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Monthly Archive for "December 2009"



Malaria in Pregnancy &Reproductive Health Bill Brieger | 19 Dec 2009

15 years since Cairo

On Monday, “Secretary of State Hillary Rodham Clinton will deliver a speech commemorating the 15th anniversary of the International Conference on Population and Development (ICPD),” held at Cairo. “At this event, Secretary Clinton will declare the U.S. Government’s renewed support for and dedication to reaching the ICPD and other related UN agreements, including the Millennium Development Goals, by 2015,” which include reducing both maternal mortality and malaria.

In a publication marking 15 years since the Cairo Conference, UNFPA has published an update entitled, “Healthy Expectations: Celebrating Achievements of the Cairo Consensus and Highlighting the Urgency for Action.” The document explains that …

In 2005, the lifetime risk of death from maternal causes was 1 in 22 for women in sub-Saharan Africa, compared with less than 1 in 6,000 for women in more developed countries. For each woman who dies, 20 additional women suffer pregnancy-related disabilities … Most maternal deaths occur to women who live in sub-Saharan Africa and South Asia. The number of maternal deaths in sub-Saharan Africa has increased as the number of women in the childbearing ages has grown.

maternal-mortality-lifetime-risk2.jpgThe attached map from UNFPA shows heightened maternal mortality in just the same regions of the world where malaria is most prevalent.

When Secretary Clinton speaks she will remind us that, “Millions of lives have been improved and saved through effective and affordable reproductive health programs, which have proven to prevent the deaths of women and children, reduce the spread of HIV/AIDS, grow economies, and preserve natural resources.” These programs should include malaria in pregnancy control as an integral part of antenatal care.

It is useful in this context to think of the ICPD guiding principles. Principle 4 addresses “Advancing gender equality and equity and the empowerment of women.” For malaria control this means ensuring malaria in pregnancy control programs are fully funded and operational since pregnant women suffer more from malaria than other adults in endemic areas.

Principle 8 recognizes the right of people to space their children. This process can be frustrated due to fetal loss during malaria in pregnancy or from peri-natal and infant mortality when children are born with low birth weight and are less likely to survive.

Neither our reproductive health nor our malaria programs are complete until we plan to meet the needs of pregnant women who are risk from this deadly parasitic disease. Integrated planning and service delivery is required.

Funding &Integrated Vector Management &Private Sector Bill Brieger | 18 Dec 2009

Ghana’s private sector support against malaria

Last week we highlighted the global role of the private sector in malaria control. Today we share some specific country level examples from Ghana.

malaria-cases-sm.jpgFor the past few years AngloGold Ashanti has been operating a successful pilot indoor residual spray (IRS) program in Obuasi District.  The project reported downward trends in hospital attendance and admission due to malaria which were attributed to the twice yearly spraying efforts.  Some pilot larviciding was also included.

Based on these efforts US President’s Malaria Initiative working with the National Malaria Control Program and partners began planning to initiate IRS in five northern districts. “PMI expanded IRS from five to six districts, protecting over 708,000 residents,” and is now planning collaboration with Ghana’s Global Fund grant recipients to expand further.

Now Now AngloGold Ashanti is ready “to extend its anti-malaria control to 40 districts in the Upper East and West, Ashanti, Western and Northern regions of Ghana, come January 2010,” as a recipient of Global Fund support from Ghana’s Round 8 Malaria Grant.

Another private partner in Ghana is the Zoomlion Waste Management Company. The Ghanaian Chronicle reports that, “The Volta Region office of Zoomlion Waste Management Company Limited has intensified its efforts to spray gutters, toilets and refuse disposal sites in the districts, as a step to destroying the breeding grounds and resting places of mosquitoes, to curb the menace of malaria.”

While such spraying may be more likely to kill culex species of malaria more than the malaria-bearing anopheles, the effort does show how the private sector can play a direct role.

Another mining company, Newmont, while not providing direct services, does offer health education to “help all those in affected areas prevent the spread of this terrible yet preventable disease,” on its website.

The telecoms giant, “MTN Ghana, a leading telecom company in Ghana, has announced that since its entrance into the Ghanaian telecom market, the company has invested about $2 million in socio-economic development projects in the areas of health and education.” More specifically, as part of its malaria fund and awareness raising efforts leading up to the Football World Cup of 2010, MTN is including Ghana in its target countries.

These examples are not meant to be exhaustive, but to show the different roles the private sector can play at the country level ranging from direct control activities to raising awareness and educating people to protect themselves.  For long term benefit, all such efforts need to be coordinated, like the IRS project, with the National Malaria Control Program and its RBM Partners.

Monitoring Bill Brieger | 17 Dec 2009

On the cards – literally and figuratively

The Herald of Zimbabwe reports that, “NEW vaccines for meningitis, hepatitis, malaria and diarrhea among other diseases that had no vaccines before are on the cards as the world moves to effectively reduce cases of infant mortality and morbidity in view of attaining the World Millennium Development Goals.”

The Herald’s article is using the common metaphor, “on the cards,” or as said in the US, “in the cards”, to refer to a predictable or likely future event.  In essence the article expresses expectations that new vaccines will be incorporated into national health programs in the near future.

The metaphor is likely based on the fact that cards, as in the kind used to play games or Tarot cards, have been used for centuries to divine the future. But there is another kind of card that is crucial for determining the success of health programs generally and malaria interventions specifically. That is the record card that shows the health services a client has received.

Unfortunately, malaria interventions are not always “on the cards” that one finds at public health service centers.  In Ghana, for example, the antenatal card (actually a small booklet) for pregnant women does have a place to write if she has received IPTp and the number of doses, but there is no official place to record whether she has been given an ITN.

anc-cards-sm.jpgThe ANC cards in common use in Burkina Faso do not even have a formal place to record IPTp doses.  In Nigeria many ANC cards as seen at the left, had no place to enter whether a woman was given an ITN or received IPTp doses. Several malaria in pregnancy projects had to print new ANC cards and clinic registers to make it possible to mark accurately the delivery of malaria control services. One wonders how accurate service and coverage data can be obtained to show progress toward achieving national malaria targets and indicators without such cards.

With no place to mark malaria interventions provided, health record cards are incomplete. No amount of divining will be able to give us proper information on whether we are achieving our malaria targets without these.

Advocacy &Communication &Community Bill Brieger | 16 Dec 2009

Town Hall Meetings – Nigerian Style

The Reproductive Health Forum discussion group on Yahoo reports plans that the “Federal Ministry of Health in its effort to revitalize the health system in the country is holding a one day Consultative Health Forum in Lere Local Government Area (LGA) of Kaduna State,” on Thursday 17th December 2009.

dscn0179sm.JPGThe town hall style meeting “will focus on maternal and child health along with related issues of water, sanitation and Malaria and will primarily be discussed with women and men of reproductive age, representatives of key health oriented Civil Society Organizations, Community Based Organizations, and Faith Based Organizations.” This is billed as the first of six such meetings that will cover all the geopolitical zones in Nigeria.

This process is in keeping with the pledge by Professor Babatunde Osotimehin Honorable Minister of Health as seen on the Ministry’s website that, “We want feedback to ensure this dialogue is dynamic, vibrant and continuous.”

The Permanent Secretary of the Ministry of Health, Mr. Linus Awute, in a recent press release acknowledged some of the problems that forum participants may also raise:

He said that it is glaring that health service delivery is not often available for the rural populace adding that 75% of Nigeria’s population is rural and cases of maternal mortality rate is very high in the rural areas. He attributed this ugly situation to the non-availability of skilled workers in the rural areas stressing that the Ministry is working round the clock to address the bad situation. He added that the Ministry is revitalizing primary healthcare as an avenue to delivering healthcare to its citizens.

As noted, the fora will address basic issues of water and sanitation.  This comes on the heels of a recent cholera outbreak in the country, about which Nigeria Health Watch observes …

Cholera is not a disease anyone should be getting in October 2009 … definitely not in Nigeria. To understand the absurdity of this; the last major outbreak of cholera in the United States occurred in 1910-1911! If we want to pursue grand dreams such as becoming one of the 20 largest economies by the year 2020 … maybe we should start with some of the apparently small steps such as preventing cholera!

Dialogue on health is definitely needed in Nigeria. Consumer out-of-pocket expenditures account for 65% of health spending in Nigeria – so citizens are definitely interested and involved in health care. The question is whether health system can be responsive to community needs. We look forward to hearing the results of the Lere LGA and the 5 other health fora.

Funding &Procurement Supply Management Bill Brieger | 15 Dec 2009

Sierra Leone – malaria emergency

The United Nations’ humanitarian news agency, IRIN, headlines an “Appeal for aid as malaria ’emergency’ looms.” Apparently there has been an upsurge in malaria deaths among children.

IRIN says that WHO and Unicef “are ‘urgently’ appealing for 1.3 million bednets, as well as anti-malaria drugs, at a cost of US$16.9 million. The situation is now considered as constituting a potential emergency,” said their statement. This press release has been reprinted in dozens of sources ranging from news agencies to relief organizations since it appeared a few days ago. How did the situation get this bad?

poor-record-keeping-at-local-health-posts2.jpgSierra Leone is the recipient of two Global Fund malaria grants from Rounds 4 and 7. The Round 4 (R4) grant began on 1st May 2005 and was to run for 5 years.  Strangely, the grant has not been approved for Phase 2 funding although Phase 1 funding supposedly ended in April 2007. The most recent progress report for the R4 grant on the Sierra Leone webpage is dated August 2008, and shows only 78% of the Phase 1 money (or 46% of the intended grant total) was disbursed by that point.

By the end of the second year the R4 there seemingly was acceptable progress toward goals of distributing ITNs and providing IPT to pregnant women.  But malaria treatment was severely lagging.  Overall the grant had been scoring a B2 – “inadequate but potential demonstrated.”

The Round 7 (R7) malaria grant, which began on 1st May 2008, is closing in on its Phase 1 endline. It is also rated B2 and has received 76% of its Phase 1 budget (or 30% of the total planned grant). During the reporting period that ended in May 2009 it appeared that treatment targets for children were being met and malaria drug stockouts were being prevented at facilities, but home/community based treatment goals were falling short.  ITN and IPT distribution looked good, but the review of the grant stated …

PR plans to procure ACTs in the first two installments and accelerate activities that were delayed in Year One. The PR has improved significantly performance on the period as well as general management of the grant … We are cautious with our B2 rating due to the weaknesses in procurement/planning which have been identified. This should be resolved in the next progress report …

It may be possible that the R4 grant had been rolled into the R7 grant. In either case, it appears that malaria treatment was the weak link, and yet IRIN reported that, “Only 26 percent of children sleep under treated bednets.” This contrasts with 56% reported on the RBM webpage for Sierra Leone based on 2007 data reported from the National Malaria Control Program.

IRIN mentioned that the WHO-Unicef communique states that, “the approach to malaria in Sierra Leone is still more curative than preventive.”  This is ironic given the better reported performance for ITNs and IPTp on both the RBM and GFATM websites and the poor performance for malaria treatment also highlighted on both.

Back to the source – WHO and Unicef representatives in the country were reacting to the following: “An analysis of recent data from the Ministry of Health and Sanitation indicates that over the past four months, there has been a significant increase in the number of children under five dying as a result of malaria.” We are not sure whether these were confirmed through laboratory tests nor whether they represent a normal seasonal rise in the disease.
Like other countries Sierra Leone has been guided by RBM to develop a road map toward achieving universal coverage by December 2010. The road map outlines the following gaps:

  • 1.6 million ITNs needed out of a projected requirement of 3.0 million
  • 7.7 million ACT doses needed out of 8.5 million
  • 1.6 million IPTp doses needed out of 1.7 million

At the same time Sierra Leone reports having US $2.5 million for ACT purchases from PLAN, Global Fund and Unicef to reach 2010 malaria treatment targets, and $11.1 million from all sources to address all interventions by 2010.

Based on the GFATM progress report findings, one wonders whether the ‘emergency‘ is really a procurement problem more than a funding problem.  This makes the emergency no less real to people suffering from malaria, but shows that technical assistance to strengthen health systems needs to receive equal attention to funding for commodities.

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PS – The role of the private sector is not mentioned in the communique even though the Concord Times of Freetown reported in June 2009 that, “The Pharmacy Board of Sierra Leone-PBSL in a bid to make Anti Malaria Drugs more accessible to the vast majority of citizenry, has deregulated the sales of Atesunate (the combination therapy for Malaria treatment) which used to be a prescription drug and could now be sold over the counter and in patent drug stores all over the country.” It also does not acknowledge the role of the corporate and NGO sectors: “Standard Chartered in partnership with the Anglican Diocese -Bo will distribute over 16,000 Insecticide-Treated Nets to different target groups in Pujehun, Bo and Freetown” (October 2009).

Peace/Conflict Bill Brieger | 14 Dec 2009

Malaria in Conflict Areas – Southern Sudan

As long as malaria endemic areas around the world overlap with conflicts within or between countries, our chances of eliminating the disease are doubtful. Médecins Sans Frontières (MSF) reports that, “Since December 2008, there has been a disturbing escalation in violent clashes across Southern Sudan,” an area which is affected by both internal and external fighters.  MSF stresses that …

This increased violence and its consequences compound the already grim medical humanitarian situation in Southern Sudan, where medical needs are critical. Mortality rates remain high, malnutrition is chronic, and regular outbreaks of preventable diseases, such as meningitis, measles and cholera, continue to pose a persistent threat to the lives of the population.

In its special report,”Southern Sudan: Facing Up to Reality,” MSF explains …

Many NGO-supported clinics lack essential medical supplies, because the MoH drug kits are inadequate or missing items, from artemisinin-based combination therapy (ACT) (for the treatment of malaria) to basic, yet essential, items like examination gloves … For example, patients who tested positive for malaria were prescribed with paracetamol instead of ACT, which is wholly ineffective in the treatment of the disease.

These problems occur in spite of the fact that global aid is targeted at malaria in Sudan.  For example, Sudan has received malaria grants from GFATM in Rounds 2 and 7. The Round 7 grant has two Principal Recipients, one for the North and one for the South.  Since starting in December 2008, the grant in the South has achieved major bednet distribution targets, but has yet to make headway on home management of malaria despite the fact that ACTs have been imported. In addition to challenges in contracting with the Sub-Recipient, the program faces both logistical and security problems as explained in the most recent progress report:

In 2009 the early start of the rainy season has obstructed the distribution activities, but overall the main risks remain in the area of insecurity. There were significant inter-tribal clashes, and the situation in the border town of Abyei remained tense. The outbursts of violence can not be predicted neither in terms of timing nor location.

USAID is also working in Southern Sudan to, “strengthen maternal and child health services and reduce the burden of HIV/AIDS, malaria, tuberculosis, and other infectious diseases.” USAID also points out the challenges from the Lords Resistance Army from Uganda, environmental degradation and inter-ethnic clashes that are hampering health and development efforts, and quotes UNHCR’s report of 2.9 million internally displaced persons in the region.

BBC reported Sunday that, “The peace process between North and South has been looking shaky.” This combined with difficulties in gaining collaboration among the various parties in the South, cast doubts on elections coming up next year and a referendum for independence in 2011.  The question arises – do people in Southern Sudan have to wait until the dust settles in 2011 to get the malaria medicines they need?

HIV &Integration Bill Brieger | 13 Dec 2009

PEPFAR Could Build Bridges to Malaria Programs

Under its new strategy, “PEPFAR patients will also be treated for tuberculosis, malaria and previously untreated tropical diseases,” according to a Washington Post editorial.  This is possible because, “PEPFAR 2 has three pillars: prevention, integration and improved health-care systems.”

pepfar.jpgThe Post further explains that with PEPFAR 2, “The goal is to make the services a routine part of each nation’s health offerings.” The Post quotes Eric Goosby, the U.S. global AIDS coordinator, as saying that, “We need to transition them into being more embedded in the countries’ infrastructure and for the countries to have true ownership of them.”

Research in Rakai, Uganda, has found, “Excellent self-reported retention and appropriate use of ITNs distributed as a part of a community-based outpatient HIV care programme. Participants perceived ITNs as useful and were unlikely to have received ITNs from other sources.” What PEPFAR 2 appears to be calling for is a more integrated systems approach that through the new US Global Health Initiatives that ensures that mothers, children and families get the full range of services they need from an improved and sustainable local health service.

Even before this greater focus on MCH, health professionals like Walensky and Kuritzkes, have noted the “massive direct and indirect benefits PEPfAR has achieved already for mothers and children. It may be that PEPfAR—by providing health infrastructure, HIV prevention, parental survival, and the opportunity to sustain economic growth.”  Though not stated directly, these views describe an environment that is also more favorable to malaria control.

There are those who see global health programs like PEPFAR and GFATM as “distracting governments from coordinated efforts to strengthen health systems and re-verticalization of planning, management and monitoring and evaluation systems.” Biesma et al. note that there is much more that donor programs “could do much more to promote country ownership through aligning their objectives with comprehensive national health.” The Washington Post editorial indicates that this is exactly where the new PEPFAR strategy is aiming.

Civil Society &Partnership Bill Brieger | 12 Dec 2009

Faith Based Malaria Campaign

fuh_logo.JPGWhen the words ‘religion’ and ‘Nigeria’ appear in the same sentence the implications can be mixed. Religion certainly plays a big part in Nigerian society. “A survey of people’s religious beliefs carried out in 10 countries (in 2004) suggests that Nigeria is the most religious nation in the world,” according to the BBC. Over 90% of Nigerians said they attended a religious service regularly, more than any of the 10 countries surveyed.

The survey also found that, “More than 90% of those surveyed in Nigeria and Indonesia said they would give their lives for their beliefs.”  This presents the other side of religion in the country.  Over the years the BBC has reported that religion is one of the major flashpoints for conflict in Nigeria. Religion continues to challenge the social and cultural fabric of the country. The difficulty in distinguishing religious, economic and ethnic sources of conflict has seemingly made the challenges more intractable.

Along comes a ray of hope, spurred by of all things, a deadly disease like malaria. The Center for Interfaith Action (CIFA) described Faiths United for Health (FUH) and reports that …

The Sultan of Sokoto and the Archbishop of Abuja, along with other leaders of Nigeria’s Muslim and Christian faiths, today joined Nigerian government officials to launch an unprecedented effort to eliminate deaths from malaria throughout the country. By the end of 2010, the religious leaders plan to train 300,000 imams, priests, pastors, and ministers to carry the malaria prevention message to cities, towns, and rural villages through sermons and other cooperative efforts.

The Christian Post quotes U.N. Secretary-General’s Special Envoy for Malaria, Ray Chambers, who attended the launch of the Nigerian Inter-Faith Action Association’s campaign in Abuja as saying, “Working together, Nigeria’s faith leaders have the credibility, influence, and reach to carry the message that ‘bed nets save lives’ to their nation’s most distant villages.”

The implication is that the more than 60 million insecticide-treated bednets being distributed in 2009-10 will only be effective if they are accepted, hung up and slept under. With such a large portion of the population attending religious services, the potential for an interfaith push to actually use the nets should have a big impact on reducing the disease. As John Bridgeland has said, “Faith-based and other leaders in civil society throughout Africa are emerging from the grassroots to ensure that nets are used properly in homes and villagers know the warning signs of malaria so they get help in a timely fashion.”

ogun-1a.jpgWhile the FUH offers hope, two important issues remain to be addressed.  First, malaria cannot be controlled in isolation and simply through campaigns. Efforts require a strong primary health system to sustain malaria control. Unfortunately This Day highlights, “Part of the irony of our national development is that rather than situations improving, some key sectors tend to deteriorate. One such instance is in the health sector where the once robust primary health care system is almost completely extinct now.”

Secondly, perceptions of malaria illness are culturally based. It is not clear how indigenous African beliefs and religion fit into FUH.

Nigerians, like most people around the world, do not abandon their cultural beliefs just because they practice a cosmopolitan faith. Without attention to the indigenous cultural core of a peoples (e.g. sacrifice of beans and palm wine to Ogun at left above), we may risk low acceptance of our ‘miraculous’ malaria interventions.

Vaccine Bill Brieger | 07 Dec 2009

Introducing the International Vaccine Access Center

ivac_logo_wtaglinefinal_resized.jpgBefore reaching her second birthday, an American child will be vaccinated against 14 diseases. A child in sub-Saharan Africa? About 6. Yet the African child will be especially vulnerable to disease due to high rates of malnutrition, co-morbidities, and weak health systems.

What’s more, the American child will have access to new vaccines as they become available. After a 15 to 20 year lag, those same vaccines will finally reach sub-Saharan Africa, perhaps in time for the next generation.

The International Vaccine Access Center, which launches on December 7, seeks to change this scenario by accelerating global access to life-saving vaccines. Vaccine uptake is delayed by a combination of incomplete epidemiological information, outdated policies, and market barriers. For instance, without information on country-specific disease burdens, policymakers are left weighing the upfront costs of revising their immunization program against uncertain future benefits.

As national policies remain unchanged, the potential market looks smaller and smaller to manufacturers. Without confirmed orders, manufactures cannot offer the reduced pricing that makes these products affordable to developing countries.

In the meantime, years pass and kids succumb to diseases that could have been prevented. The 2009 State of the World’s Vaccines and Immunizations Report estimates that existing vaccines could avert the deaths of up to 2 million children if given access to these vaccines.

IVAC sees an opportunity to save lives by shortening the lead-time between vaccine development and vaccine introduction in the developing world. Building on lessons learned from the successful Hib Initiative and Pneumococcal Vaccine Accelerated Development and Introduction Plan (PneumoADIP), IVAC will generate the epidemiological information policymakers need to make informed decisions. “For too long, access to life-saving vaccines has been delayed by the lack of evidence-based policies to support their use and delivery.

The cost of these delays is measureable in lives lost, and IVAC will aim to turn that situation around by using evidence to assure equitable vaccine access globally,” said Orin Levine, Executive Director of the new center.

ivacmodel2.jpgBased at the Johns Hopkins School of Public Health, IVAC will strive to maximize the impact of immunizations, one of the most powerful and cost-effective tools we have for improving child health. Hopefully, success will build upon success, demonstrating to manufacturers the viability of new products in developing markets and generating new investments in child health. While IVAC does not have an official malaria project as of yet, the center is exploring opportunities to accelerate the introduction of a future vaccine.
To learn more about IVAC and childhood vaccination, visit Dr. Levine’s blog at the Huffington Post.

Thanks to Jenna Rose for providing the above information.

Private Sector Bill Brieger | 07 Dec 2009

Private Sector and Health Aid

The BBC reports that, “The UN’s aid chief has said there needs to be a more effective partnership between humanitarian organisations and the private sector.” Sir John Holmes pointed to some examples of private sector response, like after the tsunami in Banda Aceh, he commented that, “We have not yet found ways to engage together systematically and productively. This is inward looking and short-sighted,” especially in some of the ongoing crises like Darfur.

If humanitarian needs are short of responses from the private sector, what of ongoing health and development programs?

For several months from early 2008 the Global Fund featured what they termed “Corporate Champions” on the front page of their website.  During the intervening months only Chevron was featured as a champion. Chevron made a commitment of US$ 30 million to the Global Fund at the World Economic Forum in Davos that January.
Product Red was another corporate effort to raise funds through a portion of sales by companies that designated and packaged special red items ranging from shoes to laptops to greeting cards. This effort, launched in 2006, has apparently generated $130 million for HIV/AIDS efforts of the Global Fund.

American Idol is another private source of support. “The Global Fund has been receiving support from ‘Idol Gives Back‘ since 2007. To date, the contribution from the initiative totals US$ 16.6 million.”

The malaria program of GFATM was designated for support from another television program. “Comic Relief in the UK announced that it will contribute £2 million over a two year period to the Global Fund, with funds being directed to support the fight against malaria in Zambia,” in April of this year.

On a continental basis the “MTN Group signed a memorandum of understanding (MoU) in March this year with the Malaria Community, a network of advocacy groups. The MoU gives expression to the commitment the telecoms operator made earlier in the year to combat malaria. Malaria Group consists of Malaria No More, the John Hopkins University VOICES Project and PATH MACEPA Project.”

MTN, while also being a sponsor of the 2010 Foorball World Cup, is involved in the “United Against Malaria” campaign involving national football associations from Ghana, Ethiopia, Ivory Coast, Mali, Tanzania, Uganda and Zambia. Bell, a former Cameroon International goal keeper who is supporting the effort describes his experiences with malaria: “I know a lot about malaria. I could have died before age five. I missed school, I missed practice, and I missed matches because of malaria.”

dsc02162-sm.JPGExxonMobil’s Africa Health Initiative has been focused clearly on malaria targets and is an active RBM Private Sector Partner. “Since the inception of the Africa Health Initiative in 2000, we have committed over $50 million to support efforts to fight malaria through disease prevention, control and treatment programs.”

RBM’s private sector constituency has been mobilized because it “possesses a breadth of expertise and implementation skills – including delivering products and programmes in the developing world. These skills include innovation, production and distribution at global and country levels. Additionally, many enterprises within the private sector have global reach.

The RBM Private Sector Constituency has included A-Z Textile Mills [Arusha], BASF, Bayer, ENI, ExxonMobil, GlaxoSmithKline, H.D. Hudson Manufacturing Company, Novartis, Procter & Gamble, Sanofi Aventis, Sumitomo Chemical, Syngenta, Vestergaard Frandsen, Medecins Sans Frontiers, the World Economic Forum, Development Finance International (DFI), Phoenix Consulting, Premier Medical Corporation, Rio Tinto, Shell International, Sigma Tau SpA, and TropMed Pharma Consulting.

The Private Sector Delegation (PSD) of RBM provides technical assistance. “The Affordable Medicines Facility for malaria (AMFm) which is hosted by the Global Fund has also been drawing on the vast experience of the PSD to inform its deliberations on co-financing mechanisms and effective delivery of the essential medicines to the target populations.”  Members also contribute in cash and kind – supporting malaria efforts where they work, sponsoring innovative demonstration programs, and prividing the malaria commodities that they produce.

The monetary value of private sector support to the global malaria effort may not approach that of large donor programs like the Global Fund, the US President’s Malaria Initiative or the World Bank booster program, but the variety of contributions can provide important lessons that can be adopted by national and donor program efforts.

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