Equity as a prerequisite to achieving Universal health coverage.

The Malaria Matchbox is an assessment toolkit designed to ignite equity in malaria programs, by correlating data on populations’ acc ess and utilization of healthcare services with countries’ malaria programming across the continuum from control to elimination. Through ensuring consideration of the root causes of health inequities across different contexts, populations and groups of individuals and contributing to developing malaria programming plans, the toolkit aims to contribute to the ambitious global health targets set under SDG3, which call on the international community to ensure healthy lives and promote wellbeing for all at all ages, and in all settings, including humanitarian and fragile (4). This will ensure that no one is left behind, irrespective of who and where they are. Achieving the SDG sub-goals of reducing maternal, newborn and infant mortality (3.1 and 3.2), as well as ending HIV, TB, malaria and neglected tropical diseases (3.3) (5) requires a continued political commitment to address a vast range of underlying social determinants of poor health such as poverty, social and geographic exclusion, harmful gender and traditional norms and financial barriers. Populations living in fragile settings or affected by conflicts, such as refugees, internally displaced people including those displaced by urbanization, construction or human development, are at particular risk of deprivation of basic healthcare services, linked to discrimination, marginalization, lack of security and many other inequities. Other marginalized populations including seasonal workers, and those displaced by urbanization/construction/human development are, also at risk. A number of studies, have also found that marginalized populations can be particularly vulnerable to malaria as they face barriers to accessing health services, including those for malaria. Ethnic or political minority groups, for instance, tend to be impoverished and mobile (6, 7), and may not have services available where they live, may be denied services based on factors such as citizenship, ethnicity, religion or political affiliation or may avoid accessing the health systems because of fear of unwanted attention from government authorities, thus limiting access to malaria prevention, diagnosis and treatment (8, 9). Gender inequality can also increase the risk of malaria and limit access to services, depending on the socio-economic context. Many women and girls live in greater poverty and the harmful effects of inequality act as barriers to accessing health services (10) in addition, to possible unequal gender norms that favor boys and men in the distribution of household resources over girls and women. Poverty, disability and geographic location further impact the availability, accessibility and utilization of health services. Generally, adolescents and young people are seen to be healthy and few services cater to their needs or able to reach them with relevant, responsive and respectful services. Growing evidence shows that adolescents often have difficulty in accessing basic health care prevention or treatment services due to financial barriers, fear of intimidation and need of parental consent (11). Out of school youth and adolescents may also have difficulty in accessing primary health care services, with potential implications for the management of malaria among these groups (12). These further disadvantage adolescent girls already more vulnerable to malaria (13). Men may also experience the consequences of harmful gender-relates barriers, which often present in work-related exposure to the vector and avoidance of proper health seeking. The fact that malaria continues to be a main cause of child mortality, although preventable and curable, reveals a broken link between primary health services and individuals. The World Malaria Report 2018 revealed insufficient levels of access to and uptake of lifesaving malaria tools and interventions; and that a considerable proportion of people at risk of malaria are not being protected, including pregnant women and children (14). Notably, 30% of febrile children do not access any treatment at any level, only 22% of pregnant women access the 4th dose of Intermittent preventive treatment PART A: INTRODUCTION 1 Policy approach Malaria Matchbox Tool 9 10 Malaria Matchbox Tool in pregnancy (IPTp) and nearly 30% of the population in Africa do not have access to any sort of vector control. Pregnant women and children continue to be at highest risk of malaria as they are the most immunologically weaker but also are at highest risk of being marginalized (14). To get back on track, the World Malaria Report 2018, calls for a comprehensive approach that includes universal access to effective vector control, early diagnosis and treatment including a renewed focus on reaching the most vulnerable and underserved populations (5).