Tropical Health Matters

While today it technically the sixth World Malaria Day, one should actually trace the origins back 13 years to the first Africa Malaria Day (AMD) in 2001, held to encourage progress based on the Africa malaria Summit in Abuja just one year before.  And since the Abuja summit and its resulting declaration were backed by the Roll Back Malaria Partnership, which formed in 1998, one could say the world has 15 years to considering in judging progress in and plans for partner investments in ridding the world of malaria.

In 2001 organizers of Malaria Day events were encouraged to feature a ‘new’ medicine that WHO said could save 100,000 child healths annually in Africa. artimisinin-based combination therapy (ACT) drugs are now the front line treatment in most all endemic countries, and deaths have declined somewhat on the order of 400,000. At that time there was only one major manufacturer of ACTs. Investments by pharmaceutical companies in generic ACTs now means that there are at least nine companies that produce prequalified ACTs. What is needed is more indigenous African pharmaceutical companies approved to invest in ACT production.

The first AMD stressed the risk of malaria to pregnant women and recommended widespread use of Intermittent Preventive Treatment in pregnancy (IPTp).  This recommendation has been adopted in countries with stable falciparum malaria transmission, but has lagged in terms of implementation, and coverage still lags below the 80% target set at the 2000 Abuja Summit.  There are missed opportunities to provide IPTp at antenatal clinics due to stock-outs, provider attitudes, and client beliefs. Weak health information systems mean that even when services are provided, reporting may not accurately reflect true coverage of IPTp.

In the meantime resistance is growing to sulphadoxine-pyrimethamine (SP), the drug used for IPTp in part due to the inability or unwillingness of country drug authorities to curb its inappropriate use for case management.  WHO now recommends more that the original two IPTp doses and suggests that pregnant women get SP at each ANC visit after quickening.  In the meantime research is underway to find substitutes for SP.

The first AMD addressed the role of insecticide treated nets (ITNs) in helping halve the world’s malaria burden by 2010.  Major progress came in 2008 when the whole United Nations community and of course companies invested in net production got behind universal coverage. In addition the advent of the long lasting insecticide-treated net with insecticide infused in the fabric from point of production pointed the way to success.

These three core interventions – ACTs, IPTp and ITNs – have been strengthened with better diagnostics and a variety of other vector control measures, Hopes for a vaccine still remain a dream, though an achievable one.  While we have high expectations for eradication, we can see that some of the health systems challenges that thwarted the first malaria eradication effort are still with us including weak procurement and supply management, inadequate human resources and gaps in health information systems.

The foregoing implies that we need at least two forms of future investment in malaria. First is investment by governments in strengthening the health system that deliver malaria services. The second investment is in continued biomedical research in order to fend off resistance by mosquitoes and parasites and of course social research to address issues of behavior, adoption of innovations and program management practices. Let’s hope that when World Malaria Day 2014 rolls around, we can measure these increases investments.

An interesting service helps track key words and issues on social media. We used TweetArchivist to track #malaria and 290 mentions occurred between March 9-11. The word cloud map produced can be seen below. As can be seen malaria is often mentioned in the same tweet as TB. Not all most common words found in the tweets seem directly related to malaria. That said, a visual presentation can be powerful.

By Emmanuel Fiagbey, VOICES Program, Ghana

When 60 journalists from 7 Television stations, 10 print media establishments and 12 radio stations gathered at the Novotel Hotel in Accra on this day, the clarion call was that, even though civil wars, border disputes, political rivalries and disputes, hunger, poverty and armed robberies etc. are critical issues attracting the attention of the media, Malaria must not be forgotten otherwise the lives of children, pregnant women and the workforce at large would be kept perpetually at risk.

In her address to the media practitioners representing the Ghana Media Malaria Advocacy Network and 15 representatives from the Ghana Football Association, the Private Sector and NGOs at this event, DR. Constance Bart-Plange, Manager of the National Malaria Control Program stated that progress so far made by Ghana in managing Malaria – almost 87% national household ownership of nets; 90% of mothers knowing the mosquito as the true cause of malaria; and national adoption of ACTs for treating the disease need to be protected.

She therefore appealed to the media to remain responsible in their reportage and promotion of all interventions being applied in the country. She called on the private sector companies in the UAM partnership to step up their workplace malaria-safe programs and always endeavour to feed the media with appropriate information on their contributions to the fight against the disease. Dr. Bart-Plange further emphasized that engaging the media, the Private Sector and the Football Association in promoting malaria advocacy tells the full story of the disease as a social and development issue that concerns all sectors of society. “It is a healthy malaria-free people who must play, watch and cheer football, the game we all love and so, we must all be part of this fight,” she reiterated.

An official of the National Malaria Control Program, Ms. Vivian Aubyn on her part reminded the media and the private sector partners of the objectives of the Ghana 2008-2015 Malaria Control Strategy and the various policies such as the New Drug Policy and the Integrated Malaria Vector Management Policy. She pleaded with the media and private sector partners to ensure their programs and activities always conform to the prescriptions of the national strategy and the existing policies.
Mr. Fred Crentsil, Vice President of the Ghana Football Association in his contribution reminded Ghanaians that “there is no excuse for a footballer to fail to perform at his or her maximum best because of a malaria attack when we all know that sleeping under insecticide treated nets effectively prevents this disease.”

In his delivery, Mr. Emmanuel Fiagbey, Country Director of the Johns Hopkins University Center for Communication Programs VOICES project called on the media to continue to strategically employ the art of news making to promote public debate and leadership decision making on important issues concerning malaria through direct news items, editorials, features, rejoinders, live interviews and documentaries. In this way, he stressed, the media will remain a powerful mechanism for mobilizing public opinion on emerging issues on Malaria and attracting appropriate responses from local and national leadership as well as the donor community. He urged members of the Ghana Media Malaria Advocacy Network and all other journalists to sustain their watchdog role of exposing abuses and misdeeds by miscreants in the health and allied professions, the pharmaceutical industry, politicians, senior civil servants, NGOs, etc in managing resources meant for malaria control.

In launching the colourful AFCON 2013 GOAL Malaria Magazine at the event, Prof. Isabella Quakyi, Former Dean of the School of Public Health of the University of Ghana and Member of the Ghana Health Service Council, who chaired the event, described the GOAL as a self teacher on Malaria prevention and treatment which should engage the attention of everyone during the AFCON 2013 tournament and after. The GOAL Magazine, she explained, “is simply telling all readers, if you love football then you must have the passion to fight malaria.” Prof. Quakyi called on all organizations and individuals to support the continued publication and distribution of this special magazine.

The Ghana AFCON 2013 Media Malaria advocacy event was organized by the Johns Hopkins University Center for Communication Programs Voices for a Malaria-free Future project in collaboration with the National Malaria Control Program, the Ghana Football Association and the Ghana Media Malaria Advocacy Network.

The Malaria Advocacy Working Group (MAWG) has been developing Recommendation for the 2013 World Malaria Day Theme. They have shared the results of these consultations below.
Background

The MAWG Messaging Workstream has been working with the wider malaria community through the MAWG to develop ideas for the 2013 World Malaria Day Theme. After an open consultation process, the final shortlisted theme suggestions were put to the vote, with 74 respondents from 18 countries across 5 continents providing their input. The results showed a clear preference for the three recommendation options outlined below.

Recommendations

• “Invest in the Future: Defeat Malaria” To be the topline theme used for World Malaria Day in 2013.
• Linkage to The Big Push Initiative: Significant advocacy channels are being developed around The Big Push* initiative over the course of 2013 and beyond. RBM partners will be invited to fully leverage these channels and messages in connection with WMD 2013 as a complementary option to the theme.  The MAWG messaging team will be providing partners with options and tools to link to and help build momentum behind this initiative in the lead up to and beyond World Malaria Day 2013.
• Extend use beyond World Malaria Day 2013

It was overwhelmingly agreed that it would be useful to extend the application of the World Malaria Day Theme for 2013 over a longer, multi-year period of 2013-15. This will allow more time to build theme messaging, collateral and use to maximize its impact. It is envisaged that the accompanying messaging and evidence points under this theme will be checked and evolved over this period.

Next steps

A smaller sub-group of the MAWG Messaging Workstream will be working over the coming months to develop options and collateral around the selected theme. We look forward to being able to share these ideas with partners early in the New Year.
We encourage RBM Board Members to play a crucial role in ensuring that the theme is used consistently by Partners of their respective constituency.

*Background on the “The Big Push”: This initiative was developed around the UN General Assembly in September. The idea is to use TheBigPush as a unifying rallying cry for multiple initiatives working towards the 2015 health MDGs (and beyond). It has already been taken up by the UNSG Every Woman Every Child initiative and by the Global Fund (in partnership with the Huffington Post).

Is there a malaria lobby? Who advocates for more funds from donor countries and within endemic countries? The Roll Back Malaria Partnership has a Malaria Advocacy Working Group (MAWG) that has as one of its objectives, “to ensure the wide dissemination of accurate information on resource allocations to inform the malaria community of current status and improve accountability both by donors and implementers.”

The MAWG has drawn attention to the wide scope of efforts to enhance malaria funding to support the Global Malaria Action Plan.  In addition to the usual international donors and domestic/government support MAWG points out the need to consider innovative fund raising mechanisms such as UNITAID’s air ticket tax. There is also stress on cost efficiencies with existing funds such as …

• More effective ways of procuring LLINs
• Less overlap of LLIN and IRS programs, at least until benefits are proven
• Rotation of insecticides used for IRS to delay resistance
• Accelerated availability and appropriate use of RDTs
• Better understanding of efficiencies of integrated health packages

The African Media and Malaria Research Network (AMMREN), was formed in November 2006. It has over 100 member journalists in 10 African countries, and is encouraging more journalists to become involved. One of AMMREN’s key Objectives is to advocate for implementation of international agreements on malaria signed by African leaders. Local advocacy becomes even more crucial with CCMs when it comes to future division of Global Fund support among the three diseases, and addition to boosting local counterpart funding.

Arsenio Manhice, an AMREN member and a reporter for the newspaper Notícias based in Maputo, Mozambique provides an example of this advocacy function. He reported on the lack of qualified human resources for malaria work and also spoke of the lack of infrastructure and logistics for indoor residual spraying. These logistical resources are the kind that need major national financial commitments for sustainability.

Both Ethiopia and the US Agency for International Development, according to VOA, are encouraging African countries to adopt a “scorecard that publicly collects and reports health data.” Such a scorecard would track 1) input indicators that relate to policy issues and availability of resources; 2) process indicators; and 3) impact and outcome indicators that outline the data results. This is an important tool for both accountability and advocacy.

A scorecard actually already exists and is maintained by the African Leaders Malaria Alliance (ALMA). The ALMA Scorecard tracks malaria related indicators in the areas of policy, public finance, financial control, commodities, implementation, and impact in addition to what are termed tracer indicators for maternal and child health. This publicly available scorecard enables countries to compare themselves and may serve to boost support for malaria and health programs. An example comparing Rwanda and Angola is seen in the attached chart.

We can conclude from the present situation that funding to sustain the current levels of progress against malaria morbidity and mortality is at risk, even though current levels are possibly only one-third of actual need.  Creative and alternative sources of funding are needed as well as better use of existing resources and greater national financial commitment in endemic countries.  Advocacy for improved malaria financing, while strong in the past, is just entering its most crucial phase.

Emmanuel Fiagby of the VOICES for a Malaria-Free Future in Ghana shares a recent workshop of the Ghana Revenue Authority at Kpetoe, Volta Region, Ghana. Below are his experiences.

The Ghana Revenue Authority has made a giant stride in the implementation of its Employee Wellbeing Program (EWP) by initiating a program which will result in the development and implementation of a Malaria Control Strategy and Program of Action for the Authority. A total of 45 officials of the GRA mostly EWP Focal Persons participated in the program.

Launching the program at the Customs Excise and Preventive Services (CEPS) Academy here, the Commissioner General of the  GRA Mr. George Blankson stated that the GRA has since its establishment shown tremendous commitment towards the welfare, health and wellbeing of its staff who are its most valued asset and therefore finds the theme for its Malaria Control strategy development exercise, “Turning Revenue Makers in to Malaria champions; a true demonstration of corporate social responsibility,” an apt reflection of what the GRA stands for.

Mr. Blankson emphasized that, the aim of the GRA in setting up its EWP of which malaria is becoming a key component is to set the pace as a leading healthy workplace in Ghana where staff and management work together to protect and promote the health, safety and wellbeing of its over 7,000 staff and almost 30,000 community members on a sustainable basis. “Today we stand at the threshold of expanding the frontiers of the Employee Wellbeing Program (EWP) to encompass malaria control programs for our staff and the wider community which GRA serves. I am extremely certain that this effort will lead to the total obliteration of the 25% absenteeism of our workforce attributed to malaria and the random deaths this disease wrecks on our institution,” the Commissioner General reiterated. He called on all officers selected to lead the malaria program and noted that by becoming champions for malaria control, they will be “contributing to sustaining a stronger workforce, a stronger community and therefore a more productive and taxpaying community.”

In her key note remarks, Dr. Kezia Malm, Deputy Manager of the National Malaria Control Program (NMCP) stressed that Ghana has made tremendous progress in the fight against malaria and it’s only through the collaborative efforts of parastatal institutions such as the GRA and others that the country would be able to sustain the gains. “Our journey to eliminating malaria can only end successfully if the support of every sector of our development effort – the public sector, private sector, NGOs, and the donor community is sustained,” she concluded.

The two day GRA Malaria Control Strategy development and action plan development program was organized by the Johns Hopkins University Center for Communication Programs Voices Project in collaboration with the Ghana Revenue Authority and the National Malaria Control Program. In setting the stage for the program, the Country Director of the Voices for a Malaria-free Future Project, Mr. Emmanuel Fiagbey pointed out that the GRA, a non-health institution becoming a champion for malaria control should be an effort worth emulating by other powerful parastatal institutions. “That the ‘Revenue Makers’ our tax officials have become malaria advocates and mentors for their colleagues should not only result in preserving the health of the GRA Workforce against malaria, it must also lead to speedy action on malaria commodities and their documentation that come to the tables of the tax officials in the course of their work,” Mr. Fiagbey emphasized.

The Ghana Revenue Authority is a major parastatal institution in Ghana made up of the Customs Excise and Preventive Service, the Internal Revenue Service and the VAT Service. Fifteen senior officers of the Authority including Mr. K. E. Enyimayew the Deputy Commissioner HR, Deputy Directors of the three arms of the Authority, Service Commanders/Commissioners and the Director of the CEPS Academy also participated in the opening activities of the program.

Malaria is often a major cause of absenteeism – either for the sick worker or the worker who has to stay home with a sick child or relative.  The GRA sets a great example how malaria training for members of the workforce can improve occupational, family and community health.

By Emmanuel Fiagby in Accra, January 23, 2012, Voices for a Malaria-Free Future

The United Against Malaria (UAM) Partnership in Ghana being led by the Johns Hopkins University Center for Communication Program Voices for a Malaria-free Future project, the National Malaria Control Program and the Ghana Football Association held a special media event in Accra as a prelude to Ghana’s attempt to win the Africa Cup of Nations (AFCON) 2012 tournament currently taking place in Gabon and Equatorial Guinea. In the photo to the right we see Ghana’s NMCP Manager launching the UAM Malaria-Safe Playbook.

Held under the theme, “Partnership for Malaria Elimination – Winning the Africa Cup of Nations – AFCON 2012 and the fight to eliminate malaria,” the event brought together about 70 personalities representing 15 News papers, 6 Television stations/channels, 6 Radio stations, the National Sports Authority, the Ghana Football Association, the NMCP, WHO, USAID/PMI/CDC, Ministry of Information, Private Sector companies, academia and the Ghana Coalition of NGOs in Malaria.

In introducing the event, the Country Director of the Johns Hopkins University Voices Project Emmanuel Fiagbey reminded participants of the significance of tapping in to the enthusiasm and support for the national team the Black Stars to win the AFCON 2012 to promote greater advocacy for eliminating malaria from Ghana. “While football is the most popular sports in Ghana, malaria is the most popular killer, we need to employ the positive popularity of football to defeat the negative popularity of malaria,” he remarked.

In a statement to the event, Mr. Kwesi Nyantakyi, President of the Ghana Football Association reminded the audience and press members (seen in photo) that footballers are not immune to malaria. Malaria, he pointed out is a big threat to footballers and the practice of their profession. “Aside that we also think society has invested in us and we need to give back what society has invested in us. That is why we have decided to use the Ghana Football Association and football as a vehicle to disseminate information on malaria prevention and treatment,” he stated.

Presenting the key note address, Prof Fred Binka, a renowned Malariologist and Dean of the School of Public Health of the University of Ghana called on all stakeholders especially communities, civil society leaders and groups, NGOs, the media, local government agencies and development partners to ensure strict adherence to the use of ACTs in treating malaria. “The support of these groups will equally be crucial in lifting our education programs up two or more notches to encourage the use of LLINs by all Ghanaians in particular our children and pregnant women,” he emphasized.

With regards to funding challenges, Prof. Binka lamented the suspension of Global Fund Round 11 grants and opined that this could lead to loss of the gains so far made and malaria could be back with a heavy toll on especially children and pregnant women. He called for new partnerships from oil producing countries (OPEC) such as Saudi Arabia and new economic giants such as China to increase their resource support for malaria control and elimination in endemic countries.

Prof. Binka further stressed that the control and elimination of malaria will involve the contribution of every sector – from local government, education, employment and social welfare as well as private companies to the Ministry of Finance. “No sector can be excluded. Indeed we need a strong partnership with global initiatives, privately financed public sector projects, industry partnerships, local, regional and national partnerships led by civil society,” he accentuated.

In conclusion, Prof Binka hoped that the opportunity of the AFCON 2012, contest will energize several potential partners to accelerate their efforts to fight malaria by creating workplace malaria control policies and programs such as provision of treated bed nets and treatment services to their employees and dependants and adopting villages and whole districts within their catchment areas, working with them to reduce mosquito density and providing them with treatment and prevention services.

In launching a set of UAM branded malaria advocacy materials developed by the JHU/CCP/Voices project in partnership with the Ghana Football Association, Dr. Constance Bart-Plange, Manager of the National Malaria Control Program called on the Private Sector  companies to ensure the application of the Malaria-Safe Pillars of increased and continuing education, adherence to improved protection practices, greater visibility of efforts in order to attract added resources and promote effective advocacy. She charged the private companies in particular to endeavour to apply the 13 Winning Moves prescribed in the Winning Moves Chart, one of the materials launched. Other materials outdoored at the event included the 2012 edition of the GOAL Malaria Newspaper and the Malaria Safe Play Book – a Resource Guide for private companies.

In her concluding remarks, the Ag. Director General of the Ghana Health Service, Dr. Gloria Quansah Asare who chaired the event called on all malaria program managers, specialists and activists to remain ever committed and creative in the presentation of malaria information to the public as demonstrated by the Voices UAM Partnership. “The more efforts we put in the development and presentation of our health messages to our audiences the more successful we would be in making such messages acceptable and easy to adopt by our clientele, she emphasized.

About United Against Malaria: Founded in the lead–up to the 2010 FIFA World Cup South Africa, United Against Malaria is an alliance of football teams and heroes, celebrities, health and advocacy organizations, governments and corporations who have united together to end malaria deaths by 2015. We have the tools and the momentum. United, we can beat malaria.

The American Society of Tropical Medicine and Hygiene’s 60th annual meeting began today in Philadelphia with a keynote talk by Jeffrey Sachs, Director of the Earth Institute at Columbia University. The talk echoed Sachs’ recent online writings about the uncertainties in Global Fund support from major donors, especially the United States. But first the good news.

Sachs reminded the audience that this year marks ten years of Global Fund existence.  In that time, he explained, many new malaria technologies have become available ranging from an alphabet soup of ACTs, RDTs, LLINs, IPT, SMS and more.  This period has also seen a major increase in global malaria financial support (World Bank, Global Fund, PMI, etc.,) from $0.2 billion in 2004 to $1.8 in 2010.

Sachs cautioned that figures in the millions and billions were not the usual grist of macroeconomists who prefer to consider the movement of trillions of dollar or more. And yet, he noted that even with this scale up over the years, millions of malaria deaths have been averted.

Then came the challenges. Global Fund support has been mostly used for commodities, as ‘acronymed’ above. What is needed are string primary health care systems, including community health workers, to deliver these interventions.  Sachs stressed that such commodities should be free to poor people, and that social marketing strategies were actually a death sentence to poor people who could not protect their families without free and equitable access to these services.

Finally, the bad news. Sachs called our current situation with Global Fund a crisis in development assistance.  He described the crisis in terms of …

• Unprecedented attaches on development assistance by Republican candidates for the US Presidency
• Lack of current White House Leadership
• Cancellation of Global Fund Round 11

Sachs wondered whether the Millennium Development Goals can now be achieved. He concluded that gains against the diseases are all at risk, and that we are on the edge of collapse after ten years of work.Clearly much of the research and programs discussed at this weeks meetings will be threatened by expected cuts in development assistance, but more importantly, lives that the rearch and programs could benefit are at greater risk.

This morning two key advocacy groups organized a teleconference with Christoph Benn, the Director for the External Relations and Partnership Cluster at the Global Fund to Fight AIDS, TB and Malaria, so that we could learn more about the recent GFATM Board Decision to cancel Round 11 proposals/funding. The main take away message is that the GFATM is NOT in an immediate financial crisis, but that longer term projections could be at risk.

Christoph Benn was reassuring about the ability to carry on and scale up commitments made for funding rounds 8, 9, and 10. Organizers of the teleconference, the Foundation for AIDS Research (amfAR) and Friends of the Global Fight (Friends), encouraged participants to strengthen advocacy efforts with the US Congress where the longer term challenges lie in getting pledges for future funding.

There was talk of the GFATM 2012-16 Strategy that calls for funding based on national policies, national need (gap analysis) and dialogue with partners.  Christoph Benn indicated that Round 11 would have been the last of the formal funding rounds as we have known them, and its cancellation simply pushes us faster towards the new funding strategy. It was also made clear that there would be a weaning of G20 countries off of GFATM money, though commitments to high risk target groups in existing projects would be honored until those grants closed.

Again the short term effect is that countries that would have needed Round 11 funding will be encouraged to apply for transitional funds that will hold them over until the 2012-16 Strategy is fully implemented.  The Roll Back malaria Harmonization Working Group, for example, will be helping countries who intended to apply for malaria grants in R11 to undertake their gap analysis and planning in order to obtain transition funding.  This can only happen after the GFATM revises the application guidelines. As Christoph Benn explained, the ramifications of last months’ Board meeting in Accra are still being worked out.

Back to the longer term concerns or what was termed the uncertainties  of funding forecasts based on donor conditions.  Many donor countries have pledged to continue their funding levels to GFATM, and the United Kingdom has even pledged an increase. But all eyes are on the U.S. Congress, who initially pledged to maintain level funding this past summer, but now is uncertain whether global health and foreign assistance will receive support. It was basically this change of heart that put the brakes on R11 funding.

Our advocacy partners had heard from members of the Congress that they were worried about the financial health of the GFATM, but now have been told that the GFATM is still very much viable.  It is the longer term expansion beyond current commitments that is in question.  Rephrasing Jeffrey Sachs’ concern, “Will Washington leave millions to die?”

Just as the Asia Pacific Malaria Eradication Network’s community engagement workshop was ending in Chiang Mai Thailand, word reached the group that the Global Fund had cancelled its call for Round 11 funding. During the workshop participants and facilitators had discussed the community systems strengthening potential of Global Fund grants and how this could benefit APMEN counties’ community engagement strategies.

The Global Fund euphemistically phrased this cancellation at the just completed Global Fund Board meeting in Accra with a key decision point that notes the Board “Agrees to establish a Transitional Funding Mechanism … in order to provide this continuation funding (and) Decides to convert Round 11 into a new funding opportunity …”   Jeffrey Sachs clearly laid a large portion of the blame on the U.S. Government, which is responsible for about a quarter of the Global Fund project money when he observed that the U.S. …

… had pledged $4 billion during 2011-13 to the Global Fund, or $1.33 billion per year. Now it is reneging on this pledge. For a government that spends $1.9 billion every single day on the military ($700 billion each year), Washington’s unwillingness to follow through on $1.33 billion for a whole year to save millions of lives is a new depth of cynicism and recklessness.

The APMEN meeting therefore closed with a call on donors to honor their commitments to the Global Fund and the community programs it makes possible.  The final session was also devoted to action planning that included brainstorming by country teams of alternative funding sources to support community engagement.

Gawrie Galappaththy from Sri Lanka expressed clearly the workshop participants’ surprise and disappointment over the Global Fund announcement.  “Many of our countries have been receiving Global Fund support since 2003, and we are collectively dependent on the Global Fund from its different rounds. The reality is that with Global Fund support being so regular, governments have shifted some of their financial support for health to other areas. An abrupt stop to Global Fund support will hit us hard.  It will be necessary to regenerate the political will all over again for malaria and health.”

Gawrie also worried that, “Malaria is a dynamic disease. If we let the pressure off, it will re-grow as happened after the first eradication effort.  If we can’t get this elimination done now, we may never have a chance to do it again.”

The Globe and Mail summarizes the problem succinctly. “The global economic crisis has claimed a new victim: a $22-billion (U.S.) health fund that has saved millions of lives in Africa and other low-income regions during the past decade… The cuts by donor governments are not just because of the economic slowdown and the financial crisis in Europe, but also because of concerns over corruption in several recipient countries.”

The BBC interviewed the HIV/AIDS Alliance on this issue, and not surprisingly learned that this is the worst of all possible times to see cutbacks in funding for disease control.  The Alliance’s Director mentioned issues that could equally apply to malaria when he said that, “These should be exciting times – the latest scientific developments …”  New vaccines, new medicines and strengthened community participation strategies are just a few of the latest malaria developments that could be threatened.

Community engagement does take time and effort, even if it does not cost anywhere near the price of nets and drugs. Communities bring valuable resources to the table, but at the same time we do not want to foist malaria control and elimination responsibilities off on vulnerable poor people in developing countries.  APMEN workshop participants are going to be engaged in advocacy themselves, and are optimistic that donors old and new will not let communities down.