Winning the war against Malaria Africa, collectively

MAMA Miriam walks purposefully out of the A to Z factory, where she works as a sewing machinist. She remembers that traumatic hot December in 2005 in her home Kisongo, Arusha, when she lost her three-year old daughter, Agnes, to cerebral malaria.

How she had loved being called “Mama Agnes!” Agnes was her first child and the healer was away when she fell sick. By the time she gave up on his return and took her little girl to the public hospital, she was told that she had delayed too long!

That year she did not have a single mosquito net in her compound, and now 11 years and three children later, she has enough for everyone in the compound to sleep under a mosquito net. Since the first LLIN campaigns in 2008, no child in her compound had acquired malaria.

Yes life was different, her family was not only malaria free, but she was one of thousands working for A to Z and manufacturing LLINs for all of Tanzanians and for many other African countries.

Mama Miriam and her family live the vision of the African Leaders Malaria Alliance (ALMA). When Africa’s Heads of State and Government met in September 2009 to form ALMA, they were convinced that freeing the continent of malaria would not only save it direct and indirect costs, but that the process of malaria control and elimination presented a golden opportunity for job creation and economic growth.

Today, as we approach the end of the first year of the Sustainable Development Goals, Africa is faced with the opportunity of building on the experience of the many families that have been able to save their children, cutting deaths from 694,000 in 2000 to 292,000 in 2015.

These young lives saved are attending school, with boosted learning outcomes from reduced absenteeism.

The reduction in the number of malaria cases and morbidity, from 262 million in 2000 to 214 million in 2015, as well as the increase in use of RDTs to ensure timely early detection and availability of ACTs for treatment, means that there is increased productivity in the agricultural, mining and manufacturing sectors, which are the backbone Africa’s growth and development. With a productive labor force, and taking a leaf out of Tanzania, the continent is aggressively pursuing local manufacturing of malaria drugs and commodities.

A more concerted effort in this regard can contribute tremendously to turning the youth bulge on the continent into a demographic dividend. In August of this year, Ministers of Health from Sub- Saharan Africa met for the World Health Organisation’s AFRO Regional Committee meeting in Addis Ababa, Ethiopia, where they adopted the framework for implementing the Global Technical Strategy for Malaria for 2016 to 2030 in the African Region.

The framework outlined the vision for an Africa free of malaria, and complemented the Catalytic Framework to End AIDS, TB and eliminate malaria in Africa by 2030 that was endorsed by the African Heads of State and Government in Kigali, Rwanda in July.

In adopting the framework, the ministers underscored three essential pillars for sustainable quality health service delivery: community involvement, focus on domestic resources and tools that work.

The use of health extension workers and community structures to ensure ownership and participation at individual household and community level is critical, and was effectively demonstrated by Ethiopia that to deliver effective primary health care, a competent universal cadre of community health workers is essential.

Countries emphasised the need to address sufficient, effective and efficient use of domestic resources, from both the public and private sectors, to bridge the substantial resource gap that still exists for universal coverage and for Africa to eliminate malaria.

On the August 28, at the 2016 TICAD meeting in Nairobi, Kenya, WHO launched a comprehensive report entitled “Public Financing for Health in Africa: From Abuja to the SDGs.” The report illustrates that for every US$100 that goes into state coffers in Africa, on average, US$16 is allocated to health; only US$10 is in effect spent, and less than US$4 goes to the right health services.

Achieving equity in both financial protection and service coverage has become paramount. The report identifies four areas of concern as being de-prioritization of heath, funding inconsistency and budget underspends and misallocation of resources. The underlying message is clear.

A comprehensive integrated service delivery model with an effective management tool is essential. The malaria parasite, together with its vector, have stubbornly adapted and developed resistance to vector control and infection treatment tools, again and again. It is therefore critical that every country develop a national resistance monitoring and management plan.

To win the war, malaria partners are actively developing new technologies to replace and complement the old whilst others engage in innovative market shaping to ensure early introduction.

To further accelerate this process and keep ahead of the parasite, countries are committing to accelerating the removal of barriers such as delayed licensing of new tools and /or delayed introduction of new guidelines and protocols for the use of the tools.

This month member countries of the United Nations meet in New York for the 71st regular session of the UN General Assembly. The assembly is focusing on the implementation of the SDGs with the theme “The Sustainable Development Goals: A universal push to transform our world.”

For malaria, the stage is set. Countries have developed road maps and have started implementing. ALMA is supporting countries to develop national and sub-national malaria scorecard accountability management tools to enhance transparency, accountability and action as we move towards malaria elimination by 2030.

What countries must focus on is the holistic adoption of the three critical pillars. The SDGs are ambitious, but like Nelson Mandela would say, “As long as poverty, injustice and gross inequality persist in our world, none of us can truly rest. It always seems impossible until it’s done.

” The ALMA vision can become a reality for all in Africa, but we all have to make it happen, just like Mama Miriam

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