139 533,342 0
ITNs from Government
Type of ITNs from Government
ITNs from Global Fund
Type of ITNs from Global Fund
ITNs from other donors
Type of ITNs from other donors
ITNs planned with PMI funding 0 0
Type of ITNs with PMI funding PBO PBO Dual AI, PBO
Total ITNs Contribution Per Calendar Year 2,295,139 533,342 0
Total ITN Surplus (Gap) 533,342 (4,419,294) (8,018,494)
EPI: expanded program on immunization; ITN: insecticide-treated mosquito net; PBO: piperonyl butoxide.
44
Table A-3. RDT Gap Analysis Table
Population at risk for malaria 123,968,672 127,687,732 131,518,364
RDT Needs
Total # of projected suspected malaria cases 12,385,998 13,682,423 14,199,676
% Percent of suspected malaria cases tested with
92.91% 92% 92%
an RDT
RDT Needs (tests) 11,508,144 12,610,785 13,105,484
Needs estimated based on other DHIS2 DHIS2 DHIS2
Partner Contributions (tests)
RDTs from Government
RDTs from Global Fund
RDTs from other donors
RDTs planned with PMI funding 10,584,067 9,024,760 13,352,834
Total RDT Contributions per Calendar Year 10,584,067 9,024,760 13,352,834
Stock Balance (tests)
Beginning balance 7,962,140 7,038,063 3,452,038
- Product need 11,508,144 12,610,785 13,105,484
+ Total contributions (received/expected) 10,584,067 9,024,760 13,352,834
Ending Balance 7,038,063 3,452,038 3,699,388
Desired end of year stock (months of stock) 6 6 6
Desired end of year stock (quantities) 5,754,072 6,305,392 6,552,742
Total Surplus (Gap) 1,283,991 (2,853,354) (2,853,354)
RDT: rapid diagnostic test.
45
Table A-4. ACT Gap Analysis Table
Population at risk for malaria 127,687,732 131,518,364 123,968,672
ACT Needs
Total projected # of malaria cases 11,266,937 11,788,171 10,081,022
Total ACT Needs (treatments) 11,266,937 11,788,171 10,081,022
Partner Contributions (treatments)
ACTs from Government
ACTs from Global Fund
ACTs from other donors
ACTs planned with PMI funding 11,110,971 12,048,789 9,414,690
Total ACTs Contributions per Calendar Year 11,110,971 12,048,789 9,414,690
Stock Balance (treatments)
Beginning balance 5,508,834 5,352,868 6,175,166
- Product need 11,266,937 11,788,171 10,081,022
+ Total Contributions (received/expected) 11,110,971 12,048,789 9,414,690
Ending Balance 5,352,868 5,613,486 5,508,834
Total Surplus (Gap) (280,600) (280,600) 468,323
ACT: artemisinin-based combination therapy.
46
Table A-5. Injectable Artesunate Gap Analysis Table
Injectable Artesunate Needs
Projected # of severe cases 965,647 1,225,828 1,280,651
Projected # of severe cases among children 0-5
446,129 679,784 715,165
years of age
Average # of vials required for severe cases
3 3 3
among children 0-5 years of age
Projected # of severe cases among children 6-13
198,923 273,022 282,743
years of age
6 6 6
among children 6-13 years of age
Projected # of severe cases among adults 321,561 273,022 282,743
9 9 9
among adults
Total Injectable Artesunate Needs (vials) 5,425,972 6,134,678 6,386,637
Partner Contributions (vials)
Injectable artesunate from Government
Injectable artesunate from Global Fund
Injectable artesunate from other donors
Injectable artesunate planned with PMI funding 1,438,124 1,418,691 1,072,748
Total Injectable Artesunate Contributions per
1,438,124 1,418,691 1,072,748
Calendar Year
Stock Balance (vials)
Beginning balance 2,103,253 0 0
- Product need 5,425,972 6,134,678 6,386,637
Ending Balance (1,884,595) (4,715,987) (5,313,889)
Total Surplus (Gap) (4,597,581) (7,783,326) (8,507,208)
47
Table A-6. RAS Gap Analysis Table
Artesunate Suppository Needs
# of severe cases expected to require pre-referral
dose (or expected to require pre-referral dose 176,523
based on # of providers for the service)
Total Artesunate Suppository Needs
223,479 334,888 349,513
(suppositories)
Partner Contributions (suppositories)
Artesunate suppositories from Government
Artesunate suppositories from Global Fund
Artesunate suppositories from other donors
Artesunate suppositories planned with PMI funding 232,849 221,442 356,826
Total Artesunate Suppositories Available 232,849 221,442 356,826
Stock Balance (suppositories)
Beginning balance 97,806 107,176 0
- Product need 223,479 334,888 349,513
+ Total contributions (received/expected) 232,849 221,442 356,826
Ending Balance 107,176 (6,269) 7,313
Desired end of year stock (quantities) 111,739 167,444 174,757
Total Surplus (Gap) (4,563) (173,713) (167,444)
RAS: rectal artesunate suppository.
48
Table A-7. SP Gap Analysis Table
PMI targeted at risk population 47,063,168 48,475,063 49,929,315
SP Needs
# of Pregnant women
% of Pregnant women expected to receive IPTp1 95% 100% 100%
Total SP Needs (doses) 6,238,192 6,210,182 6,436,914
Partner Contributions (doses)
SP from Government
SP from Global Fund
SP from other donors
SP planned with PMI funding 4,266,200 6,974,073 6,550,280
Total SP Contributions per Calendar Year 4,266,200 6,974,073 6,550,280
Stock Balance (doses)
Beginning balance 2,742,054 770,062 1,533,953
- Product need 6,238,192 6,210,182 6,436,914
Ending Balance 770,062 1,533,953 1,647,319
Total Surplus (Gap) (2,349,033) (1,571,138) (1,571,138)
IPTp: intermittent preventive treatment during pregnancy; SP: sulfadoxine-pyrimethamine.
49

FY 2024 DR Congo MOP

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FY 2024 DR Congo MOP

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U.S.

PRESIDENT’S MALARIA INITIATIVE

Democratic Republic of the Congo

ACT Artemisinin-based Combination Therapy

U.S. President’s Malaria Initiative

Rationale for PMI’s Approach in DRC

Overview of Planned Interventions

1. Vector Monitoring and Control

5. Health Supply Chain and Pharmaceutical Management

7. Social and Behavior Change

8. Surveillance, Monitoring, and Evaluation

9. Operational Research and Program Evaluation

10. Capacity Strengthening

11. Staffing and Administration

There are no planned changes in staffing and administration in MOP 2024.

2. U.S. President’s Malaria Initiative

3. Rationale for PMI’s Approach in the DRC

3.1. Malaria Overview for DRC

3.2. Key Challenges and Contextual Factors

3.3. PMI’s Approach for the DRC

3.4. Key Changes in this Malaria Operational Plan

II. OPERATIONAL PLAN FOR FY 2024

1. Vector Monitoring and Control

1.1. PMI Goal and Strategic Approach

1.2. Recent Progress (April 2022–April 2023)

1.3 Plans and Justification for FY 2024 Funding

1.3.1. Entomological Monitoring

Summary of Distribution and Bionomics of Malaria Vectors in DRC

Status of Insecticide Resistance in DRC

1.3.2. Insecticide-Treated Nets

Insecticide-treated Mosquito Net Distribution in DRC

Table 1. Streamlined Durability Monitoring

December 2020 Tanganyika Veeralin (Alpha- April/May February/ February Planned

December 2020 Tanganyika SafeNet April/May February/ February Planned

1.3.3. Indoor Residual Spraying (IRS)

2.1. PMI Goal and Strategic Approach

National Malaria Control Program Approach

PMI Objective in Support of NMCP

2.2. Recent Progress (April 2022–March 2023)

2.3. Plans and Justification for FY2024 Funding

4.1. PMI Goal and Strategic Approach

Figure 2. Map of Case Management, Community Health and Malaria in Pregnancy

4.2. Recent Progress (April 2022–April 2023)

● Procurement of 10,584,025 malaria RDTs and 9,464,310 treatments.

Table 2: Quantities of Commodities Distributed

Artemether/Lumefantrine 20/120 mg Dispersible Tablet 1 x 6x1 Blister Pack Tablets 179,064

Artemether/Lumefantrine 20/120 mg Dispersible Tablet 1 x 6x2 Blister Pack Tablets 678,420

Artemether/Lumefantrine 20/120 mg Tablet 1 x 6x3 Blister Pack Tablets 562,344

Artemether/Lumefantrine 20/120 mg Tablet 1 x 6x4 Blister Pack Tablets 750,595

Artesunate 100 mg Suppository 2 Suppositories/Blister 247,538

Artesunate/Amodiaquine 100/270 mg Tablet 25 x 3 Blister Pack Tablets 2,148,800

Artesunate/Amodiaquine 100/270 mg Tablet 25 x 6 Blister Pack Tablets 2,890,925

Artesunate/Amodiaquine 25/67.5 mg Tablet 25 x 3 Blister Pack Tablets 1,085,325

Artesunate/Amodiaquine 50/135 mg Tablet 25 x 3 Blister Pack Tablets 2,913,075

Malaria Rapid Diagnostic Test (Pf) Cassette 1 Test 10,787,463

Facility Level progress:

Community Level Progress

4.3. Plans and Justification for FY 2024 Funding

National Level Case Management Activities