Category Archives: Partnership

Private Sector and Malaria – Many Roles, Many Benefits

progress-and-impact-business-investing-in-malaria-control.jpgThe latest edition in the Roll Back Malaria Progress and Impact Series is “Business investing in malaria control: economic returns and a healthy workforce for Africa. “The report provides an overview of the direct and indirect economic costs of malaria and looks closely at activities by three businesses in Zambia to tackle the malaria problem.

These companies were “able to scale up malaria control quickly and have seen a rapid return on investment. Malaria-related spending at three company clinics in Zambia decreased by more than 75%, and a very conservative estimate showed that the companies gained an annualized rate of return of 28%.” These experiences provided “Strong models … for businesses to take leadership roles in controlling malaria, protecting their workers and their families, strengthening their businesses, and extending programmes into communities.”

In fact there are several different and complimentary business roles for participation in rolling back malaria as seen below …

  • Manufacturers of preventive and treatment commodities
  • Wholesalers and retailers of malaria prevention and treatment commodities
  • Private health service providers: Formal orthodox, Informal, Indigenous
  • Private companies and industries based in endemic areas that aim to prevent and treat malaria among their employees and surrounding communities
  • Private companies and industries that provide donations to or organize malaria programs whether they are based in endemic areas or not
  • Sales of non-malaria products with a proportion/donation to malaria programming, like PRODUCT RED
  • Private companies that donate to malaria programming through their Foundations

The RBM website that features the Progress and Impact Series on Business involvement provides 16 downloadable case studies on the different models outlined above. Several diverse examples follow:

  • The Azalaï Hotels Group in West Africa, an active participant in the United Against Malaria (UAM) campaign, implements programmes to protect its employees with nets and hotel guests against malaria.
  • The ExxonMobil Malaria Initiative protects employees, supports malaria research and enables NGOs to carry out innovative community malaria control efforts
  • The MTN telecommunications group uses its technology and communication platforms to educate communities through radio, television, SMS, billboards and fliers.
  • The Sumitomo Chemical Company not only produces long lasting insecticide-treated nets but has provided technical assistance toward the establishment of the A to Z Textile Mills, based in Arusha and Kisongo, Tanzania, to ensure locally produced net supplies.

Although not featured by RBM, AngloGold Ashanti in Ghana has maintained an indoor residual spraying from for all structures in Obuasi District for five years now. Cases of malaria illness have steadily reduced at the district hospital.  This protects employees, their families and the wider community.

The impact of individual business efforts may affect a community or a region and vary widely from place to place. In order for greater impact to be felt, national malaria control programs need to identify all potential and actual business partners and bring them into national partnership forums so that collectively the private sector impact on malaria will be most strongly felt.

Peace Corps Senegal

Thanks for the recognition of the efforts of Peace Corps Volunteers worldwide in malaria prevention. PC Volunteers and our partners here in Senegal pioneered the universal bed net coverage and malaria prevention education approach that has now been adopted by PMI and the Senegalese national malaria control program.

Already 7 of the nation’s 14 regions have achieved true universal coverage, including a pre-distribution house by house sleeping area/bed net census, village distribution and education events, and post-distribution hang checks. There is much left to do, but Senegal has made tremendous progress, and Peace Corps Volunteers have been at the center of the fight.

Looking forward as the agency celebrates 50 years, Peace Corps across Africa is developing a comprehensive campaign to replicate and adapt the experiences of PC/Senegal to the other two dozen PC programs on the continent.

Thanks again for recognizing the important role that our Volunteers can and will play in the effort to reduce malaria in Africa.

Chris Hedrick
Country Director, Peace Corps/Senegal
www.pcsenegal.org

Promoting world peace – controlling malaria

the United States Peace Corps is celebrating its 50th anniversary this year.  Volunteers have been working in malaria endemic countries since the beginning of the program. Here we will share a few recent Peace Corps malaria activities. We encourage current and former volunteers to share with us their experiences and lessons learned in controlling malaria.

peacecorps_gov.jpgIn Zambia the Peace Corps has partnered with a local NGO called Youth Activists Organization to bring advocacy messages and educational materials to the community level. Peace Corps Senegal reports that …

Peace Corps Volunteers in all regions of Senegal are leading efforts to prevent malaria, the leading cause of child mortality in Senegal. Volunteers are providing malaria prevention education and have led insecticide treated mosquito bed nets distribution campaigns that have become a model for the rest of Senegal. These efforts are leading to the first large scale universal bed net coverage in the history of Senegal, aiming to significantly reduce malaria caused disease and deaths.

Individual volunteers have written about their experiences, as seen in the following account from Senegal

I worked with three phenomenal community health workers to organize and distribute nets to every family. In the weeks leading up to the distribution, we surveyed all of the families, counting their sleeping areas and numbers of nets in good repair. Working over three days, we traveled house-to-house distributing nets. The chief of Goudel Comi was overcome with gratitude. 

Peace Corps volunteers have even been the subjects in malaria research. One study examined self-reported adverse events associated with long term antimalarial chemoprophylaxis in over 1700 Peace Corps Volunteers. Another study monitored mefloquine resistance in Peace Corps Volunteers.

The Peace Corps even enters into classrooms in U.S. schools from grades K-12 to offer curricular ideas and share experiences from the field. Students can simulate the role of a Peace Corps Volunteer working to prevent the spread of the disease.

The success of malaria control ultimately rests in and with the community. Peace Corps Volunteers are strategically placed to help make sure this happens.

Can Southern Sudan Vote for Independence from Malaria?

As the New York Times in describing preparations for the independence vote in Southern Sudan points out today, “With little more than a week to go until the vote, ballots have been printed, voters registered and campaign rallies held. A countdown clock is posted in the capital, Juba, and foreign officials are flying in for the occasion.”

According to the Times The United Nations Development Program (UNDP), which is responsible for demobilizing various armed forces in the area,may have ” grossly mismanaging the money and may have even intentionally misled donors as to the program’s success.”

The UNDP is also responsible for the Global Fund Round 7 Malaria Grant in Northern Sudan. It may be doing a better job with its malaria assignment. The most recent grant progress report rated them well with a ‘B1’, but raised the concern that, “The cash absorption rate during this reporting period is only 56% of the budget. This is attributed to delays in procurements.”

sdn_mean-ss-line-2.jpgThe North has a mix of malaria transmission situations, while the South is squarely in the endemic zone (as seen in map to right). When the South votes soon for Independence, what will be their own chances of becoming independent from malaria?

The Round 7 Malaria Grant in the South is managed by PSI. The Grant started 2 years ago and currently also rates a ‘B1’. At the most recent grant progress report dated October 2010, the following were achieved:

  • 86% of ITNs had been distributed
  • 10 BCC media campaigns had been implemented and over 6000 community organization staff had been trained, exceeding targets
  • Only 17% of targeted children had been treated with ACTs in the community
  • Health facilities exceeded expectations in terms of maintaining ACT stocks

The progress report concludes that, “Strengthening the capacity of the health system to
deliver health services including malaria interventions have fallen behind set targets, due to late SR selection and contracting, and the PR focusing on the LLIN mass distribution campaign. Nevertheless, results seem to be gaining on set targets.”

Southern Sudan is not without malaria partners. For example, PSI has been working Southern Sudan since “January 2005, distributing Serena long-lasting insecticide-treated nets (LLIN) through the commercial sector … (and providing) support to the Ministry of Health (MOH), Government of Southern Sudan, and county health departments to prevent and treat malaria.” The IRC has trained “villagers to recognize and treat young children for malaria, diarrhea and pneumonia has helped to reduce child deaths by 81 percent in one area of Southern Sudan.”

USAID is also working to help tackle the malaria problem in Southern Sudan. The area has been one of three ‘non-focus’ countries – that is not formally under the US President’s Malaria Initiative (PMI). Two of these countries, Nigeria and Democratic Republic of the Congo, have been added to the formal PMI roster. One wonders whether the fate of malaria control in Southern Sudan rests on the election outcomes.

The BBC quotes a Southern Sudanese nurse who compares the upcoming referendum, “.. as a mother giving birth to twins – once the labour pains are over, the two children can grow up as friends .” We know that malaria during ‘pregnancy’ and during ‘infancy and young childhood’ are threats to survival. We hope that all donors will continue to work for the survival of these Sudanese ‘children’ and bring about a true independence from malaria.

United Against Malaria and CECAFA: Protecting fans through football

Guest Posting by Bremen Leak, Voices for a Malaria-Free Future, Bamako Office Johns Hopkins University – Center for Communication Programs

uam-cecafa-sm.jpgThe 2010 FIFA World Cup South Africa may be over, but Africa is still fanatic about football.

That’s why the United Against Malaria partnership—forged ahead of the World Cup to raise awareness about malaria through football—continues to fill stadia and airwaves across the continent with critical messages about malaria prevention and treatment. Today it’s the humanitarian face of the CECAFA (short for the Counsel of Eastern and Central African Football Associations), organizer of Africa’s oldest football tournament and the year’s biggest football competition since the World Cup.

A 12-team tournament lasting 16 days, the CECAFA Challenge Cup has drawn as many as 60,000 fans per game since its started on Nov. 27 in Dar es Salaam, Tanzania. These fans are primarily men, considered the decision-makers and breadwinners of Tanzania.

To reach this key demographic, Voices for a Malaria-Free Future, through Johns Hopkins Bloomberg School of Public Health—a founding partner of UAM, has joined forces with CECAFA and local beverage maker Tusker to bring attention to the region’s deadly malaria statistics, one football game at a time.

In Tanzania, for example, malaria claims some 80,000 lives each year—almost one in ten of all malaria-related deaths in Africa. In the long run, those deaths rob football clubs of talent, vitality, and World Cup victory, which is why CECAFA’s chair, Leodegar Tenga, announced last week that CECAFA and UAM “shall be partners forever, until we eradicate malaria.” As a result, five additional CECAFA football federations have since joined the campaign.

The official support of CECAFA and the tireless efforts of Tenga have helped UAM continue to educate fans, inform the media, and engage business and political leaders. As the opening ceremony began, Tanzanian President Jakaya Kikwete joined Tenga on the field to greet the UAM ball boys during the opening ceremony.

Throughout the tournament, UAM banners will fly on the field and in the parking lot. Players, ball boys, team escorts, and officials will wear UAM T-shirts or uniforms. And all printed programs will feature simple messages labeled “winning moves to beat malaria, protect your family, stay healthy, and save money.” These include sleeping under a long-lasting insecticide-treated net every night, visiting a health center for malaria testing and treatment when sick, and encouraging pregnant women to seek antenatal care.

More information on UAM and CECAFA may be found online at www.unitedagainstmalaria.org and www.cecafa.net

Malaria and HIV 2010

Another World AIDS Day has come and passed. Sarah Boseley has commented on the information overload that comes this time of year on the disease and the range of basic health programming and valiant efforts to control it. This led to thoughts on whether there are any new developments concerning the connections between Malaria and HIV.

A quick look at the most recent PubMed listings for “Malaria AND HIV” mostly yielded sentences with the common theme of “AIDS, TB and Malaria” that considered the big disease funding efforts and the combined global burden of disease but few new insights on how each disease affects the other. Some interesting examples were uncovered.

On the biological side, Jiang and colleagues in the journal Vaccine (2010 Nov 23;28(50):7915-22) observed that, “Malaria and human immunodeficiency virus type 1 (HIV-1) infection overlap in many regions of the world.” Using mouse models they found that, “important implications for the development of a new form of bivalent vaccine against both HIV-1 and malaria.”

On the programming side, Lugada et al. examined how “Integrated disease prevention in low resource settings can increase coverage, equity and efficiency in controlling high burden infectious diseases,” in rural Kenya, and reported on a campaign that provided, “HIV counseling and testing, 60 male condoms, an insecticide-treated bednet, a household water filter for women or an individual filter for men, and for those testing positive, a 3-month supply of cotrimoxazole and referral for follow-up care and treatment.” (PLoS One. 2010 Aug 26;5(8):e12435)

Reid reported on how injections for suspected malaria cases in drug shops and stores Tanzania and other rural African settings sets the stage for HIV and other infections. The need to prevent such practices can help both diseases. (Rural Remote Health. 2010 Jul-Sep;10(3):1463)

Noting that, “Co-infection of human immunodeficiency virus (HIV) with malaria is one of the pandemic problems in Africa and parts of Asia,” Oguariri and co-investigators examined, “the impact of pyrimethamine (PYR) and two other clinical anti-malarial drugs (chloroquine [CQ] or artemisinin [ART]) on HIV-1 replication.” They showed that, “10 μM CQ and ART inhibited HIV-1 replication,” while “10 μM PYR enhanced HIV-1 replication.” This is important news for malaria case management in areas with high HIV prevalence. (Virus Res. 2010 Nov;153(2):269-76)

While these studies individually may not be earth-shaking, they do point to the continued need for partnership between Malaria and HIV control programs – common interests do exist together with the common desire to save lives.

Sierra Leone – nets without the Global Fund

Widespread efforts to scale up insecticide treated net ownership to meet 2010 Universal Coverage targets are underway in most endemic countries of Africa.  The majority have been using their Global Fund grants to make this leap, supplemented by contributions of other partners.

What happens when a country does not have Global Fund resources at this time? Current efforts in Sierra Leone to reach its nearly 6 million citizens provide a lesson on how to cope.

The AFP has reported on a “20-million-dollar campaign to distribute mosquito nets has been funded by the World Bank, the British Department for International Development (DFID), the Federation of the International Red Cross, the United Methodist Church and other health partners.” These partners are “attempting to get insecticide-treated mosquito nets into each household in the country and to ensure their proper use,” using a house-to-house campaign, which is challenged by poor road conditions.

VOA quotes Lianne Kuppens of Unicef in Sierra Leone who said, “”We have roughly 6 million people and we have 3.2 million bed nets already in the country as we speak. So it’s the first time ever that we are going for universal coverage of bed nets.”

Kuppens also noted that ITN use by children below 5 years of age was below 25%, a problem exacerbated by net mis-use – “nets often find their way into the marketplace or are used as fishing nets or shower scrubs. Vegetable growers use mosquito nets to protect cabbages and carrots from harmful bugs.”

VOA also reports that the campaign has a strong “hang up” component that is using “Street theatre, community radio and religious leaders (to) help convince people that hanging their nets over their beds is better in the long run than selling them or catching fish with them.”

round-7-grant-performance-summary.jpgBut back to the Global Fund …

Sierra Leone’s experience with the Global Fund (GF) may certainly be influenced by its status as a post-conflict country.  The Principal Recipient of the current Round 7 Grant, the Ministry of Health, has, according to GF progress reports, experienced some management challenges.

The Round 7 grant has been running for 2 years and just recently received a “conditional Go” for Phase 2 funding.  ITNs were a small piece of this grant that aimed more at improving malaria treatment.  By 30th April 2010 the grant had distributed only 277,093 of a targeted 312,498 nets for young children and pregnant women.

While the GF does not attempt to strengthen health systems directly, it certainly makes it possible for countries to use grants for their own health system strengthening efforts. More countries should take advantage of this potential. In the meantime, partners should continue to pull together as is the case in Sierra Leone to ensure Universal Coverage.

Chronic diseases – as if malaria were not enough

Two news stories today remind us that low and middle income countries (LIMCs) not only continue to suffer from infectious diseases like malaria, but that they are also burdened with chronic health problems arising from ‘western lifestyle’ behaviors like smoking and over-eating.

The New York Times describes efforts of cigarette companies, not only to promote use of tobacco products, but also to intimidate through lawsuits LMICs who try to control tobacco advertising and sales. Specifically …

Companies like Philip Morris International and British American Tobacco are contesting limits on ads in Britain, bigger health warnings in South America and higher cigarette taxes in the Philippines and Mexico. They are also spending billions on lobbying and marketing campaigns in Africa and Asia, and in one case provided undisclosed financing for TV commercials in Australia.

A Lancet article reported in the BBC documents how adult obesity in Brazil, Mexico and South Africa are above the average for Organization for Economic Co-operation and Development (OECD) countries. Recommendations to reverse these trends include “media campaigns promoting healthier lifestyles, taxes and subsidies to improve diets, tighter government regulation of food labeling and restrictions on food advertising.”

We have here an intersection among the public, the private and the personal. Although individuals can make personal choices and public health organizations can provide health education, the private sector can use their disproportionately enormous financial resources to advertise unhealthy behaviors and threaten in court those who oppose their efforts against health. Statements by agencies like the World Health Organization (WHO) may have a relatively smaller effect here.

The balance seems completely different when it comes to malaria. All partners appear to promoting the same healthy agenda – use of Long Lasting Insecticide-treated Nets and prompt treatment with appropriate antimalarial drugs to name a two key behaviors. The role of WHO is stronger in determining what are appropriate malaria commodities including its pre-qualification of medicines and the WHOPES evaluation scheme for reviewing insecticides.

These WHO processes influence the bulk of purchases for major international donors and national malaria control programs. This is not to say that “unqualified”, substandard or counterfeit malaria drugs don’t make it into the markets of developing countries, but the legal framework is more likely to work against such unhealthy schemes.

Hopefully the malaria partnership that promotes healthy behaviors will continue, resulting in reduced mortality among vulnerable groups such as young children.  It would be a shame for these efforts to reduce infant and child mortality were overshadowed by forces that threaten the lifespan in later years from obesity and tobacco induced cancers and coronary problems.

GAPS – funding, oversight and participation

AIDSPAN has produced another valuable issue of the Global Fund Observer (GFO) that reports and analyzes the challenges of implementing Global Fund grants. Three of the main articles address serious gaps in various areas of programming.

The first gap is one of funding. As we discussed recently, even with an overall increase in pledges to the GFATM, the amounts are inadequate to achieve goals. The inability to raise funds at all level shows serious weaknesses in commitment and planning. AIDSPAN notes consequences of this such that for example …

In fact, though, this week’s pledges provide only $2.9 billion for Rounds 10, 11 and 12. The current estimate of the cost of Phase 1 of Round 10 is $2.0 billion. So the prospects for adequately funding Rounds 11 and 12, and Phase 2 of Round 10, are currently bleak, unless funds significantly in excess of this week’s pledges end up being raised.

dscn0330-community-health-nurse-officer-in-stma-chps-sm.JPGThe second gap is in oversight of procurement and supply management (PSM). “Deficiencies in the oversight of procurement and supply management (PSM) arrangements may be exposing Global Fund grants to unnecessary and unacceptable risks. This is one of the conclusions of an audit report released by the Fund’s Office of the Inspector General (OIG) in April 2010.”
Some of the main PSM deficiencies as summarized by GFO are –

  • weak forecasting of requirements for drugs and health product
  • weak technical specifications for procurement
  • absence of, or weak, procurement policies and procedures
  • poor inventory management
  • poor storage and transportation facilities at national and sub-national level
  • weak procurement planning resulting in frequent emergency procurements and
  • inadequate management information systems

The third major gap reported in the GFO is lack of civil society participation in County Coordinating Mechanisms (CCMs) for global fund grants. The article highlights the Civil Society Action Team’s recent report. This report documented the fact that while persons affected by the three diseases in theory have representation on CCMs, they often do not take part in the real decision making.

In particular, “civil society representatives often lack the capacity and expertise to fully engage in CCM processes and to properly represent their constituents.” Lack of participation threatens the relevance and acceptability of programs.
These gaps focus on weaknesses basic health systems management processes and competencies. It is not enough to point out these gaps. Serious efforts are needed to strengthen health systems. Unless these three gaps are closed, partner interest in pursuing the noble goals of disease control and elimination will be threatened.

Promises: how gr8 is the G8?

As the G8 Summit convenes in Canada this weekend, there comes a time for reflection and accountability. In fact accountability is the theme for a publication – “The Muskoka Accountability Report takes stock of recent G-8 commitments related to development, assesses the results of G-8 actions and identifies lessons for future reporting.” The report explains that …

In 2005, at the Gleneagles Summit and the United Nations Millennium +5 Summit,G8 countries and the world’s major aid donors made commitments to increase Official Development Assistance (ODA). Based on these specific commitments, the Organization for Economic Co-operation and Development (OECD) estimated that ODA from all OECD-Development Assistance Committee (DAC) bilateral donors would increase by around $50 billion a year by 2010, compared to 2004.

behind-each-dollar.jpgThe Muskoka Report notes that ODA increased from $80 billion to $120 billion, with $24 billion coming from G8 countries. But it also explains that this $10 billion shortfall is actually $18 billion in 2004 dollar value. The report notes the following health accomplishments:

  • G8 contributions account for $12.2 billion or 78 percent of the total contributions to the Global Fund
  • G8 is on track to provide over 100 million insecticide-treated nets
    by 2010
  • For the period 2005 to 2009 G8 funding to the Global Polio Eradication Initiative was $1.68 billion

Although the dollar amounts seem large, the Washington Post reports from Toronto that, “Canada announced on Friday a multibillion-dollar initiative to combat infant mortality and improve maternal health globally, but the aid package was far smaller than expected, undercut by a new drive toward austerity that reduced the contributions of wealthy nations.”

An expected package of $10 billion from the G8 may turn out to be only $7.3 billion. “… the plan highlighted how world economic dynamics have made a sudden lurch toward less government spending.”

Oxfam has called the contribution gap between 2005 promised and 2010 realities a ‘bounced check‘ that undermines the G8’s credibility. Maybe this is an accounting trick, suggests Oxfam:

Oxfam also decried the G8’s attempt in their own accountability report to minimize their breach of faith by using 2009 dollars instead of 2004 dollars for the calculation and deducting for lower growth, thus showing only a $10 billion shortfall.

Oxfam calls on the G8 to show the “political will and leadership that at least equals that we saw at Gleneagles.” This involves not only acknowledging that the gap is nearly double the apparent dollar value, but also taking steps to close it.

Save the Children recommends that the Muskoka Summit recommit to funding, but that these “Governments need to do better at the September U.N. Summit on the Millennium Development Goals .” The President of Save the Children observed that while the G8 and upcoming G20 leaders are worried about economic stability …

… both the leaders and the public should understand that global economic growth can never be balanced if the world doesn’t address the tragic circumstances surrounding birth and early life in much of the developing world. Without decisive action, the social costs of global economic downturns will only hit harder and last longer.

The BBC reports today that, “World leaders are due to focus on the nuclear disputes with Iran and North Korea on the second day of the G8 summit in Canada.” Maybe they will eventually come to the realization that global poverty is also a problem for all. As BBC notes, “Mr Obama has called for the group to pull together to promote economic growth, saying that world economies are ‘inextricably linked’.”