Category Archives: Partnership

African Leaders Malaria Alliance Recognizes Country Achievements, Adds NTDs to its Scorecard

Advocacy, Borders, Children, Conflict, Costs, Epidemiology, Funding, Human Resources, Leadership, Monitoring, Mortality, NTDs, Partnership, Surveillance

The 30th African Union (AU) Heads of State Summit at its headquarters in Addis Ababa, Ethiopia provided an important opportunity to bring the challenges of infectious diseases on the continent to the forefront. Led by the African Leaders Malaria Alliance (ALMA), two major activities occurred, raising greater awareness and commitment to fighting neglected tropical diseases (NTDs) and recognizing the contributions countries have made in the fight against malaria.

For many years ALMA has maintained Scorecard for Accountability and Action by monitoring country progress on key malaria interventions. It later added key maternal and child health indicators.  At the AU Summit ALMA announced that NTD indicators would be added to the scorecards which are reported by country and in summary.

The scorecard will now “report progress for the 47 NTD-affected countries in sub-Saharan Africa in their strategies to treat and prevent the five most common NTDs: lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths and trachoma. By adding NTDs to the scorecard, African leaders are making a public commitment to hold themselves accountable for progress on these diseases.”

In the press release Joy Phumaphi, Executive Secretary ofALMA, explained that, “Malaria and NTDs both lay their heaviest burden on the poor, rural and marginalised. They also share solutions, from vector control to community-based treatment. Adding NTDs to our scorecard will help give leaders the information they need to end the cycle of poverty and reach everyone, everywhere with needed health care.” This will be an opportunity to demonstrate, for example, that, “In 2016, 40 million more people were reached with preventive treatment for at least one NTD than the year before.”

The combination is based on the logic that NTDs and malaria are both diseases of poverty. Malaria and several NTDs are also vector-borne. Also community platforms are a foundation for delivering needed drugs and supplies to tackle these diseases. Ultimately the decision shows that Heads of State are holding themselves accountable for progress in eliminating these diseases.

At a malaria-focused side meeting of the AU Summit Dr. Kebede Worku (Ethiopia’s State Minister of Health) shared that his government has been mobilizing large amount of resources to the fight against malaria which has led to the shrinking of morbidity and mortality since 2005. He also stressed that Africans should be committed to eliminate malaria by the year 2030. “Failing to do so is to repeat the great failure of 1960s faced at the global malaria fighting.”

The highlight for the malaria community at the Summit was the recognition of six countries that have made exemplary progress in the past year. The 6 countries that are leading the way to a Malaria-Free Africa by 2030 are Algeria, Comoros, Madagascar, the Gambia, Senegal, and Zimbabwe, recognized by ALMA for their sharp decline in malaria cases. Madagascar, the Gambia, Senegal and Zimbabwe Reduced malaria cases by more than 20 percent from 2015 to 2016. Algeria and Comoros are on track to achieve a more than 40 percent drop in cases by 2020.

H.E . Dr. Barnabas Sibusiso Dlamini, the Prime Minister of the Kingdom of Swaziland, whose King and Head of State is the current chair of ALMA, warned all endemic countries that, “When we take our eyes off malaria, the cost for our countries is huge. Yet if we increase our efforts to control and eventually eliminate malaria, the yield we get from it is tremendous. It is time that we dig deep into our pockets and provide malaria programmes with the needed resources.”

Mentioning the need for resources raises a flag that calls on us to be a bit more circumspect about progress. IRINNews notes that this is a critical time in the fight against malaria, when threatened funding cuts could tip the balance in an already precarious struggle. IRIN takes the example of Zambia to raise caution. They report that the results of malaria control and the government efforts have been uneven. While parasite prevalence among small children is down almost by half in some areas, many parts of the country have seen increases in prevalence

IRIN concludes that, “For now, the biggest challenge for Zambia will be closing the gap in its malaria elimination strategy, which will cost around $160 million a year and is currently only about 50 percent funded – two thirds from international donors and one third from the Zambian government. Privately, international donors say the government must spend more money on its malaria programme if it is to succeed.” Cross-border transmission adds to the problem.

Internal strife is another challenge to malaria success. “The recent nurses’ strike which lasted for five months may have cost Kenya a continental award in reducing the prevalence of malaria during the 30th African Union Summit in Ethiopia on Sunday.” John Muchangi in the Star also noted that, “However, Kenya lost momentum last year and a major malaria outbreak during the prolonged nurses’ strike killed more than 30 people within two weeks in October.”

Finally changes in epidemiology threaten efforts to eliminate malaria in Africa. Nkumana, et al. explain that, “Although the burden of Plasmodium falciparum malaria is gradually declining in many parts of Africa, it is characterized by spatial and temporal variability that presents new and evolving challenges for malaria control programs. Reductions in the malaria burden need to be sustained in the face of changing epidemiology whilst simultaneously tackling significant pockets of sustained or increasing transmission. Many countries like Zambia thus face both a financial and an epidemiological challenge.

Fortunately ALMA is equipped with the monitoring and advocacy tools to ensure that its members recognize and respond to such challenges. The Scorecards will keep the fight against the infectious diseases of poverty on track.

The Business Case for Malaria Prevention: Employer Perceptions of Workplace LLIN Distribution in Southern Ghana

ITNs, Partnership, Private Sector, Vector Control

Kate Klein as part of her Master of Science in Public Health program in Social and Behavioral Interventions at the Johns Hopkins Bloomberg School of Public Health undertook a study of the potential for private sector involvement in malaria prevention in Ghana. She shares a summary of her work here. During her practicum in Ghana she was hosted by JHU’s Center for Communications Programs and its USAID supported VectorWorks Program. Her practicum she was also supported by the JHU Center for Global Health, and she presented her findings in a poster at the CGH’s Global Health Day on 30th March 2017. Her essay readers/advisers were Dr. Elli Leontsini (Department of International Health) and Kathryn Bertram (Center for Communication Programs).

Malaria is endemic in all parts of Ghana and significantly burdens families, communities, and economies. Malaria remains a leading cause of morbidity and mortality in Ghana; it accounts for eight percent of deaths in the country (The Global Fund, Ghana). It was also responsible for about 38% of outpatient visits, 27.3% of admissions in health facilities, and 48.5% of under-five deaths in 2015 (Nonvignon et al., 2016). In Ghana, the estimated cost of malaria to businesses in 2014 alone was estimated to be US$6.58 million, and 90% of these were direct costs (Nonvignon et al., 2016). Malaria leads to reduced productivity due to increased worker absenteeism and increased health care spending, which negatively impact business returns and tax revenue to the state (Nabyonga et al., 2011).

Although long-lasting insecticidal treated nets (LLINs) are a well-documented strategy to prevent disease in developing countries, most governments, including Ghana, lack the resources needed to comprehensively control malaria. The Global Fund (GF), USAID/President’s Malaria Initiative (PMI Ghana), and the United Kingdom Department for International Development (DfID Ghana) are the main donors for the national malaria control strategy and have worked primarily with the public sector (World Malaria Report, 2015). As government funding remains unable to close the funding gap for malaria, there is an increasing need to revitalize the private sector in sales and distribution of this life-saving technology.

A “Journey mapping” exercise to consider the process of employers buying and distributing nets to employees, created during a PSMP advocacy workshop in December 2016

Ghana is looking to the private sector to encourage a departure from previous dependence on donor-funded free bed nets. The Private Sector Malaria Prevention (PSMP at JHU) project is being implemented in Southern Ghana to increase commercial sector distribution of LLINs. Three case studies served as a situation analysis and exemplified the potential for the PSMP: a rubber producing company, a mining company and a brewery.

All three had experience in malaria control and prevention but only one had specific experience with LLINs (which dovetailed well with its own corporate strengths in logistics management as exemplified by other bottling companies in Africa). Another supported the idea of adding LLINs to its existing indoor residual spraying and community health education efforts, but needed to consider how to develop the flexibility to engage in multiple malaria interventions.

The third had had the right climate and leadership to be able to partner with PSMP, but recently underwent a takeover by a large multinational brewing company and the resulting period of transition could potentially complicate their participation in LLIN distribution efforts from a budgetary standpoint. Generally these companies had the understanding of the potential benefits to the company of situating malaria control within their structure, and thus being early candidates for adoption of the PSMP.

While the three case study companies recognized the business case for malaria, this was not a unanimous opinion among other five companies interviewed. Their concerns ranged from a preference toward treatment interventions to concerns expressed by employees about the difficulty of achieving high levels of net usage due to an array of complaints surrounding sleeping under LLINs. Some of these others had financial constraints.

Through case studies and interviews PSMP was able to identify various challenges moving forward as well as areas where further clarity must be sought. PSMP learned that several companies are pouring their resources into strong treatment and case management programs, and one challenge will be determining how to push for preventative action, such as LLIN distribution, when treatment mechanisms are so established and bias exists.

For those companies who are making tremendous strides in malaria prevention, bringing recognition to these successes through advocacy will be necessary for encouraging future participation and convincing other similar employers of the benefits of starting their own LLIN distribution programs. Finally, PSMP needs to prioritize clarifying viewpoints on LLIN efficacy and use, with a focus on understanding why employers may hold unfavorable views and what it would take to overturn them.

In the future it will be necessary to move beyond the occupational considerations specific to mining and agro-industrial operations and consider how the work has changed the environment into a malaria habitat and the non-traditional work hours that may create more significant Anopheles mosquito exposures. PSMP should gather specific information on lifestyle, housing, and work environments during future visits with employers so that companies that have the most to gain through LLIN distribution are identified and targeted.

UN General Assembly Resolves to Fight Malaria

Advocacy, Coordination, Partnership, Private Sector

unlogo_blue_sml_enGhanaWeb reported this morning that, “The United Nations General Assembly at its 68th Session, adopted Resolution A/68/L.60, “Consolidating Gains and Accelerating Efforts to Control and Eliminate Malaria in Developing Countries, Particularly in Africa, by 2015” by consensus.”

Likewise the UN itself issued a press release confirming that in a final act the Assembly adopted this resolution in order to call for increased support for the implementation of international commitments and goals pertaining to the fight to eliminate malaria. GhanaWeb reiterated the UN’s message that, “with just less than 500 days until the 2015 deadline of the MDGs, the adoption of this resolution by the General Assembly reiterates the commitment of UN Member States to keep malaria high on the international development agenda.”

The UN Press Release explained that, “The resolution urged malaria-endemic countries to work towards financial sustainability to increase national resources allocated to controlling that disease, while also working with the private sector to improve access to quality medical services.  Further, the resolution called upon Member States to establish or strengthen national policies, operational plans and research, with a view to achieving internationally agreed malaria targets for 2015.”

DSCN0730This effort is consistent with moves two years ago in the 66th General Assembly when it called for “accelerated efforts to eliminate malaria in developing countries, particularly Africa, by 2015, in consensus resolution” (document A/66/L.58) where the “Consolidating Gains …” document was first shared. The draft of the 2012  resolution, according to the UN Press release was sponsored by Liberia on behalf of the African Group, and called on Member States, particularly malaria-endemic countries, to strengthen national policies and operational plans, with a view to scaling up efforts to achieve internationally agreed malaria targets for 2015.

The sad irony of Liberia’s current predicament wherein the Ebola epidemic is rendering it nearly impossible to provide malaria services should give us pause. According to Reuters, “Treatable diseases such as malaria and diarrhea are left untended because frightened Liberians are shunning medical centers, and these deaths could outstrip those from the Ebola virus by three or four fold.”

The new resolution (A/68/L.60) in calling for increases national resources allocated to controlling that disease from public and private sources demonstrates the importance of national commitment to sustain and advance malaria control into the era of malaria elimination. It is now up to local malaria advocates to ensure that their governments, as well as private sector and local NGO partners, follow through to guarantee the needed quantity and quality of malaria services.

Is donor assistance a right? … wrong

Funding, Partnership

In response to donor criticism of human rights issues in one malaria endemic country and because of subsequent possible links with future donor cooperation, a prominent government official of that country was quoted as saying, “We don’t like to blackmail others. It’s very dishonest, very irresponsible and unfriendly of persons to attach behavior of another community to their sharing resources.”  (Reuters) This complaint ironically comes from a country that is on record as having squandered Global Fund resources.

Are donors under obligation to ‘share’ their resources with anyone regardless of their ‘behavior’, not just in the field of human rights, but also financial accountability? No country is forced to share its resources, and while all could do more, remarks like those above from recipients add fuel to the fire of those who would be happy to curtail foreign aid all together.

Burkina Faso contributes to malaria drug supplies

Burkina Faso contributes to malaria drug supplies

It is unfortunate that many countries are highly dependent on donors to solve problems like HIV, malaria TB, NTDs and NCDs for the foreseeable future. But a solution to the perceived manipulation by donors would of course be a greater commitment of domestic resources to solve these problems.

One country that is seeking a good balance is Burkina Faso. While the country does receive major support from the Global Fund and the US President’s Malaria Initiative for its fight against malaria, Burkina Faso is stepping up to play its own part.  Government has in recent years steadily increased its financial support to buy malaria commodities from $2 million to over $4 million annually in the past few years.

Relative to donor amounts this contribution may seem small, but the point is the willingness of the government to step up and help its own people. These additional government funds have played a crucial role in filling medicine and commodity gaps that naturally occur when donor supply schedules do not match needs at a given time.

The fight against malaria will be won by having more action oriented governments like Burkina Faso and fewer complainers and embezzlers.

Jhpiego at 40 – commitment to malaria prevention and control in Burkina Faso

Learning/Training, Malaria in Pregnancy, Partnership, Strategy
Jhpiego 40th Anniversary celebration in Ouagadougou with First Lady, US Ambassador, Minister for Health and Jhpiego's President and Vice President

Jhpiego 40th Anniversary celebration in Ouagadougou with First Lady, US Ambassador, Minister for Health and Jhpiego’s President and Vice President

Jhpiego was founded in 1973 to provide technical assistance to countries where the risk of maternal mortality and morbidity was quite high.  While focusing on local capacity building from the start, Jhpiego’s model for technical assistance has evolved.  Burkina Faso first benefitted in 1983 by having health staff attend intensive training at Johns Hopkins Hospital.  Subsequently Jhpiego’s work moved to the field, and some of the early trainees became staff on the ground.

Jhpiego established an office in Ouagadougou in 1996, and one of the earliest projects focused on malaria in pregnancy as part of USAID’s flagship program “Maternal and Neonatal Health” (MNH).  It was during that time that Jhpiego collaborated with partners like CDC to do some of the early testing of the intermittent preventive treatment of malaria in pregnancy (IPTp) in West Africa.  The results of this life-saving intervention were published in the American Journal of Tropical Medicine and Hygiene.

Jhpiego continued to provide technical assistance on malaria in pregnancy interventions and capacity building to the Ministry of Health (MOH) in Burkina Faso through the MNH project and into its successor, USAID’s ACCESS project. Jhpiego worked with partners to update malaria guidelines, training materials, supervisory tools and job aids during this period.

Cover Page Directives finalisées du 23 5 2013In 2009 USAID presented the Maternal and Child Health Integrated Project (MCHIP) with the opportunity to carry out an integrated package of malaria care and prevention strengthening with the MOH and particularly the National Malaria Control Program (NMCP). Over a period of three years Jhpiego, the lead organization in MCHIP, working with together with partners from the NMCP and MOH, was able to accomplish among others the following:

  • Updating Malaria policy and guidelines
  • Updating Malaria supervisory tools and training of supervisors
  • Updating In-service training materials on malaria and training of health facility staff
  • Developing a Strategic communications plan and strategy for malaria
  • Forming of curriculum update committee on malaria at national training schools for primary health staff
  • Training of US Peace Corps Volunteers to support malaria activities in their communities
  • Building the capacity and organizational strengthening for the NMCP itself
  • Conducting a situation analysis of rapid diagnostic test acceptance and use
  • Undertaking a health systems analysis of the strengths and bottlenecks of malaria program implementation in Burkina Faso

Jhpiego 40th Malaria BoothLast week, the Burkina Faso office of Jhpiego hosted the organization’s African Malaria Technical Update Workshop with staff from 15 countries participating. Today Jhpiego is taking its 40th Anniversary celebrations to Ouagadougou.  Jhpiego will express appreciation to local partners in the fight against malaria and threats to maternal and child health.

Jhpiego has been committed on the ground in Burkina Faso to building national capacity for controlling malaria specifically for over 15 years. The recent award by USAID of its bilateral program “Improving Malaria Care” to Jhpiego last October cements Jhpiego’s commitment to the country and to reducing malaria for another five years.

Country Ownership and Global Fund Grants

Advocacy, Civil Society, Funding, Partnership

The latest edition of Global Fund Observer (#218) from AIDSPAN raised a lingering question about the Funds founding principles – what is country ownership and how is it practiced? The thoughts range from the more altruistic – let the country decide what it needs to do and we’ll give the money – to the more crude, though not stated as such – give the country enough rope (money) to hang itself.

Another founding principle involved the Global Fund seeing itself as only a financial mechanism, not a technical one like the World Health Organization or UNICEF.  AIDSPAN demonstrates how over time, while still not providing direct technical assistance, decisions from the Technical Review Panel and the Global Fund Board, among others, can be seen clearly as offering a technical guidance that must be heeded if funds are to flow.

In short AIDSPAN has shown how the Global Fund itself has taken a more directive role, though often based on programmatic evidence and advocacy from those who have a stake or experience. We also need to look at th other side of the coin – within the country, who owns the Global Fund process?

A major overhaul of Country Coordinating Mechanisms (CCMs) some years ago was stimulated by the realization that government agencies are not the sole representatives of their countries and peoples.  While civil society and non-governmental organizations were expected to play a role in CCMs, they were often ignored and rarely had major roles in deciding on and implementing Global Fund sponsored programs in their countries.  Sometimes the advocacy mentioned by AIDSPAN was prompted by CSOs and NGOs not being heard within their own countries.

AIDSPAN mentions changes that the Global Fund has strongly suggested such as having dual track principle recipients (PRs) representing government and the non-governmental sectors.  While this may have represented a somewhat heavy hand from Geneva, the results sometimes reflected the status quo ante and NGO PRs were often relegated to less well funded aspects of programming such as behavior and social change.

Global Fund recipient countries represent a wide diversity of political systems in various stages of evolution.  It would be naive to expect that country ownership really embodies democratic participation of all stakeholders, public, private and NGO, in decision making and implementing on an equal footing – and no one really believes that is fully possible in at present.  Still it is a long term goal and a principle that should guide funding decisions as much as the quality of the technical content of proposed activities.

alma-q1_2013_-_english_scorecard_sm.jpg

In the meantime we can look for additional ways and means to hold countries accountable for their health and social programming decisions. A good example is peer influence from the African Leaders Malaria Alliance (ALMA) which regularly publishes a scorecard of progress toward key health indicators. This freely available score card shows for example, in the first quarter on 2013 only six countries meeting the criteria of good financial management set by the World Bank. In the countdown to 2015, only eight countries are on track in terms of breastfeeding coverage.

As AIDSPAN observes, “But one has to acknowledge that, in the process, the concept of ‘country ownership’ is certainly evolving. Perhaps it will evolve further under the new funding model.” We hope the concept evolves along lines of full and equal partnership among all stakeholders within a country – that all sectors and peoples within a country will truly ‘own’ and thus influence the decision and actions around programs supported through the Global Fund.

Exploring integration between Neglected Tropical Diseases and Malaria Control Programs

Integration, Partnership

Oladele Olagundoye MD, MPH, an Atlas Corps Fellow at the Corporate Alliance for Malaria in Africa (CAMA), GBCHealth, New York, provides a perspective on the recently concluded Neglected Tropical Diseases meeting in Washington….

yola-cdd-helping-a-community-memebr-to-fix-an-itn-to-the-wall-sm.jpgThe Neglected Tropical Diseases (NTDs) community convened at the World Bank for a 2-day conference tagged “Uniting to Combat NTDs: Translating the London Declaration into Action” on November 17 – 18, 2012 in Washington DC. The objective was to provide a forum where all stakeholders in the fight against NTDs can identify the priorities, discuss the challenges and suggest strategies towards achieving the World Health Organization’s (WHO) targets to control and eliminate at least 10 NTDs by 2020.

Leveraging on the London Declaration of January 30, 2012 by leading pharmaceutical companies, donor agencies and non-governmental organizations (NGOs), to supply the drugs required for preventive chemotherapy (PCT) and the treatment of NTDs, the participants identified three priority areas necessary for the actualization of the WHO’s 2020 targets:

  1. Bridging the estimated $US 4.7 billion funding gap by sustaining international commitments and increased domestic funding for NTDs by endemic country governments.
  2. Building the human resource capacity and health infrastructure at the country-level to effectively absorb the increased supply of drugs, and for the scale-up of delivery services.
  3. Effective integration of intervention programs and incorporation of water and sanitation interventions (WASH), to complement the mass drug administration, and intensified disease management of NTDs.

It was encouraged that Malaria & NTDs (Lymphatic Filariasis & Dengue fever) programs should integrate their services, because the scale-up of vector control interventions (LLINs) will benefit the populations served by both programs. However, a critical barrier limiting this collaboration is the suspicion by malaria programs that NTDs managers intend to leverage on the availability of more funding for malaria programs, to achieve specific NTDs targets.

I recommend that program managers for malaria and NTDs (LF & Dengue fever) should adopt the partnerships and four One’s approach, which has contributed greatly to the success of WHO’s African Program for Onchocerciasis Control (APOC) –

  • 1 collaboration mechanism
  • 1 budget
  • 1 package of interventions and
  • 1 monitoring and evaluation framework

Ghana Footballers Fight Malaria

Communication, Partnership

News from Ghana by Emmanuel Fiagbey, Ghana Malaria Voices Project:
The Ghana Football Association (GFA) has held a special media event in Accra to highlight Ghana’s progress in the fight against malaria with support from the National Malaria Control Program and the Voices for a Malaria Free Future project of Johns Hopkins University’s Center for Communication Programs.  Just as in the previous Africa Cup of Nations (AFCON), the 2013 event will promote United Against Malaria (UAM) – an international effort for using football to draw attention to and mobilize support for malaria control efforts.

GFA’s 7th September media event was a prelude to the Ghana–Malawi qualifying match and attracted representatives from 21 print and broadcast outlets and malaria-related agencies and NGOs.

The event was opened by GFA’s president Mr. Kwesi Nyantakyi who reminded those present that …

“Because of GFA’s national reach, Mr. Nyantakyi promised to work towards bringing on board the UAM Partnership local football clubs which belong to the Ghana League Clubs Association to support dissemination of important malaria prevention and treatment messages in communities all over the country.”

a-journalist-poses-her-question-uam-20120907-sm.jpgMembers of the Ghana Media Malaria Advocacy Network (GMMAN) and other journalists who participated in the event were very enthusiastic in continuing to disseminate malaria information through their publications. They however called on the Voices Project to keep them regularly posted on developments at the malaria front.

Maybe the GFA’s enthusiastic support for United Against Malaria helped propel them to success as Ghana Beat Malawi in AFCON 2013 Qualifier a few days later!  Of course no national FA in Africa can afford to ignore the threat of malaria to their teams or their communities.

Training Ghana private sector workers to be ‘malaria-safe’

Partnership

by Emmanuel Fiagbey, VOICES Project – Akosombo, Ghana: April 24, 2012

Volta River Authority (VRA) Heads of Departments and Safety Coordinators become Malaria-Safe Agents

The Volta River Authority, one of the largest body corporates in Ghana with a total workforce of over 3,000 personnel has made yet another move to live up to its motto of “Setting standards for public sector excellence in Africa.” The Authority with its many operational sites of workers and their families located in Akosombo and Akuse in the Eastern Region, Aboadze in the Western Region, Accra and Tema in the Greater Accra Region, Sunyani and Techiman in the Brong Ahafo Region, Tamale, Wa and Bolgatanga in the three northern regions of the country has embarked on efforts to make the authority a Malaria-Safe institution.

heads-of-depts-and-safety-coordinators-who-attended-the-training-program.jpgAs part of activities marking the 2012 World Malaria Day, the Health Dept., Human Resource Dept., and the Project and Systems Monitoring Dept. of the VRA in partnership with the Johns Hopkins University Bloomberg School of Public Health Center for Communication Programs, (JHU-CCP) Voices for a Malaria-free Future project and the National Malaria Control Program, organized a one day training of 15 heads of departments and 30 Safety Coordinators of the Authority at Akosombo with the goal of equipping the officials with the knowledge and skill of operating as Malaria Safe Agents within the authority. Other departments represented at the training included the Environment and Sustainable Development Dept., Engineering Services Dept., Hydro Generation Dept., Thermal Generation Dept., General Services Dept., Real Estates and Utility Services Dept., Northern Electricity Dept., VRA Schools Dept., Corporate Communication Dept. and the Senior Staff Association.

In an opening speech read on his behalf by Mr. William Amuna, Director Project and Systems Monitoring Dept., the Chief Executive Officer of the VRA, Mr. Kweku Andoh Awotwi stated that the position of Safety Coordinators in organizing safety meetings places them in the best position and provides them the best platform to help promote malaria prevention and adoption of effective treatment behaviors among the VRA workforce, staff families and communities around them. “I would like to believe that today marks a humble beginning of the collaboration between the Volta River Authority and the JHU-CCP-Voices project for a more effective and efficient implementation of the authority’s malaria control program.”

In presenting the statistics on malaria cases within the authority, Dr. Rebecca Acquaah-Arhin, Director Health Services Dept. regretted the increase in malaria cases recorded at the authority’s health facilities in the past three years, (2009-2011) which rose from 10,803 cases in 2009 to 16,241 cases in 2011. Dr. Aquaah-Arhin explained that, in spite of the excellent health services the VRA provides to its workers and their families, and also reaching over 2 million inhabitants along the Volta lake, malaria remains a threat to performance and wellbeing. Stating the impact of the disease on the workforce, she noted that in 2009, 2,324 malaria cases were recorded among employees and their dependants. This rose to 2,523 in 2010 and dropped a little to 2,392 in 2011. Malaria, she stressed cost the VRA 82,943.84 Cedis (approximately $52,000) in 2011 alone, “and this is the challenge our partnership with the JHU-CCP Voices project and our Malaria –Safe program must lead us in planning and working to resolve,” she emphasized.

section-of-participants-discuss-the-malaria-safe-strategy.jpgA National Voice against malaria, Dr. Atsu Seake-Kwawu who led the technical session of the training programme stressed that Safety Coordinators could only operate effectively as Malaria-Safe Agents by remaining continually in touch with current relevant information on the causes, prevention and treatment of malaria and most especially the recommended interventions by the NMCP in managing the disease. He called on all Safety Coordinators at the workplace and also in their communities to ensure the recent mass distribution of LLINs produces positive results by ensuring all who have the nets sleep under them every night. “Your role as Malaria-Safe Agents and Safety Coordinators will not be complete if you fail to challenge any health worker, drug distributors etc who will continue to distribute monotherapies such as Chloroquine in your community. ACTs, in particular the AMFm brand must remain your drug of choice for the treatment of all cases of uncomplicated malaria,” he stressed.

The VRA Malaria-Safe Strategy which was presented for discussion by the Country Director of the JHU-CCP-Voices for a Malaria Free Future project Mr. Emmanuel Fiagbey outlined the objectives, barriers, opportunities for applying the strategy and actions the Volta River Authority must sponsor in order to make the organization malaria-safe. Among the key functions of the authority’s Safety Coordinators as Malaria Safe Agents identified during the training workshop were:

  • Incorporation of malaria information dissemination and education into the agenda of safety meetings at the workplace and in the community;
  • Promotion and dissemination of malaria prevention and treatment messages among the workforce, staff families and communities;
  • Facilitation and organization of special workdays to get rid of mosquito breeding sites in workers’ communities;
  • Serving as models in the use of ITNs and adoption of other prevention and treatment behaviours among their community members; and
  • Ensuring involvement of all departments of the authority in the implementation of the VRA Malaria-Safe Strategy in the three strategic objective areas of;
    1. Strengthening the workforce against malaria to reduce the effect of malaria and enhance productivity of every worker.
    2. Empowering mothers/caregivers and children and other dependants of VRA workers to be appropriately engaged in malaria prevention and treatment.
    3. Engaging surrounding communities as partners and beneficiaries in malaria prevention and treatment.

The VRA Malaria-Safe Strategy which was developed with technical assistance from the Johns Hopkins University Center for Communication Programs Voices Project and the Asuogyaman DMAT will be finalized and officially launched in November as a major component of the VRA’s annual safety week celebrations.

A World Bank for the 21st Century (and malaria elimination?)

Funding, Partnership

By the end of this week someone will be nominated to replace Robert Zoellick as President of the World Bank.  Traditionally this nomination has been made by the United States, and it appears that this tradition is likely to be maintained.  The question is whether the traditional nominee – a white, older male of US citizenship – will be able to lead the World Bank in the Twenty-first Century.

The Washington Post today features two articles on this critical rite of passage. Howard Schneider raises, “The question now is whether the bank’s new leader, who could be named in the coming days, can enhance the institution’s role at a time when developing countries are emerging as the engines of world economic growth.” The mixed roles of the Bank – lender, donor, provider of technical assistance – and the emergence of other major and upcoming economic strong houses leads Amar Bhattacharya of the G-24 Secretariat to ask whether there is a clear goal for the institution at this point in time. His answer is ‘No.’

In contrast Michael Gerson sees a positive future because Zoellick’s leadership, he believes, leaves the “rarest of legacies: a multilateral institution with its reputation enhanced. Zoellick acted decisively to help stabilize the finances of struggling nations during the worst of the financial crisis, as well as to provide relief to countries hit hard by a worldwide spike food prices. He has increased transparency at the bank while successfully raising funds to recapitalize it.”

Gerson stresses the Bank’s need to listen to countries that receive its loans or grants since he sees no ‘silver bullet’ emanating from external development or aid experts. He traces as an example the evolution in country needs and requests from Rwanda which asked for emergency food aid in 2007, but a few years later sought investments to increase agricultural productivity and “Now is asking for help building storage facilities, so expanding crop yields are not wasted.”

Schneider does stress that the technical knowledge provided by the Bank is of equal importance as the financial resources it can mobilize. Who then is in the best position to marshal needed technical inputs while at the same time maintaining a humble leadership style that emphasizes that we need to learn from the low and middle income countries themselves?

According to the Washington Post, the current suspected nominees have ranged from Hillary Rodham Clinton and Sen. John Kerry to Susan Rice and Lawrence H. Summers, though for various reasons these have said they are not interested or are unlikely choices.

wb-booster-countries.jpgJeffrey Sachs has let it be known that he is interested in the job, though Schneider notes, “But he says the administration has not approached him.” Sachs is certainly familiar with the needs of low and middle income countries, but would he or the other US candidates take a learning, rather than a prescriptive approach to working with these countries?

Another name breaks the US white male mold – Nigeria’s Finance Minister and Coordinating Minister for the Economy, Dr. Ngozi Okonjo Iweala. CP-Africa recently reported that, “Dr. Okonjo Iweala reportedly recently told the BBC that it is time to open it up to competition and that top jobs at international institutions should be filled on merit.”  They also though that such an appointee would only be successful with support from China.

What is at stake for the malaria community? Currently the World Bank has commitments for malaria control in 21 African countries up to US$ 762.8 million.  This has been used to finance over 73.8 million treated mosquito nets and 25.3 million doses of effective malaria medication over the past five years, a major dent in the overall efforts to scale up malaria control.  Given the current questionable status of Global Fund support, efforts by all other partners including the World Bank are crucial.  Hopefully the new leadership at the Bank will sustain this in line with the commitments of each national malaria control program.