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.
The 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.
Members 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.
As 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.
A 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.
Jeffrey