Tropical Health Matters

The Global Health Council’s Malaria Round Table shared the information that follows.  Reducing the already tiny USG commitment to international development would not only be mean-spirited, but would jeopardize global security.

This Thursday, November 3^rd, the Senate is likely to begin consideration of the State & Foreign Operations bill, probably as part of a “mini-bus” package with other components of the FY2012 Budget. With the current Continuing Resolution set to expire on November 18^th the Senate is under pressure to pass a bill to fund the government over the next fiscal year.

The Senate State/Foreign Operations bill is $5 billion higher than the House number, including a $700 million higher mark for global health. We need to do all we can to protect this higher funding level for global health and international affairs.

Call your Senator and urge them to protect funding for global and international affairs, and oppose all cutting amendments on the State, Foreign Operations bill during floor consideration and rejection of all harmful policy riders.

Talking Points

·         For less than 1% of our federal budget millions of lives are impacted each year. U.S. investments in global health have:

• Treated more than 3 million people living with HIV and prevent HIV transmission among millions more;
• Cut  the number of malaria cases by more than 50% in 43 countries in the last 10 years;
• Contributed to immunizing more than 100 million children each year;
• Treated 10 million people with tuberculosis;
• Delivered more than 255 million treatments to approximately 60 million people  for neglected tropical diseases;
• Increased the number of skilled birth attendants present during deliveries; and
• Supported research to develop and deliver new vaccines, drugs, and other critical health tools.

·         Further cuts to global health and international affairs programs would put lives at stake, threaten our diplomatic standing in the world, and put thousands of current and future American jobs in jeopardy. 

Putting Lives at Stake:

 

Global Health dollars support American jobs.

·         In 2005, global health activities generated $1.5 billion in Washington state and created or sustained more than 14,125 jobs.

·         In 2007, the global health sector supported more than 7,000 jobs and $508 million in salaries and wages in North Carolina.

The publication this week by African Leaders Malaria Alliance (ALMA) of progress reports of African nations toward controlling and eliminating malaria and other maternal and child health problems has been both enlightening and helpful for advocacy and planning.  If one combines these data with reports by the Roll Back Malaria Partnership (RBM) on progress towards country Roadmap targets, a good picture emerges of the steps needed to reduce malaria deaths by 2015.

The time frames of the two indices are different – RBM is looking at overcoming gaps laid out by national malaria programs in 2010, while ALMA – but they are close enough to highlight the main logistical, process and input challenges facing endemic countries. The ALMA scorecard does have one outcome indicator – operational coverage of long lasting insecticide-treated nets (LLINs) – but one needs to consult surveys such as the Malaria Indicator Survey to get more accurate coverage data, and such surveys are scheduled less frequently.

Several key issues arise from these two reports.  For example, the ALMA Scorecard shows that eight countries do not have a policy that enables community case management of malaria, a strategy that is essential for achieving universal and timely coverage of malaria treatment. Though not indicated clearly, such a policy should include the use of rapid diagnostic tests (RDTs) and the community level.

Sixteen countries do not have full funding for purchasing the RDTs they need. RDT supply problems also appear in the RBM Roadmap analysis. Eighteen countries lack full financing for their LLIN needs.  Unfortunately, if not enough funding is available to achieve universal coverage now, what will happen in three years when most of the recently distributed nets may need replacing?

Of course there are hopeful signs. The Scorecard shows that ten countries have reduced malaria deaths by more than 50%, and another seven have made substantial progress. It is unfortunate that the remaining countries are left blank implying that there are inadequate data to make such calculations.  We will have trouble eliminating malaria is our monitoring and evaluation systems cannot measure progress towards our goals.

Hopefully such tools as the Roadmap analysis and the Scorecard will spur some friendly competition among malaria endemic countries in Africa that will save more lives and boost national economies.

By Guest Writer  – Emmanuel Fiagbey, Country Director, Ghana Voices for a Malaria-free Future

The Johns Hopkins University Center for Communication Programs (JHU/CCP) Voices for a Malaria-free Future Project under its flagship program, United Against Malaria, and in collaboration with the National Malaria Control Program and other partners have presented special commemorative ceritificates and T’Shirts to the National Sports Authority here in Accra.

The Certificates signed by the Director General of the National sports Authority Mr. Worlanyo Agra will be presented to all 4,942 participants and their officials. They carry the messages:

“Be a member of the Winning Team- Sleep in treated mosquito nets every night; Take only ACTs any time you have malaria; Encourage pregnant women in your house to seek Antenatal care on time; and Keep Ghana Malaria-free for the next games.”

The over 600 T’Shirts which also carry the above messages will be presented to members of the finalist teams of all the team games including Football, Volleyball, Table tennis, Handball, Netball, Basket ball, and the winners of the first, second and third positions in all the athletics events.

Mr. Emmanuel Fiagbey, Country Director JHU/CCP Voices, in presenting the items called on all sports men and women as well as their officials to remain ambassadors in the fight against malaria. He charged them to continue to behave as models in their communities in ensuring that families make maximum use of their treated mosquito nets and no one uses any other medicine apart from ACTs in treating malaria when they fall sick of the disease.

The Director General of the National Sports Authority, Mr. Worlanyo Agra in receiving the items commended the ever growing partnership between the malaria program community and the National Sports Authority. “We would remain active members of the United Against Malaria partnership and continue to ensure that sporting activities at all levels, national, regional, district and community are used as grounds for educating our people on malaria prevention and correct treatment of the disease.

Whether you are a sports man or woman or not, mosquitoes do not know the difference and the malaria parasite they carry can kill any one of us any time if we fail to sleep in our nets or take the correct medicines”, he emphasized.

by Emmanuel Fiagbey, Ghana Country Director, Johns Hopkins University Center for Communication Programs, Voices for a Malaria Free Future Project

Malaria advocates in Ghana celebrated worldwide successes and renewed commitments to the fight against malaria at the launch of the Roll Back Malaria (RBM) partnership’s Progress and Impact (P&I) Series reports, an event organized by Voices for a Malaria-Free Future with support from RBM and the National Malaria Control Program (NMCP) of the Ghana Health Service.

The report launch and distribution convened stakeholders including the Minister of Health and the Minister of Women and Children’s Affairs, representatives of multilateral organizations, public and private sector partners, and members of the media. More than 100 participants took part in the May 27 event themed “Achieving Progress and Impact in the Fight against Malaria.”

The six reports launched included 1) Malaria Funding and resources utilization; 2) Saving lives with malaria control; 3) Mathematical modelling to support malaria control and elimination; 4) World Malaria Day 2010 Africa updates; 5) Focus on Senegal; and 6) Business investing in malaria control. Economic returns and a healthy workforce for Africa.

In officially launching the reports in Ghana, Hon. Minister of Health Mr. Joseph Yieleh Chireh (MP) (see at left) noted that in the past ten years, almost three quarters of a million children in 34 African countries avoided malaria-related deaths through the use of insecticide treated nets, indoor residual spraying, effective medicines and preventive treatment during pregnancy, citing the reports.

But malaria still carries a significant burden in Ghana, he added. “The achievement of our Better Ghana Agenda, which aims at improving the lives and living conditions of our people, hinges on our total commitment and support for all efforts directed at eliminating malaria,” he said. “The recommendations made in the reports being launched today, I must emphasize, should be the gold standard for all our countries in our march towards eliminating malaria.”

In a message on behalf of the mothers and children of Ghana, the Hon. Minister of Women and Children’s Affairs Mrs. Juliana Azumah-Mensah (MP) said, “These reports will no doubt offer accurate statistics regarding malaria infections among women and children and help us know where to step up our efforts.”  She called on all who still sell or use Sulphadoxine Pyrimethamin (SP) for treating uncomplicated malaria to stop the practice, “as the loss of the efficacy of this medicine to resistance will spell doom for all pregnant women and the babies they carry,” she emphasised.

The occasion offered an opportunity to advocate in Ghana for …

• increased resource commitments from donors and endemic country governments
• better access to and education about cost-effective prevention interventions and rapid .diagnostic tests
• stronger enforcement of drug policies
• fewer taxes and tariffs on life-saving intervention tools
• continued investments in behaviour change communication

Prof.  Fred Binka, Dean of the School of Public Health of the University of Ghana, Legon who chaired the event called on stakeholders to work together to achieve national targets, in line with these recommendations. He stressed, “With progress in individual countries, we need more sub-regional work among neighbouring countries. Mosquitoes don’t recognize political borders.”

With the 2010 World Cup taking place in Africa, a great opportunity became available to highlight health and development issues on the continent. One of those issues was malaria and the message was carried by a consortium of groups who formed United Against Malaria.

UAM has continued its efforts to advocate for malaria elimination beyond the World Cup. Late last year five CECAFA national teams joined UAM during the CECAFA Tusker Cup in Dar es Salaam, Tanzania, from late November into December. The Ghana Football Association, as one example, featured its players in television documentaries about the devastating effects of the disease.

The very nature of competition among football clubs and associations requires travel within a country and among countries.  A news story out of Jamaica (which was declared malaria-free in 1966) yesterday highlights that football can also ‘transmit’ malaria between countries …

The Jamaican Ministry of Health has reported the confirmation of three cases of malaria among players of the Haitian under-17 football team who are in Jamaica to play in the CONCACAFUnder-17 championship in Montego Bay. The Haitian players are being treated. According to the Jamaica Observer, The Ministry of Health has recommended that in the circumstances they do not participate in the tournament and therefore return to Haiti. These arrangements are presently being made. The Ministry of Health has implemented mosquito control measures and a surveillance system to try to quickly identify any new cases.

Malaria truly has no borders, as stressed on World Malaria Day in 2008. Living on an island does not protect when both people and mosquitoes can travel.  Places like Jamaica and Mauritius need to be constantly vigilant – it is not just the high burden countries that need to worry about whether we can reach malaria elimination.

This is not Jamaica’s first brush with the risk of reintroduction of malaria. An upcoming Tropical Medicine and International Health article reported that in 2006 Jamaica successfully controlled an outbreak of Plasmodium falciparum with 406 confirmed cases. The outbreak highlighted the need for increased institutional capacity for surveillance, confirmation and treatment of malaria as well as effective prevention and control of outbreaks which can occur after elimination. Jamaica appears to have successfully eliminated malaria after its reintroduction.

The West Indian Medical Journal reminds us that, “All the essential malaria transmission conditions–vector, imported malaria organism and susceptible human host–now exist in most” Caribbean countries, this re-emphasizing the need for constant surveillance. The added saddness in the current story is that not only does Haiti continue to suffer from the devastation of last year’s earthquake, but itself has been the ‘victim’ of imported disease – cholera.

As long as people, including football teams and UN Peacekeepers, continue to move around the globe, the difficulty of eliminating diseases like malaria will remain. The lack of current cases of malaria in a country is not justification for complacency, especially if the environmental and vector conditions for transmission persist.

First the good news. Roll Back Malaria’s “Saving Lives with Malaria Control: Counting Down to the Millennium Development Goals” report provides encouragement when one reads that, “it is estimated that in the past 10 years, scaling up malaria prevention has saved the lives of nearly three quarters of a million children in 34 malaria-endemic African countries, 85% of these in the past 5 years alone.”

This is the latest report in RBM’s Progress Series and indicates that, “the results suggest that if current scale-up trends are maintained until 2015, another 1.14 million African children’s lives will be saved between 2011 and 2015.”

On the other hand, RBM warns that, “if funding were to cease in 2010 and prevention efforts were to fall, an estimated 476 000 additional children would die in that same period.” Is it possible that a greater focus on future eradication of malaria could distract from saving lives now and reaching the 2015 Millennium Development Goals?

The New York Times reported three years ago that, “challenging global health orthodoxy, Bill and Melinda Gates called for the eradication of malaria.” According to the Times, the Gateses labeled this call to action ‘audacious,’ while some partners called it ‘inspirational,’ ‘noble but quixotic’ and even ‘harmful.’

Now the Seattle Times reports that Bill and Melinda Gates are, “revamping the scientific agenda with their eyes on the controversial goal they set three years ago: driving malaria to extinction”

Justifying the focus, the Seattle Times indicated that, “Although total eradication of the disease may be as much as forty years away, it’s important to start work on drugs and vaccines that could take a decade or more to bring to the field, David Brandling-Bennett, leader of the Gates Foundation’s malaria programs.”

The implications of “The increased focus on the future means the Gates Foundation is ending its support for some efforts to lessen the disease’s current toll. Those include research to improve treatment of the severe infections that strike children and pregnant women, and that are responsible for most of the estimated 850,000 annual deaths from malaria,” according to the Seattle Times. Fears have arisen that this change by Gates, due to its financial influence, may pull resources away from other malaria research and program implementation efforts.

On the programming side, Gates has pledged 3% of the total Global Fund pledges as of August 2009, which is three-quarters of the funds pledged by all non-governmental organizations (foundations, corporations, etc.). While this is important, it is unlikely that even if Gates does not continue its support for programming, the bigger threat to major malaria funding sources – i.e. governments – is the current weak global economic environment.

We can all agree that Bill and Melinda Gates have influence. Currently they are using it to advocate to other wealthy individuals, corporations and foundations to contribute more toward charitable pursuits. In the area of malaria, they can also advocate with governments – both donor and endemic – to maintain and increase their financial support for malaria control and elimination. By then the new malaria tools deriving from Gates-supported research may be ready to carry elimination into eradication world-wide.

Guest Blog by Kathryn Bertram, VOICES Project

African leaders attending the 15th African Union Summit from 19th to the 27th July in Kampala agreed to extend the Abuja call towards accelerating universal access to HIV/AIDS, TB and malaria services in Africa, and called on the Global Fund to create a new window to fund maternal, newborn and child health.

According to the AU declaration: “We appeal to development partners and donors for the replenishment of The Global Fund during its October 2010 meeting and to ensure that the new pledges are earmarked for Maternal Newborn and Child Health.”

This year’s AU Summit carried the theme of maternal, newborn and child heath in order to fill a gap that critics say existed in the African Union’s health strategies. At least 35 heads of state attended the event, despite the recent Al-Shabaab bombings that killed scores in Kampala the week before.

African Heads of State participated in at least two maternal, newborn and child health events, one of which—a maternal and child health-themed advocacy gala—was jointly sponsored by the VOICES project at Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs (JHU-CCP) and 10 other global health organizations.

Organizations called on heads of state to increase commitments to improve the health of women and children in Africa and achieve the Millennium Development Goals (MDGs).

Demonstrating that global health organizations with disparate agendas can integrate their calls to action effectively,  partners included JHU-CCP, United Against Malaria, African Leaders Malaria Alliance, UNAIDS, StopTB Partnership, Roll Back Malaria Partnership, UNITAID, The Partnership for Maternal, Newborn and Child Health, and the United Nations Foundation in addition to The Global Fund to Fight AIDS, Tuberculosis and Malaria, Friends Africa, and the Global Alliance for Vaccines and Immunization.

Maternal, newborn, and child health and development is an important issue for malaria prevention advocates as malaria heavily impacts pregnant women and children. Although recent surveys show that fewer children under-five years in Africa are dying from malaria—and ITN use by children rose 20% over 8 years across 26 African nations—malaria is still a major killer of this age group, accounting for one quarter of all deaths.

Fifty million pregnant women are also affected by malaria, accounting for ten percent of maternal mortality annually.

Uganda President H.E. Yoweri Museveni reminded other African heads of state that health investments are development investments. “We know that when we focus our resources, we have measurable impact,” he said, pointing to successes relating to maternal and child health. “For instance, 10% more children and 9% more women [in Uganda] now sleep under nets compared with six years ago.”

United Against Malaria Ambassador and African singing sensation, Yvonne Chaka Chaka, said, “So much progress has been made to stop the under-fives dying from malaria, to prevent children being orphaned by TB and HIV/AIDS…and to curb preventable diseases with widespread immunization efforts. We must continue and ramp up efforts for women and children in recognition of their importance for Africa’s future.”

According to the AU Commissioner for Social Affairs, Bience Gawanas, the summit was “historic.” She said, “[W]e have been asking about political will and leadership and there is no doubt that the AU heads of states and governments have shown the political will to promote maternal and child health on the continent.”

More information about the joint health advocacy events and the AU assembly declaration is available at the VOICES website.

Photos are of Uganda President H.E. Yoweri Museveni, AU Chair H.E. Bingu wa Mutharika, President of Malawi, and Yvonne Chaka Chaka with President Kikiwete of Tanzania.

Guest Blog by: Bremen Leak

Vuvuzelas, makarapa, and malaria awareness. For those of us in South Africa for the 2010 FIFA World Cup, the celebration of football and sport was also a celebration of life and health.

The United Against Malaria campaign, of which Johns Hopkins Bloomberg School of Public Health is a founding partner, took its life-saving message to South Africa this month for an unforgettable event, FIFA’s grand finale concert. Thousands of people saw firsthand how “the beautiful game” is raising awareness of malaria.

With the spirit of the tournament still in the air, UAM continues to unite governments, companies, soccer federations, health organizations, sports stars, and celebrities to eradicate this deadly disease, using football as the vehicle.

Voices for a Malaria-free Future has played an active role since the campaign’s beginning. We helped develop the UAM brand and directed many of its strategies, partnerships, and initiatives.

We brought world-class soccer players like Kolo Touré of Côte d’Ivoire and Stephen Appiah of Ghana to the campaign and created public service announcements with Ghana’s Black Stars (see photo) and other football federation partners.

We won the support of political and business leaders, who have educated and protected countless constituents and served as UAM champions in their home countries and abroad.

And we have educated at-risk populations through malaria-themed sports journals, malaria control program resource guides, and UAM publicity bracelets that raise funds for life-saving mosquito nets in Africa.

We’re excited to be a part of this campaign and look forward to the future. Inspired by the World Cup, we know we can do more.

Unitedagainstmalaria.org

A headline in BBC News today reads, “International Criminal Court ‘altered behaviour’ – UN.” United Nations Secretary General, Ban Ki-moon was quoted saying, “In this new age of accountability, those who commit the worst of human crimes will be held responsible.”

These comments were made at the opening of a ‘stock-taking’ conference of ICC impact on justice for Victims opening today in Uganda. A discussion paper for the conference concludes that …

By engaging victims in trial proceedings, reparation programs, and outreach activities, the Court not only acknowledges and recognizes their suffering and losses, it also helps to make proceedings in The Hague more relevant to communities affected by mass violence. Indeed, if done in a meaningful and consultative way, formal recognition of victims, coupled with effective outreach programs, can help cultivate a sense of local ownership of ICC proceedings and lay the groundwork for greater acceptance of facts established by the Court’s judgments. Such efforts can also help reduce the likelihood of future conflict and strengthen a tenuous peace.

Importantly, the same most common victims of mass violence addressed by the ICC are those most affected my malaria – women and children. And the displacement experienced by these groups in fact heightens their risk of exposure to malaria. As has been reported from eastern DRC.

One wonders whether international institutions like the Global Fund to fight AIDS, TB and Malaria has a similar impact on accountability. The mechanism for this potential impact is ‘Performance-Based Funding.’ According to the Global Fund …

Performance-based funding ensures that funding decisions are based on a transparent assessment of results against time-bound targets … Today, the performance-based funding model is used by a number of development organizations and initiatives (including the GAVI Alliance, the Millennium Challenge Account and the European Commission) as a way to ensure the accountability, efficiency and effectiveness of programs being funded.

GFATM grant reviews rate projects according to progress toward their own stated objectives. All this information is publicly available for scrutiny. The following examples where changes resulted from progress ratings are given by GFATM:

• Mali,HIV (Rated B2): Procurement bottleneck identified; UNDP and UN provided technical support to build local capacity.
• Ethiopia, Malaria (Rated B2): Government focused on problems and sought technical support from UNICEF; grant became A-rated and delivered ten million insecticide-treated bed nets to protect people from malaria.
• Senegal, Malaria (Rated C): Grant stopped, Country Coordinating Mechanism reformed, civil society involved, and new grant signed which proved successful. Country benefited from clear performance evaluation, even with a C-rating.
• Nigeria, HIV (Rated C): Grant stopped, rebuilt monitoring and evaluation system and new grant signed which proved successful. Country benefited from clear performance evaluation, even with a C-rating.

There are also examples where the accountability process resulted in grant suspension when financial improprieties were discovered, as happened in Uganda. A transparent, highly visible system of accountability is necessary, not only to preserve human rights generally, but also specifically to strengthen the right to basic health services including malaria control.

Jhpiego, through USAID Kenya’s AIDS, Population and Health, Integrated Assistance (APHIA II) Program in Eastern Province, supported observance of World Malaria Day 2010. The Provincial Malaria Control Coordinator has written to share their experiences and express they appreciation as seen below. (Photo: drying nets in Isiolo District

From: Alfred Maina
Sent: 27 April 2010 16:01
To: Kennedy Manyonyi, Deputy Project Director, APHIA II Eastern
Subject: World Malaria Day Eastern Province

Hi Dr Manyonyi,

Hope this finds you well. I wish to confirm to you that we had a successful world malaria day launch at Kibugua, Meru south district yesterday. We had a good attendance that I would estimate to about 700.We feel the involvement of the Kathatwa community unit attached to the dispensary did a lot in mobilization of the community. The Mugirirwa community unit as well as the Magnet theatre group were also involved in the event which resonated well with the local community and this is the way to go if we are to collaborate with the community in improving their health.

The Provincial health team was led by the Provincial Director of Public Health who was accompanied by the Provincial Public Health Officer, the Provincial Health Education Officer,Provincial Clinical officer and the Provincial Records and Information Officer. The Meru South DHMT was fully represented and other government departments such as Water, Children’s Office, Education, County Council and Registration. The Meru South D.C. was the guest of honour.

The main highlights of the day included:-

1. A road show/procession that started at Chuka district hospital,throughout the town streets onto the Chuka Runyenjes road, through the market centres in Magumoni and finally into the venue.
2. Involvement of Kathatwa and Mugirirwa community units through:
• Demonstration of IRS using sprayers owned by the Kathatwa unit
• Demonstration of proper use of ITNs
• Demonstration of net re-treatment by the CHWs
• Presentatin of a skit by Mugirirwa CU on malaria control interventions
• Presentation of a play by the magnet theatre group.
3. About 600 nets were distributed to the vulnerable members of the community including pregnant mothers,children under 5 and a few elderly individuals.
4. Speeches by the following people:- DPHO, APHIA 2 representative from Meru south, PSI representative, Provincial Malaria Coordinator and PDPHS.

The main speech was given by the D.C who implored the community to partner with all stakeholders in malaria control interventions in the district.

All in all the activity was a huge success and on behalf of the PHMT, I wish to register our appreciation for the financial support and the great collaboration we had in this event. We look forward to even greater partnership towards improving the health of the communities in this province.

Regards,
Dr Karagu Maina, Provincial Malaria Control Coordinator, Eastern Province