Fatima holds her baby as Mu’Awya Saidu administers a rapid malaria test during check-in at a health center in Kebbi State, Nigeria in early 2020. Photo by Breakthrough ACTION

Fatima Tukur was worried. Her baby had been running a fever and now had chills and couldn’t keep food down. Fatima thought it might be malaria, but she wasn’t sure, so she bundled up her baby and started to make her way to the nearest clinic.

On the road to the clinic, Fatima grew more and more anxious. She knew malaria tests usually took all day and she had other children to care for at home. Fatima considered buying malaria medicine from a drug shop, but she wanted the reassurance of a malaria test result. She resigned herself to spending the day waiting in the clinic and checked in as she arrived. Her baby was worth the wait.

As Fatima took a seat in the waiting area, a nurse quickly came over, checked the baby’s vital signs, and administered a rapid malaria test. Fatima was surprised. Rather than waiting all day in the clinic, she had received the baby’s test results and medicine and was on her way back home in just a few hours.

Historically, clinics and hospitals have required patients to see a provider before a malaria test can be ordered and given. Once test results are ready, patients have to see the provider again to receive a diagnosis and, eventually, a prescription. However, a new check-in procedure that was developed and tested with funding from the U.S. President’s Malaria Initiative (PMI) can be credited for Fatima’s quick visit in early 2020 and is now poised to be a game changer for overburdened health systems dealing with malaria.

To develop this new approach to malaria testing, PMI and the Nigeria National Malaria Elimination Programme (NMEP) used an innovative behavior change process that draws from human-centered design and behavioral economics. Using these disciplines created opportunities to work closely with health care providers from Kebbi, Nasarawa, and Akwa Ibom, Nigeria from the beginning of the design process to the resulting solution.

In late 2019, the providers first helped conduct interviews that identified “pain points” in current clinic practices. PMI, the NMEP, and the health care providers then used this data to generate potential solutions, test them in clinical settings, and refine them based on their findings. By working with providers to develop the new approach to testing, PMI and the NMEP increased the likelihood that it would be accepted by other health care providers.

Ultimately, the new testing approach improves providers’ adherence to malaria testing and treatment guidelines by ensuring patients with fever get a malaria test as soon as they check-in. Not only does this save patients time, but it also gives providers the information they need to make decisions about treatment right away.

Furthermore, the new procedure reduces the temptation to rely on clinical intuition, which can result in overuse of malaria medications, and makes sure life-saving medicines are available for patients who actually have malaria.

Unfortunately, many people in Nigeria are receiving and taking malaria medication even when they don’t have malaria. One study from Ebonyi State found that approximately 51 percent of public and private providers prescribed malaria treatment to patients who tested negative for the disease.

Now, thanks to the work carried out by PMI, the NMEP, and providers, everyone who comes to a clinic or hospital with a fever automatically gets a rapid malaria test as soon as they are checked in. The health care provider gets the results immediately and is able to make an informed treatment decision faster.

Automatically testing for malaria before going into a consultation with a health care provider has also increased efficiency and cut down the amount of time patients spend in clinics waiting to be seen or waiting for test results and treatment.

“You see the crowd of patients waiting outside to see me? I am not worried because those who complained of fever already have their malaria test results with them,” said Mu’Awya Saidu, Officer in Charge, Primary Health Centre Birnin Yari in Kebbi State. Under the old system he would have seen them before and after the test, but now he can treat those with malaria in just one visit. “This has made my work easier.”

The three states in Nigeria that participated in developing the testing approach now have a new tool in their fight against malaria. More importantly, it is a tool that can be put into use in other states at no additional cost. Providers hope it will, ultimately, lead to better use of life-saving malaria drugs and quality of care for patients with fever, like Fatima’s baby.