Late January, African heads of state through the African Leaders Malaria Alliance (ALMA) honored 13 African countries for their role in drastically reducing malaria incidence and death across the continent. From the time when ALMA was founded to 2015, the incidence of malaria has reduced by more than 60% while in children under the age of 5, malaria mortality has been reduced by more than 70% yet a lot still needs to be done especially in countries that are yet to meet the globally set target. In this exclusive interview, Joy Phumaphi, Executive Secretary of ALMA, speaks on the current dynamics of Africa’s fight against malaria and in spite of the numerous setbacks, she said the goal of a malaria-free Africa by 2030 can still be achieved.
How did ALMA decide to focus on malaria and why African heads of state instead of other focus groups?
The African Leaders Malaria Alliance was set up by the African heads of state, they are the ones that set it up themselves. In December 2009, there was a group of 12 African heads of state led by the president of Tanzania, they were the ones that set up ALMA. They set it up because they felt at the time that the structures that existed in the fight against malaria were not addressing the high political engagements that were necessary. At the time, they could only contribute to the control of malaria in their own country but collectively, there was no efforts in place for them to act together – either as a forum for information sharing or as a leverage to influence one another or other malaria partners to secure additional investments in malaria. The African leaders that founded ALMA saw the need for them to have an active vehicle that would be used for active engagement in the fight against malaria. 12 heads of state started ALMA but they are now 49.
Why only malaria?
They looked at the fact that there was already a UN high level organization that is in charge of HIV/AIDS and is also doing some works on tuberculosis but there is no voice at that level in Africa on malaria. There was a lot happening on HIV/AIDS so the African heads of state gathered in Abuja, Nigeria to control malaria.
Malaria was the major killer of children under five around the time that ALMA was set up and over 40% were dying of malaria. The African leaders felt they need the drive and impetus to achieve the millennium development goals (MDGs) that are linked to malaria.
What approaches are being taken by ALMA to ensure that the goals set for malaria control in Africa are achieved?
What is often lacking in malaria control is political commitment. There is also lack of ownership of the agenda, resources required, political environment that would ensure that the interventions are effectively implemented. There are also policy issues including tariffs on malaria drugs, end of monotherapy, and rapid introduction of new technologies. The African heads of state set up an accountability mechanism and action tracking mechanism so that they can track the interventions and policy changes.
There has been a lot of success. Peer pressure has played a major role because the ALMA scorecard is shared among the heads of state and when they meet, they discuss the challenges and what steps to take to address the challenges. This has worked tremendously well.
If you look at our initial scorecard released in 2011, you will find that the fact that the African governments are sharing information and collaborating with one another and there is a lot of cross-national technical support particularly among the health ministers, are bringing about good results in African countries’ individual and collective fight against malaria.
Looking at the list of African countries selected for the last awards you gave in recognition of their efforts in the fight against malaria, I noticed that some prominent African countries were not on the list. What are countries such as Botswana, Cape Verde, Eritrea, Rwanda, Sao Tome and Principe, South Africa and Swaziland doing right that countries such as Nigeria, Ghana and others that weren’t on the list could emulate?
Even though there would be prizes number one, number two and number three-placed students, it doesn’t mean that other students are not performing. The continent as a whole has done extremely well because you would have noticed that they have managed to reduce the incidence of malaria by 60% across the continent. And among under 5, African countries have reduced the incidence of malaria by 71%. It is not that the countries that are not getting awards have performed poorly, it is just that you give awards to the best in the class and the best were selected according to the criteria set by the awards committee which doesn’t use the same criteria every year. They use the same criteria for two or three years and when they see that there has been lots of improvements in the criteria, they’ll go to another one where there is most challenge. We have to be aware of these dynamics before we look at the award recipients this year.
This year, we recognized the countries that have achieved 75% reduction in mortality. There are some who recorded 71% and 60% reduction; these are still major reduction and we need to appreciate those as well. But the eight countries that were recognized were those that were able to achieve the target set by the global community. There are three countries that have consistently maintained high levels of coverage with malaria interventions; even when there are no resources, they deploy their own resources. These countries are not necessarily wealthy countries, they depend a lot on donor support which sometimes can be specified. These are Namibia, Rwanda and Senegal. They’ve consistently recorded high coverage with malaria interventions. There are other countries that have improved tremendously since the time ALMA was set up and 2015, these are Comoros, Guinea and Mali.
In countries like Nigeria we are aware that the government is looking for ways to fund the malaria programme because they’ve identified it as a priority because Nigeria has not been able to meet its target compared to other countries in Africa. Malaria is highly endemic in Nigeria and is similar to DR Congo Ethiopia although Ethiopia is doing better than Nigeria in their stream. Ethiopia has more donors than DR Congo although the three of them have more support from international donors than other African countries.
The important thing is each African country is aware of what it should do in order to achieve malaria elimination and to control malaria. They also know that they have to sustain universal coverage for more than one year in order to see the results. They are all committed to doing the right thing.
ALMA is targeting a malaria-free Africa by 2030 which is just 16 years away. Do you think is remotely possible and realistic considering the present realities in the various African countries, for the continent to be free of malaria by 2030?
People were asking the same thing in 2000 when the 75% target was set. Some people were African countries could not achieve 10% or 20% but if you look at it now, not every country achieved 75% but we have an average of 66% reduction in malaria incidence and 71% reduction among children. I think we as Africans need to have confidence in our capabilities as Africa to own our development agenda and to deliver them. We owe it to ourselves and we owe it to future generations. Yes, Africa can achieve a malaria-free Africa. That is possible; it is also possible for everyone to be committed to achieving it. We need to encourage people to have confidence that it can happen and to use the malaria message aggressively and when children present with fever, they are taken immediately to health facilities where they are diagnosed and treated quickly.
These are the steps that will stop malaria – when we own the agenda ourselves as Africans, we will achieve it. We are going to save US$24 billion if we eliminate malaria and we need this US$24 billion for other issues including fighting poverty. So we have to achieve a malaria-free Africa.
How easy is it for ALMA to work with African governments especially countries that have changed leadership, how easy are you finding working with new African governments? How does change in leadership in African countries affect the commitment of the African governments to the fight against malaria and its eradication by 2030?
We have not seen any African country where there was a change of government and the new government was not committed to the fight against malaria. We’ve already met with the minister for health of Nigeria and there is tremendous commitment to the fight against malaria. My senior level technical officer has already been there to give them technical support. We have not a single African countries where there is no commitment to the fight against malaria – even African countries where there is no malaria are highly committed to the fight against the disease on the continent.
The heads of state meet twice a year and they are extremely committed. There is full commitment from the African heads of state and I cannot say of any country that is not fully committed to the fight against malaria in Africa.
We have countries like Algeria who are on the verge of eliminating malaria actively supporting the secretariat. This is indicative of the level of commitment. The ALMA office in Africa is in Dar es Salam and has been donated by the government of Tanzania and every single time that we elect a chair, you’ll see commitment from the African governments. All of them are ready to chair ALMA and to deliver results to the people of Africa.
What would be ALMA’s agenda for 2016 towards the achievement of its goal – a malaria-free Africa?
We will continue to work with partners to provide technical support. When there is no funding, we approach organizations such as the World Bank to fund ALMA countries. We have done that for eight ALMA countries already. What we will do now for the malaria eradication process is that every country is going to have an internal malaria elimination scorecard so that if a country like Nigeria, its health minister and partners will be able to come together on a quarterly basis and see how each state is doing and within each state, they will be able to see how each local government is performing – what the problems are, and they will come up with solutions for each state to make progress in the fight against malaria.
We are going to assist each ministry of health to set this up in every ALMA country. The group that will be monitoring performance will be producing a report for the head of state who will use it to aggressively monitor their country’s performance at state level down to community level on malaria. We can indeed achieve a malaria-free Africa.
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