National Malaria Control Programme managers and other representatives from over 35 African countries attended this year’s National Malaria Control Programme (NMCP) Best Practice Sharing Workshop convened by Novartis with support from the Roll Back Malaria Partnership (RBM). I was invited to give a presentation on web-based platforms for best practice sharing.
View of Addis Ababa, June 2012
The day I arrived in Addis Ababa, I was under the impression that VOIP (Voice Over Internet Protocol which I use via Skype to stay connected with family and friends) was illegal. Although clarifications have since been given that the “draft proclamation” (emphasis on draft) actually targets specific commercial purposes (see interesting blog posts on this by Daniel Berhane), these were not good auspices for a best practice sharing conference. My greeter at Bole International Airport, Abdu, born and raised in Addis, further shared that he knows a lot of people who’ve had malaria and that it’s not easy to get access to health care.
According to Ethiopia’s Federal Ministry of Health (FMOH) and as reported in the Malaria Operational Plan, Ethiopia FY2012 (President’s Malaria Initiative, PDF), this lack of access to health care services is a probable cause of under-reporting of the burden of malaria in the country. Malaria was the leading cause of outpatient visits and health facility admissions and was one of the ten leading causes of inpatient deaths among children under five years of age in 2009/2010. (MOP, Ethiopia FY2012)
Hosted for the second time in Ethiopia, the NMCP workshop focused on fighting malaria at the community level, which is now a top priority for the FMOH. In his opening remarks, the State Minister of the FMOH Dr. Kesete Berhan Admasu said that there are about three million “model families” across the country being trained to become prevention and health champions in their “kebele” (village or neighborhood, the smallest administrative unit of Ethiopia). Ms Hiwot Solomon, also from FMOH, added that integrated community case management of malaria was rolled out in April 2011 to 35,000 health extension workers.
Welcoming more than 70 attendees, Dr. Linus Igwemezie, Head of the Novartis Malaria Initiative, said he was most excited about the new generation of drugs being developed, especially a new formulation “4-in-1” which would make the treatment go from 24 pills today to 6 pills. (Other pharmaceuticals are supporting efforts against malaria in endemic regions and developing new drugs, including Pfizer, GlaxoSmithKline, Sanofi, Shin Poong Pharmaceutical Co, and more recently Ranbaxy who introduced a one tablet per day, for three days, treatment in India last April.) Through this initiative, Novartis has distributed over 500 million of its antimalarial artemisinin-based combination therapy (ACT) without profit to the public sector in 60 countries. But Igwemezie said they’re keeping their eyes peeled on the private sector especially in the Democratic Republic of Congo and Nigeria, and are increasing production by 20% to meet demand. Responding to drug dispensing and quantification challenges raised by attendees, Snow asked Novartis to think about providing a new packaging for its ACT.
Bob Snow, Professor of Tropical Public Health at the University of Oxford, head of the KEMRI Malaria Public Health and Epidemiology Group (MPHEG) in Nairobi, Kenya, and co-chair of the workshop, shared his belief that the malaria epidemic in the 90s in Africa largely came from a sudden lack of drugs. There are now places in Africa where treatment is not available, he told attendees, so delivery of care at the community level is critical if we do not want to face a similar crisis.
For Dr. Fatoumata Nafo-Traoré, who represented the World Health Organization then but is now the new director of RBM, “no one should die from malaria for lack of a $5 bed net, a 50 cent diagnostic, and a $1 antimalarial treatment.” Although she mentioned the WHO Global Plan for Insecticide Resistance Management in Malaria Vectors, no session focused on vector and environmental controls which, some would argue, is a missed opportunity. “I think for any vector control program to be a resounding success, the involvement of the community is critical. If you take for instance a country like Namibia where the malaria endemic areas are peri-urban or rural, you have to consider the level of education in mapping out strategies of vector control,” commented Violet Chaka, the lead medical technologist with the Namibia Institute of Pathology at the Ministry of Health and Social services, Namibia, in a recent virtual expert panel on the future of malaria vector control and insecticides in GHDonline.org.
Community Case Management of Malaria from the 1st quarter 2012 scorecard maps of the African Leaders Malaria Alliance (Source ALMA)
Dr Melanie Renshaw, Chief Technical Advisor for African Leaders Malaria Alliance (ALMA), noted the gap between dollars committed and spent. “You are not doing yourself any favors by not spending the money,” Prof Snow told programme managers.
Renshaw said that the Global Fund is becoming more flexible with reprogramming of funding but needs to improve on timing. (Currently there is a 22-month approval process.) She also shared examples of non-traditional financing approaches like taxation schemes on luxury goods or visas as done in Senegal and Liberia, and called for the creation of procurement pools to drive cost down, notably for Long Lasting Insecticidal Nets.
Although rapid diagnostic tests have changed the landscape, Snow insisted in his closing statement that the battle is not won. With the United Nations meeting coming up in September, it is now high time to make the business case for ending malaria.