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Case Management &Guidelines &Policy &Uncategorized Bill Brieger | 26 Nov 2019

Systematic Approach to the Review of Malaria Management Guidelines Ghana, 2019

Mildred Komey Akosua,* James Sarkodie, Kezia Malm1 Raphael Ntumy, and Gladys Tetteh presented a poster entitled “Systematic Approach to the Review of Malaria Management Guidelines Ghana, 2019” at the 68th Annual Meeting of the American Society for Tropical Medicine and Hygiene.

The primary objective of the Ghana NMCP is to reduce morbidity & mortality due to malaria through effective strategies. Implementation of these effective malaria control strategies depends largely on the availability of up-to-date, evidence-based, and standardized reference materials to guide and improve practice. Guidelines for the management of malaria in Ghana, including the anti-malaria drug policy (ADP), guidelines for case management of malaria (CM) and guidelines for malaria in pregnancy (MiP) were last updated in 2014. The 2014 review took over six months and left behind no documented methodology to guide subsequent reviews.

The World Health Organization recommends a comprehensive review every five years. In order to make the 2019 review process concise, efficient and reproducible, the NMCP with support from the PMI Impact Malaria project outlined a methodical approach to the review.

The process established an oversight review committee; identified all stakeholders relevant to update the ADP and guidelines; prepared a reference package of technical resources and research findings; nominated experts and allocated them to topic-specific technical working groups (TWGs). (Fig 1)

Then, a series of TWG consultative meetings were held with clearly defined processes and outputs, and independent external experts and potential end users of the guidelines ratified the draft guidelines. (Fig 2 and Fig 3)

A final phase included development of training content, training manuals, and development of key job-aids. (Fig 4 and Fig 5) Costs for the review process were identified and funding obtained.

All components of the 2019 process were enhancements to the unrecorded 2014 review. The process resulted in a documented and costed methodological approach, an up-to-date ADP, MiP and CM guidelines, training curriculum, training manuals, and job aids; all developed in a timely and efficient manner over a three-month period.

It also resulted in an approach for achieving minor policy and guideline updates between comprehensive five-year reviews. Using a systematic well-defined comprehensive approach with clear expectations for inputs, process, outputs, roles, timelines, costs, and sequelae actions, results in up-to-date widely accepted policies and guidelines whose implementation can be easily operationalized, with mechanisms for minor guideline updates between comprehensive five-year reviews.

*Author affiliations: Ghana National Malaria Control Programme, PMI Impact Malaria Project, Jhpiego


Policy Bill Brieger | 31 Oct 2015

Malaria Sessions at APHA15

65cd3DCO_400x400The 143rd Annual Meeting of the American Public Health Association (#APHA15) Begins formally on 31st October 2015 in Chicago. This year’s theme, “Health in All Policies” recognizes that “many nontraditional health partners, such as housing, transportation, education, air quality, parks, criminal justice, energy, and employment agencies” contribute to healthy people and communities. Quality of housing and content of education influence malaria transmission. To the list we can add environment, agriculture and water resources.

2015_AM_logoOf interest to those working in tropical health and malaria there are many sessions, presentations and posters on malaria. See a list below. If you are in Chicago for #APHA15 take advantage of these sessions.


328782 Examining the impacts of environmental context on the efficacy of a malaria vector control intervention Tuesday, November 3, 2015 : 4:45 p.m. – 5:00 p.m. Marie Lynn Miranda, PhD, School of Natural

335281 Rise of vector resistance and insecticide costs: An assessment of insecticide change for indoor residual spraying (IRS) and malaria burden in Zimbabwe Tuesday, November 3, 2015 : 5:30 p.m. – 5:45 p.m. Beth Brennan, MPH, Abt Associates, Inc., Bethesda,

325708 Tackling malaria through a Champion Communities approach in Zambia: Using data to change behaviors and improve health outcomes Monday, November 2, 2015

333754 Can a malaria service delivery project improve gender equality? Wednesday, November 4, 2015 : 9:22 a.m. – 9:35 a.m. Elana Fiekowsky, MALD, International

338009 Is 1+1<2? Exploring Disinhibition Theory and Malaria Prevention Interventions in Angola Tuesday, November 3, 2015 Karishma Furtado, MPH, Brown School of Social Work, Washington University, St. Louis,

334502 Attitudes Beliefs and Practices Relevant to Malaria Prevention and Treatment in Madagascar and Liberia Tuesday, November 3, 2015 : 5:15 p.m. – 5:30 p.m. Stella Babalola, Associate

333934 Case Management of Malaria: A review and qualitative assessment of social and behavior change communication strategies in four countries Monday, November 2, 2015 Michael

331507 Malaria misdiagnosis and the re-emergence of viral fevers: The case for improved surveillance and diagnostics of acute undifferentiated febrile illness in

334115 Using Nollywood to Change Malaria and Family Planning Behaviors Tuesday, November 3, 2015 : 4:30 p.m. – 4:45 p.m. Babafunke Fagbemi, Executive Director at Center

334531 Setting New Standards for Transparency & Accountability: Using Mobile Technology for Data Collection and Mapping of Malaria Net Distributions in DRC Tuesday, November 3, 2015 Crystal Stafford, MPH, IMA World Health, DR Congo, Kinshasa, Congo-Kinshasa Purpose Malaria

4430.0 Malaria & vector-borne diseases Tuesday, November 3, 2015: 4:30 p.m. – 6:00 p.m. Oral Malaria is a major public health challenge and causes

II Dr. Betty Mpeka, Uganda Indoor Residual Spraying Project Phase II, Abt Associates Inc., K, Uganda Albert P. Okui, National Malaria Control Program, Ministry of Health, Uganda Ranjith De Alwis, Africa Indoor Residual Spraying (AIRS) Program, Division of International Health, Abt

health workers (CHWs) aims to reduce under five child mortality rates (U5MR) in remote communities. Kono District had a high malaria burden and U5MR. In 2009, iCCM for children aged 2-59 months expanded district-wide. We evaluated the effect of iCCM on

contacts, interstate travel plans, and EVD exposure risk. Through gained experience this expanded to include pet ownership, personal vehicle access, malaria prophylaxis, and determination of mandatory travel/work restrictions. “Low (but not zero) risk” PUM reported temperature, symptoms, and antipyretic use twice

showed CHWs to be effective in improving coverage of key MNCH practices, assessing mothers and children, and initiating treatment for malaria and diarrhea. Results indicate that a supervision process to monitor, improve and maintain clinical skill performance by CHWs within a

years of work experience in implementing and Research of Public health programs in Nigeria, particularly in HIV, reproductive Health and Malaria. I have the educational qualification and I currently work in one of the leading organizations in public health in Nigeria

initiated to improve access to quality care through private medical vendors (PMVs), a baseline survey on household experiences in managing malaria, diarrhea, and cough with difficult breathing was done in four local government areas (LGAs). A total of 3,077 children under

the participants any off-label or experimental uses of a commercial product or service discussed in my presentation. Back to: 4430.0: Malaria & vector-borne diseases Main Menu and Search Browse by Day Browse by Program Author Index Affiliation Index Disclosure Index Personal

Giridhar Mallya, MD, MSHP, Meagan Pharis, Mei Zhao, BS, Steven Zhu and Qiaoling Zeng, PhD Board 6 Case Management of Malaria: A review and qualitative assessment of social and behavior change communication strategies in four countries    Michael Toso, MSH Board

Sarah Jane Holcombe, PhD, MPPM, MPH, Sahai Burrowes, PHD, MALD, Danielle Niculescu, MPHc and Dube Jara, MPH Board 5 Tackling malaria through a Champion Communities approach in Zambia: Using data to change behaviors and improve health outcomes    Andrew Tuttle, Master

Dahn, MD MPH, Ministry of Health, Liberia, Monrovia, Liberia Objectives:  Intravenous (IV) Artesunate has become first line treatment for complicated malaria, reducing mortality by up to 35% relative to IV Quinine. The World Health Organization (WHO) changed its guidelines favoring IV

p.m. Poster Board 1 Setting New Standards for Transparency & Accountability: Using Mobile Technology for Data Collection and Mapping of Malaria Net Distributions in DRC    Crystal Stafford, MPH Board 2 Comparative Analysis of WHO Essential Medicines Listed for Diabetes among

Among the neonatal mortality patterns, severe birth asphyxia/perinatal asphyxia was the most common cause of early neonatal deaths, while severe malaria constituted the most common cause of death in children aged under-5. Conclusion: The findings revealed that place of residence is

Rajulu, Master of Science, Ling Wang, PhD and Lou Smith, MD, MPH Board 7 Is 1+1<2? Exploring Disinhibition Theory and Malaria Prevention Interventions in Angola    Karishma Furtado, MPH Board 8 Findings from a Quantitative Study to Create a Transition Guide

PhD 9:09am Gaza 2014-What did we learn?    Charles W. Cange, PhD, MSc and Karen Kelly, MD 9:22am Can a malaria service delivery project improve gender equality?    Elana Fiekowsky, MALD and Niyati Shah, MIPP See individual abstracts for presenting author’s

theory of youth peer crowds and its influence on risk behaviors. Moderator: David Bickham, PhD 4:30pm Using Nollywood to Change Malaria and Family Planning Behaviors    Babafunke Fagbemi, Executive Director at Center for Communication Programs Nigeria 4:45pm Hip Hop Stroke: Developing

Indoor Residual Spraying Project Phase II, Dr. Betty Mpeka, Uganda Indoor Residual Spraying Project Phase II, Albert P. Okui, National Malaria Control Program, Ministry of Health, Uganda, Ranjith De Alwis, Africa Indoor Residual Spraying (AIRS) Program, David F. Hoel, Centers for

was associated with reductions in children’s illness.  Control children of all ages (0-17) were 1.5 times more likely to contract malaria or pneumonia (p<0.05).  Positive but insignificant results were detected for under-5 illness incidence.  No significant results were detected for children

high food insecurity in Kenya Tuesday, November 3, 2015 Muhamed Akulima, BA in Anthropology, MA in project Planning and Management(continuing), HIV/AIDS-TB,MALARIA programme, Amref Health Africa in Kenya, Nairobi,, Kenya Background  An estimated 500,000 orphans and vulnerable children live in Central and Eastern

and providers, more efficacious medicine and adaptation to a changing environment, alert to emerging diseases like chikengunya virus, reintroduction of malaria, alongside cardiovascular and sickle cell disease, increasingly impacting women of reproductive age.  The need for complex interventions create opportunities for

providers, including the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria, also rely on affordable generic medicines to provide treatment to millions of people worldwide. In spite of the proven role

Cambodian population grew by only 13%. In 2013, road crashes accounted for 20 times more deaths in Cambodia than landmines, malaria, and dengue fever combined. Helmets are proven to reduce the risk of death by 42% and serious injury by 69%,

Health Systems &Policy Bill Brieger | 29 Jun 2014

Model World Health Organization at UNC Gillings School of Public Health

UNC GillingsNeha Acharya, who is the Director of the American Mock World Health Organization conference, set to be held within UNC’s Gillings School of Public Health from October 3rd-5th, has shared the following announcement with us:

AMWHO is the nation’s very first simulation of the World Health Assembly, and seeks to educate undergraduate and graduate students on the proceedings of global health affairs. This conference will invite over 200 students from all across the nation, and is America’s very first model WHO event.

DSCN0367The American Mock World Health Organization (AMWHO) is an authentic simulation of the World Health Assembly, the sole decision-making body of the World Health Organization. Participants assume the role of a WHO ambassador, non-governmental organization member, or media representative, and form health related positions based upon their respective roles. Throughout the conference, participants will engage in debates and discussions about a thematic health topic, and work together to create a final working resolution to send to the World Health Organization in Geneva, Switzerland.

Modeled after the Ontario and Montreal World Health Organization conferences set in Canada, the primary focus of all three is to raise student awareness of pertinent health issues facing the world today, as well as to promote understanding of the many roles students can engage in through global health policy. The conference hopes to establish an environment similar to that of the World Health Organization’s Assembly, and educate future global health leaders in the proceedings of international health entities.

This simulation will be the United States’ first model-WHO conference, and is set to take place in Rosenau Hall within the University of North Carolina at Chapel Hill’s campus from October 3rd-5th, continuing in the years to come. Register at and purchase your $45 ticket! You can also follow plans and progress on twitter.

Policy Bill Brieger | 29 Aug 2013

Malaria-Specific Elements of Declaration of the Special Summit of African Union on HIV/AIDS, Tuberculosis and Malaria

Special Summit of African Union on HIV and AIDS, Tuberculosis and Malaria (ATM), Abuja, took place in Nigeria, from 12-16 July 2013, and produced a declaration that stressed “Abuja Actions Toward the Elimination of HIV and AIDS, Tuberculosis and Malaria in Africa by 2030.”

summit_banner-sm.jpgThe participants declared on 16 July 2013 that, “We, the Heads of State and Government of the African Union, meeting at a Special Summit of the African Union in Abuja, Nigeria, on 15 and 16 July 2013 focusing on the Theme: ‘Ownership, Accountability and Sustainability of HIV/AIDS, Tuberculosis (TB) and Malaria Response in Africa: Past, Present and the Future’ to review the progress made and the challenges faced in implementing the Abuja Declaration and Plan of Action on Roll Back Malaria (RBM) of 2000; the Abuja Declaration and Plan of Action on HIV and AIDS, Tuberculosis and Other Infectious Diseases (ORID) of 2001; and the Abuja Call for Accelerated Action Towards Universal Access to HIV and AIDS, Tuberculosis and Malaria Services in Africa by 2010″ agreed to undertake several key actions.

Some actions were integrated such as, “Ensure that strategies are in place for diversified, balanced and sustainable financing for health, in particular AIDS, TB and Malaria, development of strategic health investment plans and strategies for innovative financing, including from the private sector” While others were disease specific like the following for malaria:

  • Strengthen the use of effective insecticides for control and elimination of malaria, including the use of dichlorodiphenyltrichloroethane (DDT), where necessary
  • Intensify the use of Larval Source Management (LSM) where suitable for the control and elimination of Malaria
  • Ensure that Malaria Rapid Diagnostic Tests (RDT) meet WHO procurement criteria, are quality-controlled and selected to meet local Malaria epidemiology
  • Accelerate scale-up of the WHO “T3: Test, Treat and Track” Initiative by ensuring universal access to diagnostic, testing for all suspected malaria cases and quality-assured anti-malaria treatment for confirmed infections, and tracking the diseases through timely and accurate surveillance
  • Maintain funding for, and uninterrupted supply of, life-saving malaria commodities to prevent resurgences of malaria that can occur rapidly with devastating loss of life

The summit was not an end in itself, but a benchmark. The Declaration refers to three previous Declarations against which current progress has been measured. Organizations like the African Leaders Malaria Alliance (ALMA) will continue to monitor malaria progress of all member countries who were in attendance. These commitments by endemic countries will go a long way to sustain the efforts to eliminate malaria.

Policy &Strategy Bill Brieger | 25 Jun 2013

Taking malaria capacity building to scale: Lessons on an Integrated Policy Package from Burkina Faso


Presented at Jhpiego’s Mini-University, 24 June 2013 in Baltimore by Bill Brieger, Rachel Waxman, Elaine Roman and Ousmane Badolo

Between October 2009 and March 2013, with support from the USAID Malaria Program, the Maternal and Child Health Integrated Program (MCHIP), led by Jhpiego  has worked in close collaboration with the National Malaria Control Program (NMCP) and the Family Health Directorate (MCH) to accelerate malaria prevention and control in Burkina Faso with a focus on nationwide scale up.

steps-to-scale-up-in-burkina-sm.jpgScale up is defined as program coverage nationwide.  During the project years, Jhpiego provided technical and programmatic support to address comprehensive malaria prevention and control with a focus on diagnostics, treatment, and malaria in pregnancy (MIP) in Burkina Faso.  This resulted in: 2,648 health facility providers trained using the integrated malaria training package; these providers in turn, oriented 4,867 of their colleagues.

Other key components of technical support included strengthening- a) supportive supervision; b) pre-service education; c) human capacity (team building); and d) communications and behavior change guidance at national level as well as targeting communication messages to both health facility providers and clients.  Training is US Peace Corps Volunteers helped reinforce that this guidance reached front line health facilities and volunteer community health agents.

Some of the lessons learned in going to scale are balancing reaching providers en mass with quality support; ensuring a link between revised policies and guidelines and both pre-service education and in-service training; and recognizing the need for national level leadership and capacity to ensure effective implementation.

As countries accelerate and scale up their malaria programs, the lessons learned from Burkina Faso a systematic development of an integrated package of malaria policies and guidelines are important to consider moving forward.

Policy Bill Brieger | 24 Oct 2012

After 50 Years Political Will Still Needed to Improve Child Health

On the Fiftieth Anniversary of the formal creation of the Department of Pediatrics at the University College Hospital of Ibadan, Nigeria Dr Tony Marinho shared observations about the status of child health and the need for greater political will to meet the challenges. He has provided an excerpt of his talk of 18 October 2012 below.

dscn0254a.JPGPoliticians must learn that the elimination of malaria and other health problems is their heavy responsibility, not costly conferences and four wheel drives, but funded health delivery chains, 20million posters and advertising because IGNORANCE ELIMINATION and EDUCATION ARE KEYS TO GOOD HEALTH.

Are there Health/Media Outreach Budgets, Health Ministries/ Media houses meetings and CSR ‘free’ airtime for ‘life-skill’ message advertisements? The UN Secretary General should annually select 50-100 life-skill messages for advertising agencies, the ‘Global Fund Membership’, ‘UN life-skills Partners’ and ‘Global Fund Advert Moral Media’ to disseminate on commercial packaging with UN incentives eg Annual Prizes for ‘Best life-skill Message’, ‘Best Corporation in Life Skill Dissemination’? Only a fool depends on Bill Gates to buy local airtime to save his children. A UN recommended ‘60 minutes of free airtime in 30 second slots’ should be the ‘free message’ contribution from the airwaves.

Commercial Messages out-number ‘life-skill health and social’ messages by 100-1000:1. We need ‘Annual UN/WHO/UNICEF Moral Media Campaigns’ for ‘ignorance elimination’ strategies? Let every commercial message carry a ‘piggyback’ ‘Unrelated Life-skill Message’ free.  Why is pre-pregnancy folic acid, malaria and typhoid information, not taught in schools?

Health messages are a human right. Why cannot Nigerian fathers buy ITNets for their children? Do markets, schools and religious houses have 20m posters with health messages? Politicians make 10m personal posters for votes. A picture IS worth a 1000 words, except in Africa.

Our problems are the CINS of politicians – Corruption, Incompetence, Negligence and Selfishness. There is a lack of political love which works against the malaria-ous child.

Annual professionals’ meetings should provide a feared ‘pressure group’  annual ‘State Of The State, Nation- An Audit’ The current ‘save one million lives’ may help achieve the MDGs. The original MDG team deserve a Noble Prize in Preventive Medicine for saving millions.

Asia &Elimination &Policy Bill Brieger | 19 Aug 2012

Vietnam To Tackle Ending Malaria with Asia Pacific Malaria Elimination Network

apmen_banner.gifPress Release from APMEN

In an important step toward achieving malaria elimination, Vietnam officially joins the Asia Pacific Malaria Elimination Network (APMEN) today. APMEN brings together countries in the Asia Pacific that have adopted a national or sub-national goal for malaria elimination, and connects them with a broad range of regional and global malaria partners to develop best practices for eliminating malaria and to efficiently address region-specific challenges, like Plasmodium vivax.

Vietnam has made great strides in improving the health of its citizens, which includes reducing the risk of malaria throughout the country. Malaria deaths have plummeted by 91% in the last decade, from 71 deaths in 2000 to 14 in 2011. Reported cases of malaria have also dropped by 85%, declining from 300,000 cases to 45,000 in 2011. However, similar to other countries in the Asia Pacific region, Vietnam faces substantial challenges to eliminating malaria, which include the increasing spread of drug-resistant malaria parasites and continuous movement of populations between malaria-free and malaria-endemic areas.

The most malarious regions in Vietnam – remote, forested areas – are also the country’s hardest places to reach, and require more responsive surveillance systems to effectively track down and treat malaria cases. By joining APMEN, Vietnam aims to harness the region’s collective experience, research findings and program recommendations to take on the final – and perhaps most difficult – steps to eliminating malaria. itn-in-high-endemic-area-vietnam.jpgVietnam’s malaria program, the National Institute for Malariology, Parasitology, and Entomology (NIMPE), recently completed its National Strategy for Malaria Control, Prevention and Elimination 2011-2015. With this strategic plan,

Vietnam outlined its goals of controlling and reducing malaria in higher burden areas, and the implementation of a spatially progressive malaria elimination strategy in low transmission regions. APMEN is a country-led network focused on generating and disseminating evidence-based information on what works to drive down malaria and achieve elimination in the Asia Pacific.

APMEN was developed in 2009 in response to a call to action by countries in the region to tackle malaria elimination. With Vietnam as the newest addition, APMEN connects its 12 other network countries— Bhutan, Cambodia, China, Democratic People’s Republic of Korea, Indonesia, Malaysia, Philippines, Republic of Korea, Solomon Islands, Sri Lanka, Thailand and Vanuatu— in an effort to learn from each other’s malaria program approaches, translate research into action and consider optimal program implementation.

More reading about eliminating malaria in Vietnam can be found through the UCSF Global Health Group’s country profiles. APMEN country partners work together to sustain the gains made in malaria control and ensure financial and political support for malaria elimination in the region. Further information regarding APMEN can be viewed at

Policy &Resistance &Treatment Bill Brieger | 30 May 2010

Strong words against oral artemisinin monotherapy drugs

Forty-four Ministers of Health of the African continent (as well as Brazil and India) or their representatives congregated at a special ministerial session of the 18th Roll Back Malaria (RBM) Partnership Board meeting and on the last day, 14th May 2010, signed a document in which they, “Express(ed) our governments’ engagement, with support from our development partners, to eliminate (ban and enforce) oral artemisinin-based malaria monotherapies and substandard ACTs from the market through tangible policies, strategies and regulatory measure within the next 12 months.” Hopefully these words will lead to action and soon.

art_drugs_sm.JPGThe World Health Organization has been pressing this issue strongly for several years, and as far back as 2001 a WHO publication, “Use of Antimalarial Drugs” (pg. 72), specifically stated that artemisinin should preferably be administered in combination with another effective blood schizonticide. A press release in early 2006 WHO called for an immediate halt to provision of single-drug artemisinin malaria pills, and was issued in concert new malaria treatment guidelines issued by WHO.  In another press release later in 2006 WHO announced that some pharmaceutical companies agreed to stop marketing single-drug artemisinin malaria pills, specifically the press release explained that …

“In January 2006, WHO appealed to all companies to stop marketing oral artemisinin monotherapies and to re-direct their production efforts towards ACTs. Following the January appeal, an additional 23 companies were identified and informed of WHO’s recommendation. 13 companies said they would comply with the WHO guidance. Additional companies have said they are willing to collaborate with WHO in this endeavour.”

It is not clear that WHO’s warning was heeded, because another WHO press release on 25 February 2009 stated that, “WHO today said that the emergence of parasites resistant to artemisinin at the Thai-Cambodia border could seriously undermine the success of the global malaria control efforts.” While outright resistance was not declared, Dondorp and colleagues found in 2009 that, “P. falciparum has reduced in vivo susceptibility to artesunate in western Cambodia.”

Reuters reported earlier this year that, “Pailin (Cambodia) is the origin of three drug-resistant malaria parasites over the past five decades. Thanks to prolonged civil conflict, dense jungles and movement of mass migrants in the gem mines in the 1980s and 90s, the strains multiplied and dispersed through Myanmar, India and two eventually reached Africa.” The situation is made worse by illegal pharmacies that sell counterfeit medicines. MediaGlobal stated earlier this month that, “the government (of Cambodia) has shut down 65 percent of illegal pharmacies. The number of illegal pharmacies has decreased from 1,081 in November 2009 to 379 in March 2010.”

Action by the 44 African Ministers of Health is not too late, but it could have come sooner. The Ministers pledged to “Report on progress in eliminating oral artemisinin-based monotherapies in May 2011,” as they signed up “to the commitment against the use of oral artemisinin-based monotheraples for malaria control.”

Nigeria, with the highest malaria burden in Africa, was one of the countries that apparently missed the meeting. Onwujekwe and co-researchers recently documented the sales or provision of monotherapy artesunate drugs in most of the public and private hospitals as well as pharmacies they studied in Anambra State. Nigeria’s policy concerning monotherapy artemisinin drugs was to all those already on the market to continue until their license ran out.

As we reported previously, some of those licenses will not expire until 2012.  We hope Nigeria and all other malaria endemic countries will act sooner than later and be able to report the complete removal of monotherapy artemisinin drugs my May 2011.  We want to eliminate malaria, not eliminate the effectiveness of ACTs.

Health Rights &Policy Bill Brieger | 05 Feb 2010

Workplace health – what is feasible?

girl-selling-ingredients-2.jpgNigeria’s Daily Champion Newspaper reports that, “CHIEF Executive Officer of Friends of the Global Fund Africa (Friend Africa)- an advocacy and fund raising organization, Akudo Anyanwu Ikemba has canvassed the need for institutionalize workplace policies to ensure the protection of health and right of workers.”

Participants at the 2-day Workplace Policy Workshop recognized that, “The HIV/AIDS scourge, tuberculosis and malaria are impending threats to productivity that could have negative economic impact on the workforce if not properly tackled.”  Akudo Ikemba also explained that “there is need for Small and Medium Enterprises (SMEs) to embark on deliberate workplace policies.”

In reality ‘small’ enterprises does not begin to describe the work setting for the majority of people in Nigeria and Africa generally. “This sector may be invisible, irregular, parallel, non-structured, backyard, under ground, subterranean, unobserved or residual.” It is hard to imagine members of this sector setting workplace health policies.

Their numbers are substantial. Geoffrey Nwaka estimates that the sector accounts for between 45% and 60% of the urban labor force.  The proportion is probably even greater in rural communities wheremost people work in subsistence agriculture.

Onyenechere reminds us that just because health services are available, it does not mean that the poorer people in the informal sector can access these. People in the informal sector have their own informal ways of raising money for health care. Yusuf and colleagues found that rotational credit/savings schemes have been used to finance health services, thus increasing access to a social service that many could not easily afford.

med-shop-alagba-2.jpgSo how do people in the informal sector get malaria control services? The local butcher, carpenter or seamstress certainly does not keep a medical clinic on retainer. Most people in both rural and urban settings rely on the patent medicine seller or pharmacy shops.

A healthy and productive workplace is essential for national, community and individual development.  We need to be a bit more creative in ensuring that the informal sector and its employees have the same access to malaria prevention and treatment services as those working in the larger commercial and industrial sectors.

Advocacy &Policy Bill Brieger | 20 Sep 2009

Does ALMA spell Political Will?

Almost 10 years after the Abuja Declaration, are African leaders reasserting their political will to eliminate malaria? What will be different this time?

Coming on the heels of a visit to see African malaria success stories, “Ray Chambers, the Secretary-General’s Special Envoy for Malaria, has briefed Mr. Ban (UN Secretary General) on his recent high-level visit to Tanzania and Uganda, where he and UN World Health Organization Director-General Margaret Chan reviewed the progress being made in those two countries against the disease.”  Now leaders from these and other countries are coming to UN Headquarters to continue the discussions.

The Sunday Vision website pictures Ugandan President Yoweri Museveni at a stopover in London on his was to a scheduled meeting with other African leaders at the UN General Assembly in New York to form the African Leaders’ Malaria Alliance (ALMA) this week. UGPulse also comments that. “Twelve African countries will on September 23rd launch the African Leaders Malaria Alliance in New York City.”

According to the website of the UN’s Special Envoy for Malaria, “ALMA will provide a forum in which Heads of State can exchange ideas and articulate policy preferences, as well as anticipate, prevent and overcome obstacles on the path toward the achievement of the December-2010 goal of universal coverage.  ALMA will serve to strengthen the position of member nations in relation to global partners and in the implementation of in-country strategies.”

Apparently now is the time when “African countries promise to expand dramatically in dimension, depth and intensity.”

ALMA is associated with the word ‘bold.’ As UN spokespeople say, ALMA is to be “one of the boldest actions taken against malaria in the modern era… First, the leaders intend to have disease-prevention functions completely under control in Africa by the end of 2010. Additionally, the leaders will announce the even bolder initiative of ‘near zero deaths by malaria by 2015,'” in keeping with the Millennium Development Goals.

Compared to Abuja of 2000, the formation of ALMA 2009 is taking place in much different times. We now have major malaria funding from the Global Fund, the US President’s Malaria Initiative, the World Bank Malaria Booster Program, DfID, UNICEF and other partners.  We have numerous NGOs in both northern countries and endemic countries increasing awareness and action.

We certainly have progress on many indicators generally (though few countries reach RBM’s 80% goals for 2010), and hopes of success in places like Rwanda, parts of Ethiopia, Equatorial Guinea and Zanzibar, though these successes may not translate easily to high burden countries like Nigeria and DRC.

What we still do not have in 2009 are strong, integrated and accountable health systems that will ensure that malaria interventions are scaled up to reach all and are also sustained so that elimination efforts have a chance to succeed.

RBM was launched in 1998 on a platform of health systems reform and strengthening – that is an acknowledgment that malaria interventions cannot succeed on campaigns alone and in isolation from the health system. Unless ALMA addresses addresses health system strengthening for the sustained delivery of malaria interventions, it will simply become a faint echo of Abuja 2000.

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